DISCLOSURE STATEMENT , hereby acknowledge that I am aware of the confidential nature of the settlement agreement between [ initials ] and Jeffrey Epstein, stating that the amount of the settlement shall be kept strictly confidential and shall not be disclosed by me to anyone. I am also aware that if this confidentiality is breached by me, [ initials] may file a lawsuit against me in federal or state court seeking damages, equitable relief, and attorney's fees and costs . Dated this day of , 2009. Name: Address: Signature: EFTA00725589