EFTA01294991.pdf

.9
W
Form Request for Taxpayer Give Form to tho
(Rev. December 2011) Identification Number and Certification requester. Do not
Department 04 the Treasury send to the IRS.
Inuit& Reins SeMce
Name shown on your Income nos rtiun)
4-K.
Eosins N A —Nil;Ir
nemeddiaraelirded Nary nem& a dins hem above
I
,Wd 6.0cre
Check appropriate box for federal tat ci
q indMdvaascre proprietor O C Corporafion O $ Corporation O Partnership O That/estate
O Limited [meaty company. Enter the tax classification (C-C corporation. S=S Caporatkm, Pipannennip)e O Exempt payee
b
YS O
Other ON iretruct•OnV►
Add, Requester's name and Seen (optional)
List Tie 0 tower et
Illiall 11Ni ayer Identification Number (TIN)
Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name' line 1 Sect security a mean 1
to avoid backup withholding. For individuals, this Is your social security number (SSN). However, for a
resident alien. sole proprietor. Or disregarded entity, see the Pan I instructions On page 3. For other
entities, It is your employer identification number (EIN). If you do not have a number, see How to get a
77N on pogo 3.
Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose employer kisallfcabon number
T r
number to enter.
Part II Certification
Under penalties of perjury. I certify that:
1. The minter shown on this form % my correct taxpayer Identification number (or I am waiting for a number to be Issued to me), and
2. I am not subject t0 backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a (allure to report all interest or dividends. or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report as interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt contributions to an individual retirement arrangement ORA), and
generally. payments other than Intst and dividends. you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 4.
Sign sosiumo
/2.
Here I us. pongee. Date la / 4 v/3/-
General Instructions Note. If a requester gives you a form other than Form W-9 to request
your TIN, you mull use the requester's form if it is substantially similar
Section references we to the Internal Revenue Code unless otherwise to this Form W-9.
rated.
Definition of • U.S. person. For federal tax purposes, you are
Purpose of Form considered a U.S. person If you we:
A person who is required to file an information return with the IRS must • An individual who b a U.S. citizen or U.S. resident alien.
obtain your correct taxpayer Identification number (TIN) to report, for • A partnership. Corporation, company, or association created or
example, Income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States,
you paid, acquisition or abandonment of secured property. cancellation • An estate (other than a foreign estate), or
of debt or oontrioutione you made to an IRA.
• A domestic trust (as defined In Regulations section 301.7701-7).
Use Form W-9 only if you are a U.S. person (Including a resident
alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or
requester) and, when applicable, to: business in the United States are generally required to pay a withholding
tax on any foreign partners' share of Income from such business.
1. Certify that the TIN you are giving Is correct (or you are waiting for a Further, in certain cases where a Form W-9 has not been received, a
number to be issued), partnership is required to presume that a partner Is a foreign person.
2. Certify that you are not subject to backup withholding, or and pay the withholding tax. Therefore, If you are a U.S. Porten that IS a
3. Claim exemption from backup withholding If you are a U.S. exempt partner in a partnership C0nduCting a trade or business in the United
payee. If appicable, you are also certifying that as a U.S. person, your States, provide Form W-9 to the partnership to establish your U.S.
abocable share of any partnership Income from a U.S. trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners' share of
effectively connected inC0Me.
Cat No. 10231 X Form W-9 (Rev. 12.2011)
SDNY_GM_00053659
.NEIDENTIAL
CONFIDENTIAL - PURSUANT TO FED. R.QP DB-SDNY-0016483
EFTA_00164240
EFTA01294991