EFTA01295004.pdf

W-9
Form Request for Taxpayer Gin Form to the
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Part I Taxpayer Identification Number (TIN)
Enter your TN in the appropriate box. The TIN provided must match the name given on the Nene line I Socief security number
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident elan, sole proprietor, or disregarded entity, see the Part 1 Inatnictions 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 par 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
number to enter.
Port II Certification
Under penalties of periwig, I catty that
1. Tice number shown on this fonn is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I em not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Scrubs (IRS) that I am subject to beckon withholding as a result of a blurs to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other V.S. parson (defined below).
Certificate instructions. You must cross out hem 2 above If you have been notified by the IRS that you we currently subject to backup withholding
because you have failed to report all interest and dividends on you tax retum. For reel estatetransactions, item 2 doss not apply. For mortgage
interest aaccqquuiisition or abandonment Of recur , conflation ofd ntributions to an individual retirement wrangernent (IRA), and
generally, payments other than interest and dividenditcr irre not the certification, but you must prowide your coact TIN. See the
instructions on page 4.
WWI Signature el ,,
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General Instructions If a requester gIves you • form other than Form W-9 to request
your TN, you must use the requester's form a his substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted.
DelWien of a U.S. person. For federal tax purposes, you are
Purpose of Form considered a U.S. person If you are
A person who is required to fie an information return with the IRS must • M individual who is a U.S. citizen or V.S. resident alien,
obtain your coned taxpayer identification number (TIN to report, for • A pannership, 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 • M *Mate (other than a foreign estate), or
of debt, or contrbutions 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 nabs for partnerships. Partnerships that conduct a trade or
requester) and, when applicable, tot 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 dung b correct (or you are waiting for a Further, in certain cases where a Form W4 hos not been received, a
number to be issued), partnership is required to presume that a partner 6 a kaolin pawn,
2. Certify that you we not subject to backup withholding, or and pay thee withholding tax. Therefore, if you are a U.S. person that is a
3. Claim exemption front backup withholding If you are a U.S. exempt partner in a partnership conducting a trade or business in the United
payes h applicable, you ars also certifying that as a U.S. person, your States, provide Form W-9 to the partnership to establish your U.S.
allocable 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
/Moot:wt.,' connected income
Cat. No. 10231% Fan, W-9 (Few. 12.201t)
SDNY_GM_00053686
.NEIDENTIAL
„QC)
CONFIDENTIAL - PURSUANT TO FED_ DB-SDNY-0016510
EFTA 00164267
EFTA01295004