EFTA01390352.pdf

ry N. N. TAX ELECTION/DECLARATION OF TAX STATUS This Account AgriSIAM IS designed tot use by both U.S. Persons and Non-U.S. Persons. Please check the box next to the applicable kern below. Client certified that Client will natty (NMI in witting Immediately if the repatriation certified to below ceases to be two and correct 1.O u.s.WMOf US. Resider* Alen Form W9 Request for Taxpayer Identification Number and Certification Substitute Name (as sMvm on your Income tax return) Bust eke rumeldtsimprdad DMA, narba, if -different from above Check aperaphase box for federal tax chestfication (required): O Individual/sole premise* ❑ C Carpeting') O S Coe-porton O PenneraNp ❑ TnaMeatete D Exempt Mee lability company. Enter the tax chaaiticartion (C-C seeperesion. Spa caperation, Pepartnerehip) ► a. Other a Rdtee (number. street sad apt or WEIS no.) City, State, and ZIP cot anti I Taxpayer Identification Number ITIN) SoMI Security Number Ems you/ lite in the appropriate bet The TIN provided must match the name ghee on the Name line to avoid backup withholding For inekeduals. this Is your social security number (SVC For of or entith M Is your employee identifIcadon ',menu rum IMO EmPIOyet Mentahcadon Number OD- 1,10MOD MinCertification Under penahias 01 PertilifY. I cethh the. I. It number shown on this form Is my correct taxpayer Ittliortion number for I am waiting eze • rumnber to be Issued to me). and 2. I arn not autOct to backup withholding because: (a) I am exempt from backup withholdnu. or lb) I have not been notified by lb, Internal Revenue Setae 41115) that I am maim to betty withholding as a result alabasters so report MI Interest or deAdende or kasha IRS has manse ma Mall am no boor sottoot to backup withholding. and 3.1am • US. erten or other U.S. person (defined In the itrnrce003). Certification Instructions Y I cross car born 2 above if you have ishotrhed by the IRS that you are amenity subject to backup VAthholdIng because you have failed port all intemst d clIvIderwis Sign Signature et Nora U S. demon I Data c-7-3-+-13 20 Non.0 S Person I am not a U.S. Demon (including a U.S. resident Men). I am submitting the applicable form we with the forrn to corlifY my foreign status and. d aerdicabkt. clean tax treaty benefits. for OM mph,: Client is not a U.S. person enduing • U.S. resident alien,. Client agrees to erovkle 043SI with this application the applicable Internal Revenue Service ORS Form W4 to Gerd* the client's foreign Matta we forms and instructions ere avaistda on the IRS website at www.usgov. 13-AWM-0196 6 012146032813. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0094831 CONFIDENTIAL SDNY_GM_00241015 EFTA01390352