EFTA01371168.pdf

FormW-9 (Rev. December 2014) Request for Taxpayer Give Form to the requester. Do not Depxtment of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service 1 Name (as n on your Income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, a different from above 3 Check appropriate box for federal tax classification; check oNyone of the following seven boxes: 4 Exemptions (codes apply only to ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate certain entities, not individuals: see instructions on page 3): singlemember LLC g ❑ Limited lability company. Enter the tax classification (C•C corporation. S•5 corporation, P•pannership)► Exempt payee code anT) Exemption from FATCA reporting 0 Note. For a se-vie-member LW that is disregarded. do not check LW: check the appropriate box in the hne above for the tax classification of the angle-member owner. code (if any) a le 0 Other (see instructions) ► frophe to scOwnlis moveavioa °ado U U S $ Address (number. street. and apt. or suite no.) Requester's name and address (optional) City, state, and ZW code N 7 List account number(e) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part 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 TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer Identification number guidelines on whose number to enter. Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to 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 withholcfing as a result of a failure 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 V.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt fr0M FATCA reporting is correct. 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 all 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 (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature of Here U.S. person ► Date. General Instructions • Form 1098 (home mortgage interest), 1098-E (student loan interest). 1098-1 (tuition) Section references are to the Internal Revenue Code unless otherwise noted. • Form 1099-C (canceled debt) Future developments. Information about developments affecting Form W-9 (such • Form 1099-A (acquisition or abandonment of secured property) as legislation enacted after we release it) is at wivie'rs.goy/fw9. Use Form W-9 only if you are a U.S. person (including a resident alien). to Purpose of Form provide your correct 11N. M individual or entity (Form W-9 requester) who is required to Me an information II you do not return Form W-9 to the requester with a TIN, you might be sublet( return with the IRS must obtain your correct taxpayer identification number (TIN) to backup withholding. See What is backup withholding? on page 2. which may be your social security number (SSN). individual taxpayer identification By signing the filledbut form, you: number ((TIN), adoption taxpayer identification number (ATIN). or employer 1. Certify that the TIN you are giving is correct (or you are waiting for a number identification number (EIN), to report on an information return the amount paid to to be issued). you, or other amount reportable on an information return. Examples of information rearm include, but are not limited to. the following: 2. Certify that you are not subject to backup withholding. or • Form 1099.INT (interest earned or paid) 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, yaw allocable share of • Form 109943IV (dividends, including those from stocks or mutual hands) any partnership income from a U.S. trade or business is not subject to the • Form 1099-MISC (various types of income, prizes. awards. or gross proceeds) withholding fax on foreign partners' share of effectively connected income, and • Form 10998 (stock or mutual fund sales and certain other transactions by 4. Certify that FATCA code(s) entered on this form Of any) indicating that you are brokers) exempt from the FATCA reporting, is correct. See What is FATCA reporting? on • Form 1099-S (proceeds from real estate transactions) page 2 for further information. • Form 109aK (merchant card and third party network transactions) Cat. No. 10231X Form W-9 (Rev. 12-2014) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0064387 CONFIDENTIAL SDNY_GM_00210571 EFTA01371168