EFTA01355693.pdf

IV. TAX ELECTIOWDECLARATION OF TAX STATUS INs Account Agreement es designed for use by both U.S. Persons end Non.U.S Persons. Please check the box next to the applicable item below. Client cedilla that Client will notify 0851 in writing immediately if the representation certified to below ceases to be true and correct. 1. CI U.S. Citizen or U.S. Resident Alien Form W9 Request for Taxpayer Identification Number and Certification Substitute Mania (as shown on your income tax return): Business name/disregarded entity name, d different from above Check appropnate box for federal tax classification (required): El Individual/sole proprietor D C Corporation 0 S Corporation 0 Partnerehip Ill Trust/estate 0 Exempt Payee 0 Limited liability company. Enter the tax classification (C=C corpOration, 5=5 corporation, Pepartnership) 0 Other 0 Address (number, street, and qpk or suite no.) City, State, and ZIP Code f t 'Taxpayer Identification Number (TIN) dial security Enter your TIN in the IMPropnate box. The TIN provided must match the name given on the "Name" line Ski& to avoid backup withholding. For individuate, this is your social security number ISSN). For other entities, it is your empbyer identification number (FIN). Part I I Certification Under penalties of perjury, t 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: tritium exempt from backup withholding. or (Where not boon notified by the Internal Revenue Service (IRSI that I em subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am he longer subject to backup withholding. and 3. I am a U.S. citizen or other U.S. efined in the instructions). Certification instructions. You at er09a o t item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to r all interee nit dividends on return. Sign 'Signature of Here Pertlen Pert 9' 11113 I am not a U.S. person (including • U.S. resident alien). I am submitting the applicable Form W'8 with this form to certify my foreign status and, if applicable, claim tax treaty benefits. For example: Client is not a U.S. person pnciuding a U.S resident alien). Client agrees to provide 0BSI with this application the applicable Internal Revenue Service (IRS) Form V/-S to certify the client's foreign status. W.8 forms and instructions are available on the IRS website at www.irs.gov. 13'AWM'0196 6 012145 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0040945 CONFIDENTIAL SDNY_GM_00187129 EFTA01355693