EFTA01355812.pdf

IV. TAX ELECTI0WDECLARATI0N OF TAX STATUS This Account Agreement is designed for use by both U.S. Persons and Non-U.S. Persons. Please check the box next to the applicable tern below. ent certifies that Client will notify DBSI in writing Immediately it the representation certified to below ceases to be two and correct. 1.O U.S. Citizen or U.S. Resident Alien Form W9 __Seuent for Teexpayer ldentikcation Number and Certification Subititute ThThep Vle tin N YVA.Inr I nX t" q 1-1-1. Narne (as shown on your income tax return) Business name/disregarded emery mutt rl different from above Check appropriate box for federal tax classification (required) O Individual/sole proprietor O C Corporation CI S Corporation I Pennershrp O Trustlestate El Exempt payee O Limited liability company. Enter the tax classification ICeC corporation 5.5 corporation, P.pertnershlp) p Other P Address (number. Seen. and apt or suite no.) City. State. and 2iP code Part ,Taxpayer Identification Number (T1N) Social Secvnty ember Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name' IS to avoid backup withholding. For individuals. this Is your social security number ISSN). For other entitles, it Is your employer identification number (EINI. Pan Certification Under penalties of penury. I certify that: 1. The number shown on this form is my coffee( taxpayer identilicaticn number for I am waiting for a number to ho issued to me). and 2.1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (iil I have not been notified by the Internal Revenue Service URS) that I am subject t0 backup withh0lding as a mitt of a failure to report ell Interest or dividends. or (CI the IRS has notified me that I am no longer subject to backup withholding. and 3. I am a U.S. cituen or other U.S. person (defined In the instructional. Certification Instructions. You ingsatfoss em 2 above if you have been TORS that you are currently subject to backup withholding because you have failed to regort all interest an dividends on your Sign Signature of Here u.S. person P Dale 2.0 Non.U.S Person I am not a U.S. person tincluding a U.S. resident alien). i am submitting the applicable Form W.8 with this form to certify my forerun status and. if applicable. claim tax treaty benefits For example: Client is not a U.S. person 'including a U.S. resident alien). Client agrees to provide DBSI with this application the applicable Internal Revenue Service (IRS) Form W-8 to certify the client's foreign status. W8 forms and instructions are available on the IRS websito at www.Irs.gov. 13-AWM'0196 6 012146 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0041093 CONFIDENTIAL SDNY_GM_00187277 EFTA01355812