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Form W -9
(Rev. August 2013)
Request for Taxpayer Give Form to the
requester. Do not
Department of Ina Treasury Identification Number and Certification send to the IRS.
Internal Revenue Service
Name las shown o your ncome tax return)
c•i Business name/disregarded entity name. it different from above
Check appropriate box for federal tax clasmfcation: Exemptions (see instructions):
0 Inds/dual/sole proprietor 0 C Corporation 0 S Corporation 0 Partnership 0 Trust/estate
Exempt payee code Iff any)
O Limited liability company. Enter the tax classification (C=C corporation. S=5 corporation. P•partnership)e Exemption from FATCA reporting
code (if any)
O Other (see instructions) le
Address (number. street. and apt. or suite no.) Requester name and address (optional)
City. state, and ZIP code
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. fhe 1IN provided must match the name given on the 'Name" line I Social security mintier
to avoid backup withholding. For individuals, this is 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.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identificabon number
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 withholding 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 U.S. person (defined below), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from 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. pereone Date e
General Instructions withholding tax on foreign partners' share of elfectivety connected income, and
4. Certify that FATCA code(s) entered on this form fit any) indicating that you are
Section references are to the Internal Revenue Code unless otherwise noted. exempt from the FATCA reporting, is correct.
Future developments. The IFS has created a page on IRS.gov for information Note. If you are a U.S. person and a requester gives you a form other than Form
about Form W-9. at www.irsgov/w9. Information about any future developments W-9 to request your TIN, you must use the requester's form if it is substantally
affecting Form W-9 (such as legislation enacted after we release 4) MI be posted similar to this Form W-9.
on that page.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
Purpose of Form person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
A person who s required to file an information return with the IRS must obtain your
correct taxpayer identification number (Tea) to raper( for example. income paid to • A partnership, corporation, company, or association created or organized in the
you. payments made to you in settlement of payment card and third party network United States or under the bws of the United States.
transactions. real estate transactions. mortgage interest you paid acquisition or • An estate (other than a foreign estate), or
abandonment of secured property. cancellation of debt, or contributions 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 fincludng a resident alien). to Special rules for partnerships. Partnerships that conduct a trade or business in
provide your correct TN to the person requesting it (the requester) and. when the Urvted States are generally required to pay a withholding tax under section
applicable. to: 1446 on any foreign gannets' share of effectively connected taxable ncome from
such business. Further, rn certain cases where a Form W-9 has not been received.
1. Certify that the TIN you are giving is correct (or you are waiting for a number the rules under section 1446 require a partnership to presume that a partner is a
to be issued), foreign person, and pay the section 1446 mihholding tax. Therefore. if you are a
2. Certify that you are not subject to backup withholding. or U.S. person that is a partner in a partnership COnduCtong a trade or business in the
3. Claim exemption from backup wthhdding if you are a U.S. exempt payee. If United States. provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income.
applicable. you are also certifying that as a U.S. person. your allocable share of
any partnership income from a U.S. trade or bus mess is not subject to the
Cat. No. 10231X Form W-9 (Rev. 6-2013)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0 116026
CONFIDENTIAL SDNY_GM_00262210
EFTA01456743
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