W-9 FORMFom W口9
(Rev.October 20181
騰翻穀∬腱躙″
Request for Taxpayer
ldentiftcatlon Number and Certlficatlon
) Go to www.h*.govlForml{9 for lnstruc-tione and the latect information.
Give Form to the
requester. Do not
send to the lRS.
{ Exemptions (codos apdy onty to
certain 6ntiti6s, not individuals; so€
instructlons on pago 3):
Exompt payoe codo (H any)
Exomption from FATCA reporting
COde O'anyl
tlpplabwEffi d/ffirxUSJ
Reque€ter's name and address (optiona0
Date>
. Form 1099-DlV (dividends, including those from stocks or mutual
funds)
. Form 1099-MISC (various types ol income, prizes, awards, or gross
proceeds)
. Form 1 099-8 (stock or mutual fund sales and cedain other
transactions by brokers)
. Form 1 099-5 (proceeds from real estate transactions)
o Form 1099-K (merchant card and thlrd party network transactions)
. Form 1098 (home mortgage interest), 1098-E (sludent loan interest)'
1098-T (tuition)
. Form 1 099-C (canceled debt)
. Form 1 099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S' person (ncluding a resident
alien), to provide your conect TlN.
lf you do not retum Form W'9 to the requester with aTlN, you might
be subjact to backtp withholding. See What is backup withholding,
latet-
1 Name (as shown on your income ta)( rslum). Name is required on this lin6; do not leave this line blank.
2 Business namo/dlsregarded entity name, ifdiflerent from above
(number, street, and apt. or suito no.) 566 instuctions.
7 Ust account numbe(s) here
Note: lf ths account is in more than on€ name, se€ the instructions for line 1. Also seo What Name and
Number To Give the Requester for guidelines on whose number to ent€r'
Enter V*r ftru in th€ appropriate box. The TIN provided must match the namo given on line t to avoid
baciglp withholding. F6i individuals, this is generally your social security number (SSN). However, for a
i"riO"ht alien, soliproprietor, or disregarded entity, se€ the instructions lor Part l, later. For other
entities, it is your erirptiyer identifcation number (ElN). lf you do nol havo a number, see How to get I
f,N, later.
Under penalties of periury, I certify that:
1. The number shown on this form is my conect taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subioct to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notifiod by the lntemal Revenue
Service flRSjthat t am subjeci to bacr"up withhoding as a re"rit of a failure to report all interest or dividends, or (c) the IRS has notili€d 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 teporting is conect.
Certification instruc{ons. you must cross out item 2 above il you have been notified by the IBS that you are cunent}y subiect to backup withholding because
t;;;;;l;id to *port uil interest and dividends on your tax ratum. For real estate transactions, item 2 does not apply' For tortgage interest paid,
acquisition or abandonment oi u""urJ property, cancellation of debt, contributions to an individual retirement arrangement (lRlJ' and generally, payments
other than interest and oirio"na., yo,
"I" "bi r"qrir"o to sign the ce*if,cation, but you must provide your corect TlN. See the instructions for Part ll, later'
Here
Sigmture of
U.S. perron )
General lnstructions
Section references are to the lntemal Revenue Code unless othenvise
noted.
Future d€velopments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to lile an
information rotum with the IRS must obtain your conect taxpayer
identification number (l-lN) which may be your social security number
(SSN), individual taxpay€r identification number (lTlN), adoption
iaxpaye, identification number (ATIN), or employer identilication numb€r
1ett1, io report on an information rstum the amount paid to you, or othsr
amount reportabl€ on an inrormation retum. Examples of information
retums include, but are not limited to, the following.
. Form 1099-lNT (nterest €amod or paid)
3 Check appropriste box for foderai tax classmcation o, th6 person whos€ nam6 is oniered on lino 1 . Check only one ol the
following seven boxes.
n tnoiriauuyrote proprietor or fl c corporation n s corporation I Partnerstrip fl Truevestate
singlo-rnember LLC
I UmiteA lability company. Entor the tax cla$ification (C=C corporation, S=S corporation, P=Partnershlp) >
l{oto: Check the appropriate box in the lin6 abov€ tor th6 tar classification of th6 slnglo-m€mbor owner. Do not ch€ck
LLC lf tho LLC is classified as a single-memb€r LLC that is dlsregarded from ths owno. unless the owner of the LLG ls
another LC thatis not disrogarded from the ownerfor U.S.federaltax puposes Oth輛 se,a singlo‐member LttC
“
disregarded hm the owner should check the appropnate box forthe tax ciassltatlon ofrts owner
Cat No 10231X Fom W-9(Rev 10-201動