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Form W-9 (Rev. 10-2018) Page 3
<br />Criminal penalty for falsifying information. Willfully falsifying
<br />certifications or affirmations may subject you to criminal penalties
<br />including fines and/or imprisonment.
<br />Misuse of TINs. If the requester discloses or uses TINs in violation of
<br />federal law, the requester may be subject to civil and criminal penalties.
<br />Specific Instructions
<br />Line 1
<br />You must enter one of the following on this line; do not leave this line
<br />blank. The name should match the name on your tax return.
<br />If this Form W-9 is for a joint account (other than an account
<br />maintained by a foreign financial institution (FFI)), list first, and then
<br />circle, the name of the person or entity whose number you entered in
<br />Part I of Form W-9. If you are providing Form W-9 to an FFI to document
<br />a joint account, each holder of the account that is a U.S. person must
<br />provide a Form W-9.
<br />a. Individual. Generally, enter the name shown on your tax return. If
<br />you have changed your last name without informing the Social Security
<br />Administration (SSA) of the name change, enter your first name, the last
<br />name as shown on your social security card, and your new last name.
<br />Note: ITIN applicant: Enter your individual name as it was entered on
<br />your Form W-7 application, line 1 a. This should also be the same as the
<br />name you entered on the Form 1040/1040A/1040EZ you filed with your
<br />application.
<br />b. Sole proprietor or single -member LLC. Enter your individual
<br />name as shown on your 1040/1040A/1040EZ on line 1. You may enter
<br />your business, trade, or "doing business as" (DBA) name on line 2.
<br />c. Partnership, LLC that is not a single -member LLC, C
<br />corporation, or S corporation. Enter the entity's name as shown on the
<br />entity's tax return on line 1 and any business, trade, or DBA name on
<br />line 2.
<br />d. Other entities. Enter your name as shown on required U.S. federal
<br />tax documents on line 1. This name should match the name shown on the
<br />charter or other legal document creating the entity. You may enter any
<br />business, trade, or DBA name on line 2.
<br />e. Disregarded entity. For U.S. federal tax purposes, an entity that is
<br />disregarded as an entity separate from its owner is treated as a
<br />"disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter
<br />the owner's name on line 1. The name of the entity entered on line 1
<br />should never be a disregarded entity. The name on line 1 should be the
<br />name shown on the income tax return on which the income should be
<br />reported. For example, if a foreign LLC that is treated as a disregarded
<br />entity for U.S. federal tax purposes has a single owner that is a U.S.
<br />person, the U.S. owner's name is required to be provided on line 1. If
<br />the direct owner of the entity is also a disregarded entity, enter the first
<br />owner that is not disregarded for federal tax purposes. Enter the
<br />disregarded entity's name on line 2, "Business name/disregarded entity
<br />name." If the owner of the disregarded entity is a foreign person, the
<br />owner must complete an appropriate Form W-8 instead of a Form W-9.
<br />This is the case even if the foreign person has a U.S. TIN.
<br />Line 2
<br />If you have a business name, trade name, DBA name, or disregarded
<br />entity name, you may enter it on line 2.
<br />Line 3
<br />Check the appropriate box on line 3 for the U.S. federal tax
<br />classification of the person whose name is entered on line 1. Check only
<br />one box on line 3.
<br />IF the entity/person on line 1 is
<br />THEN check the box for ...
<br />a(n)...
<br />• Corporation
<br />Corporation
<br />• Individual
<br />Individual/sole proprietor or single-
<br />• Sole proprietorship, or
<br />member LLC
<br />• Single -member limited liability
<br />company (LLC) owned by an
<br />individual and disregarded for U.S.
<br />federal tax purposes.
<br />• LLC treated as a partnership for
<br />Limited liability company and enter
<br />U.S. federal tax purposes,
<br />the appropriate tax classification.
<br />• LLC that has filed Form 8832 or
<br />(P= Partnership; C= C corporation;
<br />2553 to be taxed as a corporation,
<br />or S= S corporation)
<br />or
<br />• LLC that is disregarded as an
<br />entity separate from its owner but
<br />the owner is another LLC that is
<br />not disregarded for U.S. federal tax
<br />purposes.
<br />• Partnership
<br />Partnership
<br />• Trust/estate
<br />Trust/estate
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reporting,
<br />enter in the appropriate space on line 4 any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />• Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />• Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dividends.
<br />• Corporations are not exempt from backup withholding for payments
<br />made in settlement of payment card or third party network transactions.
<br />• Corporations are not exempt from backup withholding with respect to
<br />attorneys' fees or gross proceeds paid to attorneys, and corporations
<br />that provide medical or health care services are not exempt with respect
<br />to payments reportable on Form 1099-MISC.
<br />The following codes identify payees that are exempt from backup
<br />withholding. Enter the appropriate code in the space in line 4.
<br />1—An organization exempt from tax under section 501(a), any IRA, or
<br />a custodial account under section 403(b)(7) if the account satisfies the
<br />requirements of section 401(f)(2)
<br />2—The United States or any of its agencies or instrumentalities
<br />3—A state, the District of Columbia, a U.S. commonwealth or
<br />possession, or any of their political subdivisions or instrumentalities
<br />4—A foreign government or any of its political subdivisions, agencies,
<br />or instrumentalities
<br />5—A corporation
<br />6—A dealer in securities or commodities required to register in the
<br />United States, the District of Columbia, or a U.S. commonwealth or
<br />possession
<br />7—A futures commission merchant registered with the Commodity
<br />Futures Trading Commission
<br />8—A real estate investment trust
<br />9—An entity registered at all times during the tax year under the
<br />Investment Company Act of 1940
<br />10—A common trust fund operated by a bank under section 584(a)
<br />11—A financial institution
<br />12—A middleman known in the investment community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 664 or described in section
<br />4947
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