Case File
efta-01357571DOJ Data Set 10OtherEFTA01357571
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01357571
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
IV. TAX ELECTION/DECLARATION 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 item below.
Client certifies that Client will notify OBS, in writing immediately if the representation certified to below ceases to be true and correct.
1.O U.S. Citizen or U.S. Resident Alien
Form W9
Substitute
Request for Taxpayer Identification Number and Certification
usiness name/disregarded entity name, d different from above
appropriate box for federal tax classification (require
Individual/sole proprietor 0
C Corporation 0
S Corporation 0
Partnership 0
Trust/estate
O Limited liability company. Enter the tax classification (C=C corporation, 5=5 corporation, P=partnership)
Other
El Exempt payee
MAI
110.4
Taxpayer Identification Number (TIN)
Port II
Sign
Here
Enter your TIN in the appropriate box. The TIN provided must match the name given on the -Name" line
to avoid backup withholding. For individuals, this is your social security number ISSN). For other
entities, it is your employer identification number IEIN).
Social Security Number
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: la) I am exempt from backup withholding, or lb) I have not been notified by the Internal Revenue
Service 1IRS) 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 in the instructions).
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.
2.0 Non-U.S. Person
I am not a U.S. person (including a U.S. resident alien). I am submitting the applicable Form W8 with this form to certify my foreign 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 OBSI with this application the applicable Internal Revenue
Service (IRS) Form W-8 to certify the client's foreign status. W-8 forms and instructions are available on the IRS website at www.irs.gov.
13-AWM-0198
6
012145.032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0044196
CONFIDENTIAL
SDNY_GM_00190380
EFTA01357571
Technical Artifacts (3)
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Domain
www.irs.govSWIFT/BIC
DECLARATIONSWIFT/BIC
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