EFTA Document EFTA01448495

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 OBSI 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 Name (as shown on your income tax return) useness name/disregarded entity name, d different from above Chock appropriate box for federal tax classification (required): 0 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 ► Address (number. street. and apt. or suite no.) 0 Exempt payee City. State. and ZIP code 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 ISSNI. For other entities, it is your employer identification number ION). aai aoccurny Number Employer Identification Number DO 111111:19 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 (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 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. Signature of U.S. person Date 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 WM 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-0103534 CONFIDENTIAL SDNY_GM_00249718 EFTA01448495