EFTA Document EFTA01365768

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 comities that Client will notify DBSI in writing immediately if the representation certified to below ceases to be true and correct. 1.[7] U.S. Citizen or U.S. Resident Alien Form W9 Request for Taxpayer Identification Number and Certification Substitute a CC tt Pit. i Name (as shown on your income let return) 8115111033 name/disregarded entity name, it different from above Check appropriate box for federal tax clamification (required): 0 Exempt payee GI Individual/sole pr*Prieter 0 C Corporation K S Corporation K Partnership K Trust/estate El Limited liability company. Enter the tax classification (C-C corporation. SeS corporation, Pepartnership) P Other I Address (number, street, and apt. or suite no.) City, State, and ZIP code aliTaxpayer Identification Number (TIN) 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 (FIN). N Security Number DMI-D LW I Sign Here Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am wailing for a number to be issued ha rne), and 2. I sin not subject to backup withholding because a) I am exempt from backup withholding. or at) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a resuh 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, end 3. I am e U.S. citizen or other U.S. person( fined In the Instructions). Certification instructions. You must cross oiti 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 P 2.0 Non-U.S. Person 9 I am not a U S poison (including a U.S. resident alien). I am submitting the applicable Form W-8 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 OFISI 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 el www.irs.gov. 13'AWM-0196 0 012145.032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0056851 CONFIDENTIAL SDNY GM_00203035 EFTA01365768