Text extracted via OCR from the original document. May contain errors from the scanning process.
gas 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
Request for Taxpayer Identification Number and Certification
Substitute
0
Name (as shown on your income tax return)
Business name/reneger:led entity name, It different horn above
Chock appropriate box for federal tax classification (required),
O
Individual/solo proprietor pc Corporation K s Corporation II Partnership K
Taistreostate
O
Limited liability company. Enter the tax classification (C=C corporation, S-S corporation, Pspartnership) a
Other a
O Exempt payee
Address (number, street. end apt or suite no.)
City, State, and ZIP code
diTaxpayer 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
entitles, it is your ernpknier identification number
Part II
Sign
Here
um
DICENITT1
Employer Identification Number
LEI-EDI IMOD
Certification
Under penalties of penury. I certify that:
1. The number shown on this form Is mycorrect taxpayer identification number Sartain waiting for a number to be Issued to me). and
2. I ern not subject to backup withholding because: (a) I am exempt from backup withholding. or (h) i have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a remit of a tenure to report all Interest or dividends. or fa) 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. Y ;mai-cross sOZ item 2 above if you have been notified by the IRS that you are currently subject to backup with/to/ding
because you have failed
pen all interest 44 cfividends on
Signature of
U.S. person a
Date
f
2.0 Non-US. Person
I am not a U.S person anducfing a U.S. resident alien). I am submitting the applicable Form W-8 with this form to certify my foreign status and. H applicable.
claim tax treaty benefit
For example: Client is not a U.S. person (including a U.S. resident alien). Client agrees to provide OBS! with this application the appicable Internal Revenue
Service (RS) Form VV-8 to certify the client's fOriegn status. WEI forms and Instructions are available on the IRS website at www.irs.gov.
11AWM-0196
6
012145.032813
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0056871
SDNY_GM_00203055
EFTA01365776