EFTA Document EFTA01392921

IV. TAX ELECTION/DFCLARA I ION OF TAX STATUS This Account Agreement is designed for use by both U.S. Persons and Non-US. Persons. Please check the box next to the applicable item below. Client certifies that Client veil notify DEISI in writing Immediately il the representation certified to below ceases to be stue and correct. $52g.wAik,w(Fs.:~s Form W9 Substitute Request for Taxpayer Idaatification Number and Certifioation B netrittE~gign.Wrelflikibertill - (4 ~inns nernaatch5ZaY reinSdifIrreillkfrent ithever r itrePPFOlifUl.fr6krairieriter~ratirrIblerall-IFIfirkkilreeterdsra./ Lk itiaireole proprietor I. C ~Oration El S COMoradon El Pettnershipp True/Gets K Limited liability company. Enter the tax classification (C.0 corporation. SeS corporation, Pepartneahlp) ti Other D Ei FaelinfR Perin MdtlarrafkYntbek telddlit.Str5WOBAS, &id° ei) Abut 'Qrbf}.. ':a4XFV•eaff. 7 - #1"In5, USVI F:: p• I Taxpayer Identification Number (TIN) ritlii,allnitheapcito~iar The TIN provided must match the name given on the "Name tine to avoid bear* withholding:F& individuals, this is your social security number ISSN). For other entities. it Is your employer Identlficabon number WIN). P, r. II Sign Here ~owl Identification Number LO-LLIJ I DE1 Certification Under penalties of perjury. I certify that: 1. The number shown on this tom, is my correct tata»Yer Identifikation number (or I am waiting for a number to be Issued to me). and 2. I am not subject to backup withholding because: tel land exernpt from backup withholding. or lb) I have not been notified by the Internal Revenue Semite (IRS) that I am subject to backup withholding as a result of a talk» to report all interest or dividends. or lc) the IRS has notified me that I am no longer sublet* to backup withholding. and 3.1 am a U.S. Øen or other U.S. pen In the instructions). C..erdfication inatructiona. You st cross out ism above if you have been by the IRS the' you ale cwamdy subject to backup wilhhohing because you have failed to rt all interest and d inde on your tax 2.0 Non-US. Person I am not a U.S. person Including a U.S. resident alien). I am submitting the applicable Form W-8 with this form to cowl,/ my toregn status and. if applicable, claim tax treaty benefits. For example. Client is not a Lt.& person (including a U.S. resident alenl. Client agrees to provide DBSI with this application the applicable Internal Revenue Service (IRS) Ferm W.8 to certify the darts foreign status. W-8 forms and Instructions am available on the IRS website at www.irs.gov. [THIS SPACE INTENTIONALLY LEFT BLANK] 12.PVVM-0573 e 012145 011113 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0098236 CONFIDENTIAL SDNY_GM_00244420 EFTA01392921