Form W-9 - Request For Taxpayer Identification Number And Certification - 2015 Page 3
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Form W-9 (Rev. 11-2015)
Page
Line 2
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However, the following payments made to a corporation and reportable on Form 1099-
MISC are not exempt from backup withholding: medical and health care payments,
If you have a business name, trade name, DBA name, or disregarded entity name, you
attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f),
may enter it on line 2.
and payments for services paid by a federal executive agency.
Line 3
Exemption from FATCA reporting code. The following codes identify payees that are
exempt from reporting under FATCA. These codes apply to persons submitting this form
Check the appropriate box in line 3 for the U.S. federal tax classification of the person
for accounts maintained outside of the United States by certain foreign financial
whose name is entered on line 1. Check only one box in line 3.
institutions. Therefore, if you are only submitting this form for an account you hold in the
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership
United States, you may leave this field blank. Consult with the person requesting this
for U.S. federal tax purposes, check the “Limited Liability Company” box and enter “P” in
form if you are uncertain if the financial institution is subject to these requirements. A
the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation,
requester may indicate that a code is not required by providing you with a Form W-9
check the “Limited Liability Company” box and in the space provided enter “C” for C
with “Not Applicable” (or any similar indication) written or printed on the line for a
corporation or “S” for S corporation. If it is a single-member LLC that is a disregarded
FATCA exemption code.
entity, do not check the “Limited Liability Company” box; instead check the first box in
A—An organization exempt from tax under section 501(a) or any individual retirement
line 3 “Individual/sole proprietor or single-member LLC.”
plan as defined in section 7701(a)(37)
Line 4, Exemptions
B—The United States or any of its agencies or instrumentalities
If you are exempt from backup withholding and/or FATCA reporting, enter in the
C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of
appropriate space in line 4 any code(s) that may apply to you.
their political subdivisions or instrumentalities
Exempt payee code.
D—A corporation the stock of which is regularly traded on one or more established
• Generally, individuals (including sole proprietors) are not exempt from backup
securities markets, as described in Regulations section
1.1472-1(c)(1)(i)
withholding.
E—A corporation that is a member of the same expanded affiliated group as a
• Except as provided below, corporations are exempt from backup withholding for
corporation described in Regulations section 1.1472-1(c)(1)(i)
certain payments, including interest and dividends.
F—A dealer in securities, commodities, or derivative financial instruments (including
• Corporations are not exempt from backup withholding for payments made in
notional principal contracts, futures, forwards, and options) that is registered as such
settlement of payment card or third party network transactions.
under the laws of the United States or any state
• Corporations are not exempt from backup withholding with respect to attorneys' fees
G—A real estate investment trust
or gross proceeds paid to attorneys, and corporations that provide medical or health care
H—A regulated investment company as defined in section 851 or an entity registered
services are not exempt with respect to payments reportable on Form 1099-MISC.
at all times during the tax year under the Investment Company Act of 1940
The following codes identify payees that are exempt from backup withholding. Enter
the appropriate code in the space in line 4.
I—A common trust fund as defined in section 584(a)
1—An organization exempt from tax under section 501(a), any IRA, or a custodial
J—A bank as defined in section 581
account under section 403(b)(7) if the account satisfies the requirements of section 401(f)
K—A broker
(2)
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
2—The United States or any of its agencies or instrumentalities
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of
Note. You may wish to consult with the financial institution requesting this form to
their political subdivisions or instrumentalities
determine whether the FATCA code and/or exempt payee code should be completed.
4—A foreign government or any of its political subdivisions, agencies, or
instrumentalities
Line 5
5—A corporation
Enter your address (number, street, and apartment or suite number). This is where the
6—A dealer in securities or commodities required to register in the United States, the
requester of this Form W-9 will mail your information returns.
District of Columbia, or a U.S. commonwealth or possession
Line 6
7—A futures commission merchant registered with the Commodity Futures Trading
Commission
Enter your city, state, and ZIP code.
8—A real estate investment trust
Part I. Taxpayer Identification Number (TIN)
9—An entity registered at all times during the tax year under the Investment
Enter your TIN in the appropriate box. If you are a resident alien and you do not have
Company Act of 1940
and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification
10—A common trust fund operated by a bank under section 584(a)
number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see
11—A financial institution
How to get a TIN below.
12—A middleman known in the investment community as a nominee or custodian
If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.
However, the IRS prefers that you use your SSN.
13—A trust exempt from tax under section 664 or described in section 4947
If you are a single-member LLC that is disregarded as an entity separate from its owner
The following chart shows types of payments that may be exempt from backup
(see Limited Liability Company (LLC) on this page), enter the owner’s SSN (or EIN, if the
withholding. The chart applies to the exempt payees listed above, 1 through 13.
owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a
corporation or partnership, enter the entity’s EIN.
IF the payment is for . . .
THEN the payment is exempt for . . .
Note. See the chart on page 4 for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an
Interest and dividend payments
All exempt payees except
SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or
for 7
get this form online at You may also get this form by calling
1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification
Broker transactions
Exempt payees 1 through 4 and 6 through
Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification
11 and all C corporations. S corporations
Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website
must not enter an exempt payee code
at and clicking on Employer Identification Number (EIN) under
because they are exempt only for sales of
Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by
noncovered securities acquired prior to
calling 1-800-TAX-FORM (1-800-829-3676).
2012.
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write
Barter exchange transactions and patronage
Exempt payees 1 through 4
“Applied For” in the space for the TIN, sign and date the form, and give it to the
dividends
requester. For interest and dividend payments, and certain payments made with respect
to readily tradable instruments, generally you will have 60 days to get a TIN and give it to
Payments over $600 required to be reported
Generally, exempt payees
the requester before you are subject to backup withholding on payments. The 60-day
1
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and direct sales over $5,000
1 through 5
rule does not apply to other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to the requester.
Note. Entering “Applied For” means that you have already applied for a TIN or that you
Payments made in settlement of payment
Exempt payees 1 through 4
intend to apply for one soon.
card or third party network transactions
Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form
W-8.
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See Form 1099-MISC, Miscellaneous Income, and its instructions.
W-9
Substitute Form
(posted 11-2015)
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