Form W-9 - Request For Taxpayer Identification Number And Certification - 2015 Page 4
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Form W-9 (Rev. 11-2015)
Page
Part II. Certification
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You must show your individual name and you may also enter your business or DBA name on the
“Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one),
To establish to the withholding agent that you are a U.S. person, or resident alien, sign
but the IRS encourages you to use your SSN.
Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, or 5
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List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal
below indicate otherwise.
representative or trustee unless the legal entity itself is not designated in the account title.) Also see
For a joint account, only the person whose TIN is shown in Part I should sign (when
Special rules for partnerships on page 2.
required). In the case of a disregarded entity, the person identified on line 1 must sign.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Exempt payees, see Exempt payee code earlier.
Note. If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Signature requirements. Complete the certification as indicated in items 1 through 5
below.
Secure Your Tax Records from Identity Theft
1. Interest, dividend, and barter exchange accounts opened before 1984 and
broker accounts considered active during 1983. You must give your correct TIN, but
Identity theft occurs when someone uses your personal information such as your name,
SSN, or other identifying information, without your permission, to commit fraud or other
you do not have to sign the certification.
crimes. An identity thief may use your SSN to get a job or may file a tax return using your
2. Interest, dividend, broker, and barter exchange accounts opened after 1983
SSN to receive a refund.
and broker accounts considered inactive during 1983. You must sign the certification
To reduce your risk:
or backup withholding will apply. If you are subject to backup withholding and you are
merely providing your correct TIN to the requester, you must cross out item 2 in the
• Protect your SSN,
certification before signing the form.
• Ensure your employer is protecting your SSN, and
3. Real estate transactions. You must sign the certification. You may cross out item 2
• Be careful when choosing a tax preparer.
of the certification.
If your tax records are affected by identity theft and you receive a notice from the IRS,
4. Other payments. You must give your correct TIN, but you do not have to sign the
respond right away to the name and phone number printed on the IRS notice or letter.
certification unless you have been notified that you have previously given an incorrect
TIN. “Other payments” include payments made in the course of the requester’s trade or
If your tax records are not currently affected by identity theft but you think you are at
business for rents, royalties, goods (other than bills for merchandise), medical and health
risk due to a lost or stolen purse or wallet, questionable credit card activity or credit
care services (including payments to corporations), payments to a nonemployee for
report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.
services, payments made in settlement of payment card and third party network
For more information, see Publication 4535, Identity Theft Prevention and Victim
transactions, payments to certain fishing boat crew members and fishermen, and gross
Assistance.
proceeds paid to attorneys (including payments to corporations).
Victims of identity theft who are experiencing economic harm or a system problem, or
5. Mortgage interest paid by you, acquisition or abandonment of secured
are seeking help in resolving tax problems that have not been resolved through normal
property, cancellation of debt, qualified tuition program payments (under section
channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach
529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and
TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
pension distributions. You must give your correct TIN, but you do not have to sign the
1-800-829-4059.
certification.
Protect yourself from suspicious emails or phishing schemes. Phishing is the
What Name and Number To Give the Requester
creation and use of email and websites designed to mimic legitimate business emails
and websites. The most common act is sending an email to a user falsely claiming to be
For this type of account:
Give name and SSN of:
an established legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
1. Individual
The individual
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not
2. Two or more individuals (joint
The actual owner of the account or,
request personal detailed information through email or ask taxpayers for the PIN
account)
if combined funds, the first
numbers, passwords, or similar secret access information for their credit card, bank, or
individual on the account
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other financial accounts.
3. Custodian account of a minor
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The minor
If you receive an unsolicited email claiming to be from the IRS, forward this message to
(Uniform Gift to Minors Act)
phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property
to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You
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4. a. The usual revocable savings
The grantor-trustee
can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or
trust (grantor is also trustee)
contact them at or 1-877-IDTHEFT (1-877-438-4338).
b. So-called trust account that is
The actual owner
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not a legal or valid trust under
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
state law
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5. Sole proprietorship or disregarded
The owner
Privacy Act Notice
entity owned by an individual
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to
The grantor*
6. Grantor trust filing under Optional Form
persons (including federal agencies) who are required to file information returns with the
1099 Filing Method 1 (see Regulations
IRS to report interest, dividends, or certain other income paid to you; mortgage interest
section 1.671-4(b)(2)(i)(A))
you paid; the acquisition or abandonment of secured property; the cancellation of debt;
or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form
For this type of account:
Give name and EIN of:
uses the information on the form to file information returns with the IRS, reporting the
above information. Routine uses of this information include giving it to the Department
7. Disregarded entity not owned by an
The owner
of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and
individual
U.S. commonwealths and possessions for use in administering their laws. The
8. A valid trust, estate, or pension trust
Legal entity
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information also may be disclosed to other countries under a treaty, to federal and state
9. Corporation or LLC electing
The corporation
agencies to enforce civil and criminal laws, or to federal law enforcement and
corporate status on Form 8832 or Form
intelligence agencies to combat terrorism. You must provide your TIN whether or not
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you are required to file a tax return. Under section 3406, payers must generally withhold
a percentage of taxable interest, dividend, and certain other payments to a payee who
10. Association, club, religious, charitable,
The organization
does not give a TIN to the payer. Certain penalties may also apply for providing false or
educational, or other tax-exempt
fraudulent information.
organization
The partnership
11. Partnership or multi-member LLC
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or prison)
that receives agricultural program
payments
Signature Page
ID
Signature Verification via
Application
14. Grantor trust filing under the Form 1041
The trust
Filing Method or the Optional Form
1099 Filing Method 2 (see Regulations
section 1.671-4(b)(2)(i)(B))
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List first and circle the name of the person whose number you furnish. If only one person on a joint
Associate Initials
account has an SSN, that person’s number must be furnished.
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Circle the minor’s name and furnish the minor’s SSN.
W-9
Substitute Form
(posted 11-2015)
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