Form W-9 - Request For Taxpayer Identification Number And Certification - 2015
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4W-9
Request for Taxpayer
Give Form to the
Form
requester. Do not
Identification Number and Certification
(Rev. November 2015)
send to the IRS.
*Substitute Form*
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
4 Exemptions (codes apply only to
3 Check appropriate box for federal tax classification; check only one of the following nine boxes:
certain entities, not individuals; see
Individual/sole proprietor or
C Corporation
S Corporation
Partnership
Trust/estate
instructions on page 3):
single-member LLC
Exempt payee code (if any)
▶
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Exemption from FATCA reporting
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax
classification of the single-member owner.
code, if any
Not Applicable
Exempt Charitable Corporation
Non-Exempt Charitable Corporation (also enter the "exempt payee code " in box 4)
(Applies to accounts maintained outside the U.S.)
▶
Other (see instructions)
5 Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup
withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien,
–
–
sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer
or
identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Employer identification number
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
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Part II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS)
that I am subject to backup withholding as a result 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; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct (not applicable to Scottrade clients).
Certification instructions. You must cross out 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. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or
abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest
and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.
Sign
Signature of
Here
▶
▶
U.S. person
Date
General Instructions
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
Section references are to the Internal Revenue Code unless otherwise noted.
• Form 1099-A (acquisition or abandonment of secured property)
Future developments. Information about developments affecting Form W-9 (such as
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your
legislation enacted after we release it) is at
correct TIN.
Purpose of Form
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup
withholding. See What is backup withholding? on page 2.
An individual or entity (Form W-9 requester) who is required to file an information return
with the IRS must obtain your correct taxpayer identification number (TIN) which may be
By signing the filled-out form, you:
your social security number (SSN), individual taxpayer identification number (ITIN),
1. Certify that the TIN you are giving is correct (or you are waiting for a number to be
adoption taxpayer identification number (ATIN), or employer identification number (EIN),
issued),
to report on an information return the amount paid to you, or other amount reportable
2. Certify that you are not subject to backup withholding, or
on an information return. Examples of information returns include, but are not limited to,
the following:
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of any
• Form 1099-INT (interest earned or paid)
partnership income from a U.S. trade or business is not subject to the withholding tax on
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
foreign partners' share of effectively connected income, and
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for
further information.
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
Cat. No. 10231X
W-9
Substitute Form
(posted 11-2015)
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