Payee Information Form-Substitute W-9/foreign Vendor Information Form - The University Of Texas At Austin Page 2
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2Payee Information Form Page 2
Part IV.CERTIFICATION. This section required for all entities. Check and sign only one of the following certifications.
Certification for U.S. CITIZENS and LAWFUL PERMANENT RESIDENTS only
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 (as defined by IRS Form W-9 rev December 2014), and 4.
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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.
PAYEE SIGNATURE:
DATE:
Certification for NON-U.S. INDIVIDUALS and NON U.S. ENTITIES only
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true,
correct, and complete. I further certify under penalties of perjury that I am the individual who is the beneficial owner of the income or an
authorized agent of the beneficial owner, and the individual or organization on Section 1 is not a U.S. person or a U.S. organization. I agree
that I will submit a new form within 30 days if any information on this form becomes incorrect.
PAYEE SIGNATURE:
DATE:
Univ of Texas Dept Contact Name:
Contact’s Email Address:
Vendor: Return signed form to the UT department who sent you the form.
Departments: Submit completed form to the Vendor ID Section. For instructions on submitting completed forms and creating GGV documents
visit
https://purchasing.utexas.edu/ap/vendor-identification-vid-section
Are you a state-certified Historically Underutilized Business (HUB)? Yes
No
If not, do you qualify? Yes
No
(If Yes, see below for details)
INSTRUCTIONS AND INFORMATION
Purpose of Form: An organization that is required to file an information return with the IRS must obtain your correct Taxpayer Identification
Number (TIN) in order to report income paid to you. The TIN is either the payee’s Social Security Number (SSN) or Employer Identification
Number (EIN) or, for foreign individuals residing but not working inside the United States, an Individual Taxpayer Identification Number.
Nonresident alien information must be obtained to determine the payee's tax status for compliance with IRS withholding and reporting
requirements. The additional information for other payee types is needed to satisfy State of Texas requirements for establishing vendor records.
Also see
https://
for detailed instructions.
Taxpayer Name and Number Specific Instructions: To prevent payments from being subject to backup withholding, you must provide a
correct TIN. A TIN is considered incorrect if the name and TIN combination does not match or cannot be found on IRS or Social Security
Administration (SSA) records.
Exemptions: See
https://
for detailed instructions.
Historically Underutilized Businesses (HUB): The State of Texas is encouraging state agencies to utilize these businesses. You or your firm
qualifies if 51% owned by a person or persons who have been historically underutilized because of their identification as a member of certain
groups: Black Americans, Hispanic Americans, Asian-Pacific Americans, Native Americans, or Women-any ethnicity. Vendor inquiries
concerning HUB certification should contact the UT Austin HUB/SB Program at hub@austin.utexas.edu, 512-471-2851. With few exceptions,
under TEX.GOV'T.CODE ANN. sec. 559.003 (1)(2) & (3) (Vernon Supp. 1992), you are entitled to request to be informed about the information
that the university collects, under Sections 552.021 and 552.023 of the Government Code, you are entitled to receive and review the information,
and under Section 559.004 of the Government Code, you are entitled to have the university correct information about you that is incorrect.
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