Form W-9 - Request For Taxpayer Identification Number And Certification - 2017 Page 4
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Form W-9 (Rev. 11-2017)
Page
The following chart shows types of payments that may be exempt
M—A tax exempt trust under a section 403(b) plan or section 457(g)
from backup withholding. The chart applies to the exempt payees listed
plan
above, 1 through 13.
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
IF the payment is for . . .
THEN the payment is exempt
code should be completed.
for . . .
Line 5
Interest and dividend payments
All exempt payees except
for 7
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
S corporations must not enter an
exempt payee code because they
chance the old address will be used until the payor changes your
address in their records.
are exempt only for sales of
noncovered securities acquired
Line 6
prior to 2012.
Enter your city, state, and ZIP code.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Part I. Taxpayer Identification Number (TIN)
Payments over $600 required to be
Generally, exempt payees
Enter your TIN in the appropriate box. If you are a resident alien and
reported and direct sales over
2
1 through 5
you do not have and are not eligible to get an SSN, your TIN is your IRS
1
$5,000
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
Payments made in settlement of
Exempt payees 1 through 4
below.
payment card or third party network
If you are a sole proprietor and you have an EIN, you may enter either
transactions
your SSN or EIN.
1
See Form 1099-MISC, Miscellaneous Income, and its instructions.
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner’s SSN (or EIN, if the owner has
2
However, the following payments made to a corporation and
one). Do not enter the disregarded entity’s EIN. If the LLC is classified as
reportable on Form 1099-MISC are not exempt from backup
a corporation or partnership, enter the entity’s EIN.
withholding: medical and health care payments, attorneys’ fees, gross
Note: See What Name and Number To Give the Requester, later, for
proceeds paid to an attorney reportable under section 6045(f), and
further clarification of name and TIN combinations.
payments for services paid by a federal executive agency.
How to get a TIN. If you do not have a TIN, apply for one immediately.
Exemption from FATCA reporting code. The following codes identify
To apply for an SSN, get Form SS-5, Application for a Social Security
payees that are exempt from reporting under FATCA. These codes
Card, from your local SSA office or get this form online at
apply to persons submitting this form for accounts maintained outside
You may also get this form by calling 1-800-772-1213.
of the United States by certain foreign financial institutions. Therefore, if
Use Form W-7, Application for IRS Individual Taxpayer Identification
you are only submitting this form for an account you hold in the United
Number, to apply for an ITIN, or Form SS-4, Application for Employer
States, you may leave this field blank. Consult with the person
Identification Number, to apply for an EIN. You can apply for an EIN
requesting this form if you are uncertain if the financial institution is
online by accessing the IRS website at and
subject to these requirements. A requester may indicate that a code is
clicking on Employer Identification Number (EIN) under Starting a
not required by providing you with a Form W-9 with “Not Applicable” (or
Business. Go to to view, download, or print Form
any similar indication) written or printed on the line for a FATCA
W-7 and/or Form SS-4. Or, you can go to to
exemption code.
place an order and have Form W-7 and/or SS-4 mailed to you within 10
A—An organization exempt from tax under section 501(a) or any
business days.
individual retirement plan as defined in section 7701(a)(37)
If you are asked to complete Form W-9 but do not have a TIN, apply
B—The United States or any of its agencies or instrumentalities
for a TIN and write “Applied For” in the space for the TIN, sign and date
C—A state, the District of Columbia, a U.S. commonwealth or
the form, and give it to the requester. For interest and dividend
possession, or any of their political subdivisions or instrumentalities
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
D—A corporation the stock of which is regularly traded on one or
the requester before you are subject to backup withholding on
more established securities markets, as described in Regulations
payments. The 60-day rule does not apply to other types of payments.
section 1.1472-1(c)(1)(i)
You will be subject to backup withholding on all such payments until
E—A corporation that is a member of the same expanded affiliated
you provide your TIN to the requester.
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
Note: Entering “Applied For” means that you have already applied for a
F—A dealer in securities, commodities, or derivative financial
TIN or that you intend to apply for one soon.
instruments (including notional principal contracts, futures, forwards,
Caution: A disregarded U.S. entity that has a foreign owner must use
and options) that is registered as such under the laws of the United
the appropriate Form W-8.
States or any state
G—A real estate investment trust
Part II. Certification
H—A regulated investment company as defined in section 851 or an
To establish to the withholding agent that you are a U.S. person, or
entity registered at all times during the tax year under the Investment
resident alien, sign Form W-9. You may be requested to sign by the
Company Act of 1940
withholding agent even if item 1, 4, or 5 below indicates otherwise.
I—A common trust fund as defined in section 584(a)
For a joint account, only the person whose TIN is shown in Part I
J—A bank as defined in section 581
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
K—A broker
code, earlier.
L—A trust exempt from tax under section 664 or described in section
Signature requirements. Complete the certification as indicated in
4947(a)(1)
items 1 through 5 below.
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