Form W-9 - Request For Taxpayer Identification Number And Certification - 2011 Page 3
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Form W-9 (Rev. 12-2011)
Page
Part I. Taxpayer Identification Number (TIN)
Other entities. Enter your business name as shown on required federal
tax documents on the “Name” line. This name should match the name
Enter your TIN in the appropriate box. If you are a resident alien and
shown on the charter or other legal document creating the entity. You
you do not have and are not eligible to get an SSN, your TIN is your IRS
may enter any business, trade, or DBA name on the “Business name/
individual taxpayer identification number (ITIN). Enter it in the social
disregarded entity name” line.
security number box. If you do not have an ITIN, see How to get a TIN
Exempt Payee
below.
If you are a sole proprietor and you have an EIN, you may enter either
If you are exempt from backup withholding, enter your name as
your SSN or EIN. However, the IRS prefers that you use your SSN.
described above and check the appropriate box for your status, then
check the “Exempt payee” box in the line following the “Business name/
If you are a single-member LLC that is disregarded as an entity
disregarded entity name,” sign and date the form.
separate from its owner (see Limited Liability Company (LLC) on page 2),
enter the owner’s SSN (or EIN, if the owner has one). Do not enter the
Generally, individuals (including sole proprietors) are not exempt from
disregarded entity’s EIN. If the LLC is classified as a corporation or
backup withholding. Corporations are exempt from backup withholding
partnership, enter the entity’s EIN.
for certain payments, such as interest and dividends.
Note. See the chart on page 4 for further clarification of name and TIN
Note. If you are exempt from backup withholding, you should still
combinations.
complete this form to avoid possible erroneous backup withholding.
How to get a TIN. If you do not have a TIN, apply for one immediately.
The following payees are exempt from backup withholding:
To apply for an SSN, get Form SS-5, Application for a Social Security
1. An organization exempt from tax under section 501(a), any IRA, or a
Card, from your local Social Security Administration office or get this
custodial account under section 403(b)(7) if the account satisfies the
form online at You may also get this form by calling
requirements of section 401(f)(2),
1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
2. The United States or any of its agencies or instrumentalities,
Identification Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can apply for
3. A state, the District of Columbia, a possession of the United States,
an EIN online by accessing the IRS website at
or any of their political subdivisions or instrumentalities,
and clicking on Employer Identification Number (EIN) under Starting a
4. A foreign government or any of its political subdivisions, agencies,
Business. You can get Forms W-7 and SS-4 from the IRS by visiting
or instrumentalities, or
IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).
5. An international organization or any of its agencies or
If you are asked to complete Form W-9 but do not have a TIN, write
instrumentalities.
“Applied For” in the space for the TIN, sign and date the form, and give
Other payees that may be exempt from backup withholding include:
it to the requester. For interest and dividend payments, and certain
payments made with respect to readily tradable instruments, generally
6. A corporation,
you will have 60 days to get a TIN and give it to the requester before you
7. A foreign central bank of issue,
are subject to backup withholding on payments. The 60-day rule does
8. A dealer in securities or commodities required to register in the
not apply to other types of payments. You will be subject to backup
United States, the District of Columbia, or a possession of the United
withholding on all such payments until you provide your TIN to the
States,
requester.
9. A futures commission merchant registered with the Commodity
Note. Entering “Applied For” means that you have already applied for a
Futures Trading Commission,
TIN or that you intend to apply for one soon.
10. A real estate investment trust,
Caution: A disregarded domestic entity that has a foreign owner must
use the appropriate Form W-8.
11. An entity registered at all times during the tax year under the
Investment Company Act of 1940,
Part II. Certification
12. A common trust fund operated by a bank under section 584(a),
To establish to the withholding agent that you are a U.S. person, or
13. A financial institution,
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, below, and items 4 and 5 on page 4
14. A middleman known in the investment community as a nominee or
indicate otherwise.
custodian, or
For a joint account, only the person whose TIN is shown in Part I
15. A trust exempt from tax under section 664 or described in section
should sign (when required). In the case of a disregarded entity, the
4947.
person identified on the “Name” line must sign. Exempt payees, see
The following chart shows types of payments that may be exempt
Exempt Payee on page 3.
from backup withholding. The chart applies to the exempt payees listed
Signature requirements. Complete the certification as indicated in
above, 1 through 15.
items 1 through 3, below, and items 4 and 5 on page 4.
IF the payment is for . . .
THEN the payment is exempt
1. Interest, dividend, and barter exchange accounts opened
for . . .
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
Interest and dividend payments
All exempt payees except
certification.
for 9
2. Interest, dividend, broker, and barter exchange accounts
Broker transactions
Exempt payees 1 through 5 and 7
opened after 1983 and broker accounts considered inactive during
through 13. Also, C corporations.
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
Barter exchange transactions and
Exempt payees 1 through 5
your correct TIN to the requester, you must cross out item 2 in the
patronage dividends
certification before signing the form.
Payments over $600 required to be
Generally, exempt payees
3. Real estate transactions. You must sign the certification. You may
reported and direct sales over
1 through 7
2
cross out item 2 of the certification.
$5,000
1
1
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
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, attorneys' fees, gross proceeds paid to an attorney, and payments for
services paid by a federal executive agency.
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