Form W-7(Coa) - Certificate Of Accuracy For Irs Individual Taxpayer Identification Number
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1
2Certificate of Accuracy for IRS Individual
W-7(COA)
Form
OMB Number
Taxpayer Identification Number
(Rev. November 2011)
1545-0074
►
See Publication 4520
Department of the Treasury
►
Form use only by IRS Certifying Acceptance Agents when submitting Form W-7
Internal Revenue Service
Certificate of Accuracy
The undersigned
is an authorized representative of
, a Certifying Acceptance Agent under an agreement entered into with
(CAA Business Name)
/20
/
the Internal Revenue Service dated
. The undersigned certifies with regard to Form W-7 submitted for
, that the applicant is not eligible for a SSN and has
(Form W-7 Applicant’s Name)
provided the documentation checked below that sufficiently supports the applicant’s identity and foreign status.
A passport is the only document that proves both “foreign status” and “identity”. If a passport is not provided,
REMINDER:
a combination of two or more documents must be provided to meet the documentation requirements.
Check the box under each category (identity, foreign status) that corresponds to the documents reviewed by you.
Foreign
Supporting Document
Identity
Status
Passport (Stand Alone Document)
National Identification Card (must be current and contain
name, photograph, address, date of birth and expiration date)
U.S. Drivers License
*
Civil Birth Certificate (Required for applicants under 18 if passport is not provided)
Medical Records (valid only for dependents under age 14 (under age 18
*
if a student)
Foreign Drivers License
U.S. State Identification Card
Foreign Voters Registration Card
U.S. Military Identification Card
Foreign Military Identification Card
School Records (valid only for dependents under age 14
*
(under age 18 if a student))
Visa issued by U. S. Department of State
United States Citizenship and Immigration Services (USCIS)
Photo Identification
*May be used to establish “foreign status” only if the documents are foreign
Check and complete the following paragraph only if the applicant is applying for an ITIN under
“Exception 1(a) - Partnership Interest”.
The undersigned further certifies that the Applicant has provided a copy of the relevant pages of the Partnership
Agreement of
and
(Name of Partnership)
EIN
as documentation in support of meeting the requirements for Exception 1(a).
The undersigned further certifies that the documentation was reviewed in accordance with the procedures set forth in the
Acceptance Agent Agreement and is authentic, complete, and accurate based on the information and documentation
submitted by the applicant.
The Certifying Acceptance Agent shall retain copies of all relevant documents including signed copies of the Forms W-7
submitted to the IRS on behalf of the applicant upon which the Certifying Acceptance Agent has relied upon to certify the
applicant’s foreign status and identity.
(Signature Date)
(Signature of Authorized Representative)
Acceptance Agent EIN and Office Code
14194
Form
(Rev. 11-2011)
Catalog Number 56020G
Department of the Treasury – Internal Revenue Service
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