Substitute Form W-9 - Payer'S Request For Taxpayer Identification Number (Tin) - Kinross Gold Corporation

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Substitute Form W-9 - Kinross Gold Corporation
Department of the Treasury Internal Revenue Service - Payer's Request for Taxpayer Identification Number (TIN)
UNITED STATES SHAREHOLDERS ONLY
Part 1 - Taxpayer Identification
Name: __________________________________________________________________________
(please print)
Please provide your Taxpayer Identification No. or
Social Security No. in the space at the right and cer-
Social Security Number
tify by signing and dating below.
or Taxpayer Identification Number: ____________________________________________________
Awaiting TIN
Individual /
Check appropriate box:
Corporation
Partnership
Sole proprietor
Other
Address:
Exempt from backup withholding
Part 2 - Certification - Under the 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),
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 (the "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. person (including a U.S. resident alien).
Certification Instructions
You must cross out part 2) above if you have been notified by the IRS that you are currently subject to backup withholding because of under-reporting or lack of reporting
of interest or dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from
the IRS that you are no longer subject to backup withholding, do not cross out such part 2).
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
Signature(s)
Date - Day
Month
Year
YOU MUST COMPLETE THE FOLLOWING CERTIFICATE IF YOU CHECKED THE "AWAITING TIN" BOX ABOVE.
Certificate of Awaiting Taxpayer Identification Number
I certify under penalties of perjury that (i) a TIN has not been issued to me, (ii) either a) I have mailed an application to receive a TIN to the appropriate Internal
Revenue Service Center or Social Security Administration Office or b) I intend to mail or deliver an application in the near future, and (iii) I understand that if I do not
provide a TIN by the time of payment, I will be subject to backup withholding at a rate of 28% of all reportable payments made to me.
Signature(s)
Date - Day
Month
Year
NOTE: Failure to complete and return this Substitute Form W-9, may result in backup withholding being withheld
at a rate of 28% on any payments made to you.
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