(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
on page 3.
Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only
following seven boxes.
Individual/sole proprietor or
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation,
Check the appropriate box in the line above for the tax classification of the single-member owner.
Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is
disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions)
Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
Address (number, street, and apt. or suite no.) See instructions.
City, state, and ZIP code
Requester’s name and address (optional)
List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see
How to get a
If the account is in more than one name, see the instructions for line 1. Also see
What Name and
Number To Give the Requester
for guidelines on whose number to enter.
Social security number
Employer identification number
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 (defined below); and