Form W-9 "Substitute W-9 Form - Request for Taxpayer Identification Number and Certification" - Virginia

Form W-9 is a Virginia Department of Taxation form also known as the "Substitute W-9 Form - Request For Taxpayer Identification Number And Certification". The latest edition of the form was released in December 1, 2017 and is available for digital filing.

Download an up-to-date Form W-9 in PDF-format down below or look it up on the Virginia Department of Taxation Forms website.

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Download Form W-9 "Substitute W-9 Form - Request for Taxpayer Identification Number and Certification" - Virginia

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W-9
Request for Taxpayer Identification
Form
Commonwealth of Virginia
Number and Certification
Substitute W-9 Form
Revised December 2017
Please select the appropriate Taxpayer Identification Number (EIN or SSN) type and
 Social Security Number (SSN)
enter your 9 digit ID number . The EIN or SSN provided must match the name given
 Employer Identification Number (EIN)
on the “Legal Name” line to avoid backup withholding. If you do not have a Tax ID
number, please reference "Specific Instructions ‐ Section 1." If the account is in more
than one name, provide the name of the individual who is recognized with the IRS as
__   __   __   __   __   __      
__ __ __
the responsible party.
Dunn & Bradstreet Universal Numbering System
(see
(DUNS)
instructions)
Legal Name:
__   __   __   __   __   __      
__ __ __
Business Name:
Entity Type
Entity Classification
Exemptions (see instructions)
 Individual
 Corporation
 Professional Services
 Medical Services
Exempt payee code
(if any):
 Sole Proprietorship
 S‐Corporation
 Political Subdivision
 Legal Services
(from backup withholding)
 Partnership
 C‐Corporation
 Real Estate Agent
 Joint Venture
 Trust
 Disregarded Entity
 VA Local Government
 Tax Exempt Organization
Exemption from FATCA reporting
code (if any):
 Estate
 Limited Liability Company
 Federal Government
 OTH Government
 Government
 Partnership
 VA State Agency
 Other
 Non‐Profit
 Corporation
Contact Information
Name:
Legal Address:
Email Address:
Business Phone:
City:
State :
Zip Code:
Fax Number:
Remittance Address:
Mobile Phone:
Alternate Phone:
City:
State :
Zip Code:
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 later in general instructions), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not
apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual
retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but
you must provide your correct TIN. See instructions titled Certification
Printed Name:
Date:
Authorized U.S. Signature:
 
 
 
 
 
 
 
 
 
 
 
                         
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
   
   
   
 
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
   
 
 
 
   
   
 
 
 
 
 
 
   
 
     
 
 
 
 
 
 
   
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
 
 
 
    
 
 
 
 
 
 
  
       
 
 
 
 
 
   
 
 
 
 
 
   
 
 
   
     
   
 
 
   
   
 
          
 
 
   
 
   
 
     
     
   
   
   
     
 
 
 
 
 
   
 
          
 
 
   
 
 
 
 
 
 
 
 
   
   
 
 
 
   
 
 
 
 
 
 
   
 
 
 
 
 
   
   
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
   
   
 
 
   
 
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
       
 
 
 
 
 
 
   
 
 
   
 
 
 
 
   
         
   
 
   
 
 
 
 
   
 
 
 
 
 
         
 
 
   
 
 
 
   
 
 
 
 
   
   
 
 
 
   
 
 
 
W-9
Request for Taxpayer Identification
Form
Commonwealth of Virginia
Number and Certification
Substitute W-9 Form
Revised December 2017
Please select the appropriate Taxpayer Identification Number (EIN or SSN) type and
 Social Security Number (SSN)
enter your 9 digit ID number . The EIN or SSN provided must match the name given
 Employer Identification Number (EIN)
on the “Legal Name” line to avoid backup withholding. If you do not have a Tax ID
number, please reference "Specific Instructions ‐ Section 1." If the account is in more
than one name, provide the name of the individual who is recognized with the IRS as
__   __   __   __   __   __      
__ __ __
the responsible party.
Dunn & Bradstreet Universal Numbering System
(see
(DUNS)
instructions)
Legal Name:
__   __   __   __   __   __      
__ __ __
Business Name:
Entity Type
Entity Classification
Exemptions (see instructions)
 Individual
 Corporation
 Professional Services
 Medical Services
Exempt payee code
(if any):
 Sole Proprietorship
 S‐Corporation
 Political Subdivision
 Legal Services
(from backup withholding)
 Partnership
 C‐Corporation
 Real Estate Agent
 Joint Venture
 Trust
 Disregarded Entity
 VA Local Government
 Tax Exempt Organization
Exemption from FATCA reporting
code (if any):
 Estate
 Limited Liability Company
 Federal Government
 OTH Government
 Government
 Partnership
 VA State Agency
 Other
 Non‐Profit
 Corporation
Contact Information
Name:
Legal Address:
Email Address:
Business Phone:
City:
State :
Zip Code:
Fax Number:
Remittance Address:
Mobile Phone:
Alternate Phone:
City:
State :
Zip Code:
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 later in general instructions), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions: You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not
apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual
retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but
you must provide your correct TIN. See instructions titled Certification
Printed Name:
Date:
Authorized U.S. Signature:
Commonwealth of Virginia Substitute W-9 Form Instructions
General Instructions
Nonresident alien who becomes a resident alien.
payments from fishing boat operators. Real estate
Generally, only a nonresident alien individual may
transactions are not subject to backup withholding.
use the terms of a tax treaty to reduce or eliminate
Section references are to the Internal Revenue Code
You will not be subject to backup withholding on
U.S. tax on certain types of income. However, most
unless otherwise noted.
payments you receive if you give the requester your
tax treaties contain a provision known as a “saving
correct TIN, make the proper certifications, and
Future developments. The IRS has created a page
clause.” Exceptions specified in the saving clause
report all your taxable interest and dividends on
on IRS.gov for information about Form W-9, at
may permit an exemption from tax to continue for
your tax return.
www.irs.gov/w9. Information about any future
certain types of income even after the payee has
developments affecting Form W-9 (such as
Payments you receive will be subject to backup
otherwise become a U.S. resident alien for tax
legislation enacted after we release it) will be
withholding if:
purposes.
posted on that page.
1. You do not furnish your TIN to the requester,
If you are a U.S. resident alien who is relying on an
2. You do not certify your TIN when required (see
Purpose of Form
exception contained in the saving clause of a tax
Section 2 Certification – Page 3 for details),
A person who is required to file an information
treaty to claim an exemption from U.S. tax on
3. The IRS tells the requester that you furnished an
return with the IRS must obtain your correct
certain types of income, you must attach a
incorrect TIN,
taxpayer identification number (TIN) to report, for
statement to Form W-9 that specifies the following
4. The IRS tells you that you are subject to backup
example, income paid to you, payments made to
five items:
withholding because you did not report all your
you in settlement of payment card and third party
1. The treaty country. Generally, this must be the
interest and dividends on your tax return (for
network transactions, real estate transactions,
same treaty under which you claimed exemption
reportable interest and dividends only), or
mortgage interest you paid, acquisition or
from tax as a nonresident alien.
5. You do not certify to the requester that you are
abandonment of secured property, cancellation of
2. The treaty article addressing the income.
not subject to backup withholding under 4 above
debt, or contributions you made to an IRA.
3. The article number (or location) in the tax treaty
(for reportable interest and dividend accounts
Use Form W-9 only if you are a U.S. person
that contains the saving clause and its exceptions.
opened after 1983 only).
(including a resident alien), to provide your correct
4. The type and amount of income that qualifies for
TIN to the person requesting it (the requester) and,
Certain payees and payments are exempt from
the exemption from tax.
when applicable, to:
backup withholding. See Exempt payee code on
5. Sufficient facts to justify the exemption from tax
1. Certify that the TIN you are giving is correct (or
page 3 and the separate Instructions for the
under the terms of the treaty article.
you are waiting for a number to be issued),
Requestor of Form W-9 for more information.
Example. Article 20 of the U.S.-China income tax
2. Certify that you are not subject to backup
What is FATCA reporting? The Foreign Account Tax
treaty allows an exemption from tax for scholarship
withholding, or
Compliance Act (FATCA) requires a participating
income received by a Chinese student temporarily
3. Claim exemption from backup withholding if you
foreign financial institution to report all United
present in the United States. Under U.S. law, this
are a U.S. exempt payee. If applicable, you are also
States account holders that are specified United
student will become a resident alien for tax
certifying that as a U.S. person, your allocable share
States persons. Certain payees are exempt from
purposes if his or her stay in the United States
of any partnership income from a U.S. trade or
FATCA reporting. See Exemption from FATCA
exceeds 5 calendar years. However, paragraph 2 of
business is not subject to the withholding tax on
reporting code on page 3 and the Instructions for
the first Protocol to the U.S.-China treaty (dated
foreign partners’ share of effectively connected
the Requestor of Form W-9 for more information.
April 30, 1984) allows the provisions of Article 20 to
income, and
continue to apply even after the Chinese student
Updating Your Information
4. Certify that FATCA code(s) entered on this form
becomes a resident alien of the United States. A
(if any) indicating that you are exempt from the
You must provide updated information to any
Chinese student who qualifies for this exception
FATCA reporting, is correct.
person to whom you claimed to be an exempt
(under paragraph 2 of the first protocol) and is
payee if you are no longer an exempt payee and
Definition of a U.S. person. For federal tax
relying on this exception to claim an exemption
anticipate receiving reportable payments in the
purposes, you are considered a U.S. person if you
from tax on his or her scholarship or fellowship
future from this person. For example, you may need
are:
income would attach to Form W-9 a statement that
to provide updated information if you are a C
• An individual who is a U.S. citizen or U.S. resident
includes the information described above to
corporation that elects to be an S corporation, or if
alien,
support that exemption.
you no longer are tax exempt. In addition, you must
• A partnership, corporation, company, or
If you are a nonresident alien or a foreign entity,
furnish a new Form W-9 if the name or TIN changes
association created or organized in the United
give the requester the appropriate completed Form
for the account, for example, if the grantor of a
States or under the laws of the United States,
W-8 or Form 8233.
grantor trust dies.
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section
What is backup withholding? Persons making
Penalties
301.7701-7).
certain payments to you must under certain
Failure to furnish TIN. If you fail to furnish your
conditions withhold and pay to the IRS a percentage
Foreign person. If you are a foreign person or the
correct TIN to a requester, you are subject to a
of such payments. This is called “backup
U.S. branch of a foreign bank that has elected to be
penalty of $50 for each such failure unless your
withholding.” Payments that may be subject to
treated as a U.S. person, do not use Form W-9.
failure is due to reasonable cause and not to willful
backup withholding include interest, tax-exempt
Instead, use the appropriate Form W-8 or Form
neglect.
interest, dividends, broker and barter exchange
8233 (see Publication 515, Withholding of Tax on
transactions, rents, royalties, nonemployee pay,
Civil penalty for false information with respect to
Nonresident Aliens and Foreign Entities).
payments made in settlement of payment card and
withholding. If you make a false statement with no
third party network transactions, and certain
1
Commonwealth of Virginia Substitute W-9 Form Instructions
reasonable basis that results in no backup
your ITIN (IRS Individual Taxpayer Identification
“doing business as (DBA)” name on the “Business
withholding, you are subject to a $500 penalty.
Number).
Name” line.
d. If you are a Sole Proprietor, check the "Social
Partnership. A partnership is an entity reflecting a
Criminal penalty for falsifying information. Willfully
Security Number (SSN)" box and enter the SSN of
relationship existing between two or more persons
falsifying certifications or affirmations may subject
the sole proprietor.
who join to carry on a trade or business. Enter the
you to criminal penalties including fines and/or
e. If you are a Single-Member LLC that is
partnerships entity's name on the "Legal Name"
imprisonment.
disregarded as an entity, check the "Social Security
line. This name should match the name shown on
Misuse of TINs. If the requester discloses or uses
Number (SSN)" box and enter the member's SSN.
the legal document creating the entity. You may
TINs in violation of federal law, the requester may
Note: If an LLC has one owner, the LLC's default tax
enter your business, trade, or "doing business as
be subject to civil and criminal penalties.
status is "disregarded entity". If an LLC has two
(DBA) name on the "Business Name" line.
owners, the LLC's default tax status is "partnership".
Specific Instructions
Trust. A legal entity that acts as fiduciary, agent or
If an LLC has elected to be taxed as a corporation, it
trustee on behalf of a person or business entity for
must file IRS Form 2553 (S Corporation) or IRS Form
Section 1 -Taxpayer Identification
the purpose of administration, management and
8832 (C Corporation).
Check the appropriate Tax Identification Number
the eventual transfer of assets to a beneficial party.
Vendors are requested to enter their Dunn and
(TIN) type. Enter your EIN/SSN in the space
Enter the name of the legal entity on the "Legal
Bradstreet Universal Numbering System (DUNS), if
provided. If you are a resident alien and you do not
Name" line.
applicable. See number requirement below.
have and /or are not eligible to get an SSN, your TIN
Estate. A separate legal entity created under state
is your IRS individual taxpayer identification number
Dunn and Bradstreet Universal Numbering System
law solely to transfer property from one party to
(ITIN). Enter it in the social security number box. If
(DUNS) number requirement . The United States
another. The entity is separated by law from both
you do not have an ITIN, see How to get a TIN
Office of Management and Budget (OMB) requires
the grantor and the beneficiaries. Enter the name
below.
all vendors that receive federal grant funds have
of the legal entity on the "Legal Name" line.
their DUNS number recorded with and
How to get a TIN. If you do not have a TIN, apply
Government. The Government of any State, any
subsequently reported to the granting agency. If a
for one immediately. To apply for an SSN, get Form
Political Subdivision of any State, any Agency or
contractor has multiple DUNS numbers the
SS-5, Application for a Social Security Card, from
Instrumentality of a State or of a Political
contractor should provide the primary number
your local Social Security Administration office. Get
Subdivision of a State.
listed with the Federal government’s Central
Form W-7, Application for IRS Individual Taxpayer
Contractor Registration (CCR) at www.ccr.gov . Any
Non-Profit. An organization that is organized and
Identification Number, to apply for an ITIN or Form
entity that does not have a DUNS number can apply
operated exclusively for exempt purposes and none
SS-4, Application for Employer Identification
for one on-line at http://www.dnb.com/us/ under
of its earnings may inure to any private shareholder
Number, to apply for an EIN. You can get Forms W-
the DNB D-U-N Number Tab.
or individual.
7 and SS-4 from the IRS by calling 1-800-TAX-FORM
(1-800-829-3676) or from the IRS’s Internet Web
Legal Name. If you are an individual, you must
Corporation. A company recognized by law as a
Site www.irs.gov.
generally enter the name shown on your social
single body with its own powers and liabilities,
security card. However, if you have changed your
separate from those of the individual members.
If you do not have a TIN, apply for a TIN
last name, for instance, due to marriage without
Enter the entity's name on the "Legal Name" line
immediately, write “Applied For” in the space for
informing the Social Security Administration of the
and any trade or "doing business as (DBA)" name on
the TIN, sign and date the form, and give it to the
name change, enter your first name, the last name
the "Business Name" line.
requester. For interest and dividend payments, and
shown on your social security card, and your new
certain payments made with respect to readily
S-Corporation. A corporation that is taxed like a
last name. If the account is in joint names, list first
tradable instruments, generally you will have 60
partnership: a corporation in which five or fewer
and then circle the name of the person or entity
days to get a TIN and give it to the requester before
people own at least half the stock. Enter the
whose number you enter in Part I of the form. If you
you are subject to backup withholding on
entity's name on the "Legal Name" line and any
are using a name other than that which is listed on
payments. The 60-day rule does not apply to other
trade or "doing business as (DBA)" name on the
a Social Security Card, please enter the legal entity
types of payments. You will be subject to backup
"Business Name" line.
name as filed with the IRS. In general, enter the
withholding on all such payments until you provide
C-Corporation. A business that is taxed as a
name shown on your income tax return. Do not
your TIN to the requester. Note: Writing “Applied
separate entity: a business taxed under Subchapter
enter a Disregarded Entity Name on this line.
For” means that you have already applied for a TIN
C of the Internal Revenue Code and legally distinct
or that you intend to apply for one soon.
Business Name. Business, Disregarded Entity,
from its owners. Enter the entity's name on the
trade, or DBA ("doing business as") name.
Enter the TIN which coincides with the 'Legal
"Legal Name" line and any trade or "doing business
Name' provided on the form.
Entity Type. Select the appropriate entity type.
as (DBA)" name on the "Business Name" line.
a. If you are an individual, check the "Social
Individual. If you are an individual, you must
Limited liability Company (LLC). An LLC with at least
Security Number (SSN)" box and enter the SSN.
generally enter the name shown on your income tax
two members is classified as a partnership for
b. If you are a Grantor or Revocable Trust, check
return.
federal income tax purposes unless it files Form
the "Social Security Number (SSN)" box and enter
8832 and affirmatively elects to be treated as a
the SSN of the Grantor.
Sole proprietor. Enter your individual name as
corporation. Enter the name of the partnership or
c. If you are a Resident Alien, check the "Social
shown on your social security card on the “Legal
corporation. An LLC with only one member is
Security Number (SSN)" box and enter your SSN or
Name” line. You may enter your business, trade, or
treated as an entity disregarded as separate from its
owner for income tax purposes (but as a separate
2
Commonwealth of Virginia Substitute W-9 Form Instructions
entity for purposes of employment tax and certain
6 - A dealer in securities or commodities required to
A - An organization exempt from tax under section
excise taxes), unless it files Form 8832 and
register in the United States, the District of
501(a) or any individual retirement plan as defined
affirmatively elects to be treated as a corporation.
Columbia, or a possession of the United States
in section 7701(a)(37)
If you are a single-member LLC (including a foreign
7 - A futures commission merchant registered with
B - The United States or any of its agencies or
LLC with a domestic owner) that is disregarded as
the Commodity Futures Trading Commission
instrumentalities
an entity separate from its owner, enter the
8 - A real estate investment trust
C - A state, the District of Columbia, a possession of
owner’s name on the “Legal Name” line. Caution:
9 - An entity registered at all times during the tax
the United States, or any of their political
A disregarded domestic entity that has a foreign
year under the Investment Company Act of 1940
subdivisions or instrumentalities
owner must use the appropriate Form W-8.
10- A common trust fund operated by a bank under
D - A corporation the stock of which is regularly
section 584(a)
traded on one or more established securities
Entity Classification. Select the appropriate
11 - A financial institution
markets, as described in Reg. section 1.1472-
classification type.
12 - A middleman known in the investment
1(c)(1)(i)
Contact Information. Enter your contact
community as a nominee or custodian
E - A corporation that is a member of the same
information.
13 - A trust exempt from tax under section 664 or
expanded affiliated group as a corporation
described in section 4947.
described in Reg. section 1.1472-1(c)(1)(i)
Enter your Legal Address. Enter your Remittance
F - A dealer in securities, commodities, or derivative
Address. A Remittance Address is the location in
The following chart shows types of payments that
financial instruments (including notional principal
which you or your entity receives business
may be exempt from backup withholding. The chart
contracts, futures, forwards, and options) that is
payments.
applies to the exempt payees listed above, 1
registered as such under the laws of the United
through 13.
Enter your Business Phone Number. Enter your
States or any state
Mobile Phone Number, if applicable. Enter your Fax
G - A real estate investment trust
Number, if applicable. Enter your Email Address.
IF the payment is for. . . THEN the payment is exempt for. .
H - A regulated investment company as defined in
Interest and dividend
All exempt payees except for 7
For clarification on IRS Guidelines, see www.irs.gov.
section 851 or an entity registered at all times
payments
during the tax year under the Investment Company
Exemptions
Broker transactions
Exempt payees 1 through 4 and 6
Act of 1940
through 11 and all C corporations.
If you are exempt from backup withholding and/or
I - A common trust fund as defined in section 584(a)
S corporations must not enter an
FATCA reporting, enter in the Exemptions box, any
exempt payee code because they
J - A bank as defined in section 581
are exempt only for sales of
code(s) that may apply to you. See Exempt payee
K - A broker
noncovered securities acquired
code and Exemption from FATCA reporting code
L - A trust exempt from tax under section 664 or
prior to 2012.
below.
described in section 4947(a)(1)
Barter exchange
Exempt payees 1 through 4
M - A tax exempt trust under a section 403(b) plan
transactions and
Exempt payee code. Generally, individuals
patronage dividends
or section 457(g) plan
(including sole proprietors) are not exempt from
Payments over $600
Generally, exempt payees 1
backup withholding. Corporations are exempt from
Section 2 - Certification
2
required to be reported
through 5
backup withholding for certain payments, such as
and direct sales over
To establish to the paying agent that your TIN is
1
interest and dividends. Corporations are not
$5,000
Payments made in
Exempt payees 1 through 4
correct, you are not subject to backup withholding,
exempt from backup withholding for payments
settlement of payment
or you are a U.S. person, or resident alien, sign the
made in settlement of payment card or third party
card or third party
certification on Form W-9. You are being requested
network transactions.
network transactions
to sign by the Commonwealth of Virginia.
Note. If you are exempt from backup withholding,
1
See Form 1099-MISC, Miscellaneous Income, and
For a joint account, only the person whose TIN is
you should still complete this form to avoid possible
its instructions.
shown in Part I should sign (when required).
erroneous backup withholding.
2
However, the following payments made to a
corporation and reportable on Form 1099-MISC are
Real estate transactions. You must sign the
The following codes identify payees that are exempt
not exempt from backup withholding: medical and
certification. You may cross out item 2 of the
from backup withholding:
health care payments, attorneys' fees, gross
certification.
1 - An organization exempt from tax under section
proceeds paid to an attorney, and payments for
501(a), any IRA, or a custodial account under
services paid by a federal executive agency.
section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2)
Exemption from FATCA reporting code. The
2 - The United States or any of its agencies or
Submission:
following codes identify payees that are exempt
instrumentalities
from reporting under FATCA. These codes apply to
Commonwealth Vendor Group
3 - A state, the District of Columbia, a possession of
persons submitting this form for accounts
Post Office Box 1971
the United States, or any of their political
maintained outside of the United States by certain
Richmond, VA 23218-1971
subdivisions, or instrumentalities
foreign financial institutions. Therefore, if you are
4 - A foreign government or any of its political
only submitting this form for an account you hold in
subdivisions, agencies, or instrumentalities
the United States, you may leave this field blank.
5 - A corporation
Consult with the person requesting this form if you
are uncertain if the financial institution is subject to
these requirements.
3
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