Are you looking for a new opportunity as an independent contractor? If so, you'll want to complete the Independent Contractor Application Form. This form is used by businesses to assess your qualifications and determine if you are a good fit for an open position. Completing the form accurately and thoroughly will help ensure that your application is considered. Be sure to include all relevant information, including your skills and experience.
This information will help you comprehend better the details of the independent contractor application before you begin filling it out.
Question | Answer |
---|---|
Form Name | Independent Contractor Application |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | E-mail, CVVC, WY, Licensee |
FOR OFFICIAL USE ONLY
Date Received:_______/_______/__________
Reviewed by:___________________________________________
Comments:_____________________________________________
________________________________________________________
________________________________________________________
INDEPENDENT CONTRACTOR APPLICATION
Applications are considered for all independent contractors, and contractors are treated during the agreement, without regard to race, color, religion, sex, national origin, age, disability, or any other prohibited basis of discrimination as provided under applicable state and federal law.
Position(s) Applying For:__________________________________________________________________________________________
BACKGROUND INFORMATION
Name:__________________________________________________________________________________________________________
Street Address:__________________________________________________________________________________________________
City:________________________________ State:_______________________________ Zip:_________________________________
Phone:______________________________ Fax:________________________________ Email:_______________________________
Type of Entity (e.g., individual, corporation, partnership, etc):________________________________________________________________
Description of Primary Business:___________________________________________________________________________________
SIC (if business)_______________________________ SSN (if individual)_____________________________ EIN (if business)_______________________________
Products/Services Offered (check all that apply): |
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□ Consulting |
□ Professional |
□ Other |
CONTRACTING REQUEST
Anticipated Rates: $_____________________________________________________________________________________________
Hours Available per Week:_______________________________________________________________________________________
What is the earliest date you can begin work?:___________________________________________________________________
PROFESSIONAL REFERENCES
Name: |
Company: |
Position: |
Contact Info: |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
___________________________ |
PREVIOUS POSITIONS (Please begin with most recent)
Company:__________________________ Phone:______________________________ Contact:____________________________
Address:________________________________________________________________________________________________________
Employment Dates: |
Pay or Salary: |
Reason for leaving: |
Position & Duties |
From_______________________ |
Start_______________________ |
___________________________ |
___________________________ |
To_ ________________________ |
Final_______________________ |
___________________________ |
___________________________ |
Company:__________________________ Phone:______________________________ Contact:____________________________
Address:________________________________________________________________________________________________________
Employment Dates: |
Pay or Salary: |
Reason for leaving: |
Position & Duties |
From_______________________ |
Start_______________________ |
___________________________ |
___________________________ |
To_ ________________________ |
Final_______________________ |
___________________________ |
___________________________ |
Company:__________________________ Phone:______________________________ Contact:____________________________
Address:________________________________________________________________________________________________________
Employment Dates: |
Pay or Salary: |
Reason for leaving: |
Position & Duties |
From_______________________ |
Start_______________________ |
___________________________ |
___________________________ |
To_ ________________________ |
Final_______________________ |
___________________________ |
___________________________ |
EXISTING CONTRACTUAL RELATIONSHIPS (Please list all current independent contractor relationships)
Company:______________________________________________________________________________________________________
Address:____________________________ |
Obligations:_________________________ |
Industry Type:_ ______________________ |
____________________________________ |
____________________________________ |
____________________________________ |
Phone:______________________________ |
Effective Date:______________________ |
Monthly Hours Worked:______________ |
Contact:____________________________ |
End of Term:________________________ |
____________________________________ |
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Company:______________________________________________________________________________________________________
Address:____________________________ |
Obligations:_________________________ |
Industry Type:_ ______________________ |
____________________________________ |
____________________________________ |
____________________________________ |
Phone:______________________________ |
Effective Date:______________________ |
Monthly Hours Worked:______________ |
Contact:____________________________ |
End of Term:________________________ |
____________________________________ |
Company:______________________________________________________________________________________________________ |
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Address:____________________________ |
Obligations:_________________________ |
Industry Type:_ ______________________ |
____________________________________ |
____________________________________ |
____________________________________ |
Phone:______________________________ |
Effective Date:______________________ |
Monthly Hours Worked:______________ |
Contact:____________________________ |
End of Term:________________________ |
____________________________________ |
ADDITIONAL INFORMATION
Are you legally eligible for work in the U.S.A.? |
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Yes (verification required) |
□ |
No |
Have you ever contracted with HHA before? |
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Yes |
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No |
If yes, when? (Please attach previous contract application)_________________________________________________________________
Do you have liability and/or malpractice insurance? |
□ Yes |
□ No |
If yes, please attach proof of insurance to application.
Do you agree to obtain any and all licenses that may be |
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required to do business as an independent contractor or |
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Yes |
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No |
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Do you understand that as an independent contractor, |
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you would not be eligible for unemployment benefits at |
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the end of any contract with HHA? |
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Yes |
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No |
Do you understand that as an independent contractor, |
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you would be responsible for payment of any and all |
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state and/or federal income taxes, Social Security, |
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payroll taxes and you will receive a form 1099 for |
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service provided to HHA by you? |
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Yes |
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No |
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SIGNATURE/CERTIFICATION
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for immediate denial of my appointment or removal from consideration or, if I have entered into a contract with this company, for immediate termination of that contract. I authorize HHA to make any necessary inquiries and investigations into my education, references, or employment history. I further authorize, unless otherwise indicated on this application, the release of my information to HHA by any of the schools, services, or employers listed on this application.
I also hereby release from liability HHA and its representatives for seeking, gathering, and using such information to make decisions concerning my status as an independent contractor for HHA and all other persons or organizations for providing such information.
THIS IS NOT AN APPLICATION FOR EMPLOYMENT. I understand and agree that if this application is accepted, my status will be that of an independent contractor and as such, I will be solely responsible for all tax liabilities pertaining to monies received in the course of services I perform.
If I am retained by HHA as an independent contractor I will:
•Not be entitled to workers compensation benefits.
•Not be entitled to unemployment insurance benefits unless unemployment coverage is provided by me or some other entity.
•Be obligated to pay federal and state income tax on any moneys paid pursuant to the contract.
•Be required to provide professional and liability insurance.
I represent and warrant that I have read and fully understand the foregoing, and that I seek to become and independent contractor under these conditions.
Signature:_______________________________________________________________________Date:_______/_______/__________
Employment Eligibility Verification |
USCIS |
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Department of Homeland Security |
Form |
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OMB No. |
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U.S. Citizenship and Immigration Services |
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Expires 08/31/2019 |
►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form
Last Name (Family Name)
First Name (Given Name)
Middle Initial
Other Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)
U.S. Social Security Number
- -
Employee's
Employee's Telephone Number
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):
1. |
A citizen of the United States |
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2. |
A noncitizen national of the United States (See instructions) |
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3. |
A lawful permanent resident |
(Alien Registration Number/USCIS Number): |
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4. |
An alien authorized to work |
until (expiration date, if applicable, mm/dd/yyyy): |
Some aliens may write "N/A" in the expiration date field. (See instructions)
Aliens authorized to work must provide only one of the following document numbers to complete Form
An Alien Registration Number/USCIS Number OR Form
1.Alien Registration Number/USCIS Number:
OR
2.Form
OR
3.Foreign Passport Number: Country of Issuance:
QR Code - Section 1
Do Not Write In This Space
Signature of Employee |
Today's Date (mm/dd/yyyy) |
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Preparer and/or Translator Certification (check one):
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I did not use a preparer or translator. |
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A preparer(s) and/or translator(s) assisted the employee in completing Section 1. |
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator |
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Today's Date (mm/dd/yyyy) |
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Last Name (Family Name) |
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First Name (Given Name) |
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Address (Street Number and Name) |
City or Town |
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State |
ZIP Code |
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Employer Completes Next Page
Form |
Page 1 of 3 |
Employment Eligibility Verification |
USCIS |
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Department of Homeland Security |
Form |
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OMB No. |
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U.S. Citizenship and Immigration Services |
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Expires 08/31/2019 |
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")
Employee Info from Section 1 |
Last Name (Family Name) |
First Name (Given Name) |
M.I. Citizenship/Immigration Status |
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List A |
OR |
List B |
AND |
List C |
Identity and Employment Authorization |
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Identity |
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Employment Authorization |
Document Title
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any)(mm/dd/yyyy)
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Document Title |
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Issuing Authority |
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Issuing Authority |
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Document Number |
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Document Number |
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Expiration Date (if any)(mm/dd/yyyy) |
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Expiration Date (if any)(mm/dd/yyyy) |
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Additional Information |
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QR Code - Sections 2 & 3 |
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Do Not Write In This Space |
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Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the
(2)the
The employee's first day of employment (mm/dd/yyyy): |
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(See instructions for exemptions) |
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Title of Employer or Authorized Representative
Last Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name)
City or Town
State
ZIP Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable) |
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B. Date of Rehire (if applicable) |
Last Name (Family Name) |
First Name (Given Name) |
Middle Initial |
Date (mm/dd/yyyy) |
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C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
Document Title
Document Number
Expiration Date (if any) (mm/dd/yyyy)
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative |
Today's Date (mm/dd/yyyy) |
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Name of Employer or Authorized Representative
Form |
Page 2 of 3 |
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.
LIST A |
LIST B |
LIST C |
Documents that Establish |
Documents that Establish |
Documents that Establish |
Both Identity and |
Identity |
Employment Authorization |
Employment Authorization |
OR |
AND |
1.U.S. Passport or U.S. Passport Card
2.Permanent Resident Card or Alien Registration Receipt Card (Form
3.Foreign passport that contains a temporary
4.Employment Authorization Document that contains a photograph (Form
5.For a nonimmigrant alien authorized to work for a specific employer because of his or her status:
a.Foreign passport; and
b.Form
(1)The same name as the passport; and
(2)An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form.
6.Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form
1.Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
2.ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address
3.School ID card with a photograph
4.Voter's registration card
5.U.S. Military card or draft record
6.Military dependent's ID card
7.U.S. Coast Guard Merchant Mariner Card
8.Native American tribal document
9.Driver's license issued by a Canadian government authority
For persons under age 18 who are
unable to present a document
listed above:
10.School record or report card
11.Clinic, doctor, or hospital record
12.
1.A Social Security Account Number card, unless the card includes one of the following restrictions:
(1)NOT VALID FOR EMPLOYMENT
(2)VALID FOR WORK ONLY WITH INS AUTHORIZATION
(3)VALID FOR WORK ONLY WITH DHS AUTHORIZATION
2.Certification of report of birth issued by the Department of State (Forms
3.Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal
4.Native American tribal document
5.U.S. Citizen ID Card (Form
6.Identification Card for Use of Resident Citizen in the United States (Form
7.Employment authorization document issued by the Department of Homeland Security
Examples of many of these documents appear in Part 13 of the Handbook for Employers
Refer to the instructions for more information about acceptable receipts.
Form |
Page 3 of 3 |
Form |
Request for Taxpayer |
Give Form to the |
(Rev. November 2017) |
Identification Number and Certification |
requester. Do not |
Department of the Treasury |
▶ Go to www.irs.gov/FormW9 for instructions and the latest information. |
send to the IRS. |
Internal Revenue Service |
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1Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2Business name/disregarded entity name, if different from above
<![endif]>3. |
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the |
4 Exemptions (codes apply only to |
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<![endif]>page |
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following seven boxes. |
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certain entities, not individuals; see |
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instructions on page 3): |
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<![endif]>on |
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Individual/sole proprietor or |
C Corporation |
S Corporation |
Partnership |
Trust/estate |
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<![endif]>type.orPrint InstructionsSpecific |
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Exempt payee code (if any) |
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Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶ |
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Note: Check the appropriate box in the line above for the tax classification of the |
Exemption from FATCA reporting |
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LLC if the LLC is classified as a |
code (if any) |
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another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a |
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is disregarded from the owner should check the appropriate box for the tax classification of its owner. |
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Other (see instructions) ▶ |
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(Applies to accounts maintained outside the U.S.) |
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5 Address (number, street, and apt. or suite no.) See instructions. |
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Requester’s name and address (optional) |
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<![endif]>See |
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6 City, state, and ZIP code |
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7 List account number(s) here (optional) |
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Part |
I |
Taxpayer Identification Number (TIN) |
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Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid |
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Social security number |
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backup withholding. For individuals, this is generally your social security number (SSN). However, for a |
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resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other |
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entities, it is your employer identification number (EIN). If you do not have a number, see How to get a |
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TIN, later. |
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or |
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Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and |
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Employer identification number |
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Number To Give the Requester for guidelines on whose number to enter. |
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–
Part II Certification
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
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 the instructions for Part II, later.
Sign |
Signature of |
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Here |
U.S. person ▶ |
Date ▶ |
General Instructions |
• Form |
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Section references are to the Internal Revenue Code unless otherwise |
funds) |
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• Form |
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noted. |
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proceeds) |
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Future developments. For the latest information about developments |
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• Form |
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related to Form |
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transactions by brokers) |
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after they were published, go to www.irs.gov/FormW9. |
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• Form |
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Purpose of Form |
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• Form |
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An individual or entity (Form |
• Form 1098 (home mortgage interest), |
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information return with the IRS must obtain your correct taxpayer |
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• Form |
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identification number (TIN) which may be your social security number |
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(SSN), individual taxpayer identification number (ITIN), adoption |
• Form |
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taxpayer identification number (ATIN), or employer identification number |
Use Form |
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(EIN), to report on an information return the amount paid to you, or other |
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alien), to provide your correct TIN. |
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amount reportable on an information return. Examples of information |
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If you do not return Form |
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returns include, but are not limited to, the following. |
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• Form |
be subject to backup withholding. See What is backup withholding, |
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later. |
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Cat. No. 10231X |
Form |
Form |
Page 2 |
By signing the
1.Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2.Certify that you are not subject to backup withholding, or
3.Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and
4.Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.
Note: If you are a U.S. person and a requester gives you a form other than Form
Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
•An individual who is a U.S. citizen or U.S. resident alien;
•A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;
•An estate (other than a foreign estate); or
•A domestic trust (as defined in Regulations section
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form
In the cases below, the following person must give Form
•In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;
•In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
•In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form
Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form
1.The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.
2.The treaty article addressing the income.
3.The article number (or location) in the tax treaty that contains the saving clause and its exceptions.
4.The type and amount of income that qualifies for the exemption from tax.
5.Sufficient facts to justify the exemption from tax under the terms of the treaty article.
Example. Article 20 of the
If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form
Backup Withholding
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest,
You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1.You do not furnish your TIN to the requester,
2.You do not certify your TIN when required (see the instructions for Part II for details),
3.The IRS tells the requester that you furnished an incorrect TIN,
4.The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or
5.You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form
Updating Your Information
You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
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Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.
If this Form
a.Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on your Form
b.Sole proprietor or
c.Partnership, LLC that is not a
d.Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.
e.Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.
IF the entity/person on line 1 is |
THEN check the box for . . . |
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a(n) . . . |
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Corporation |
Corporation |
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Individual |
Individual/sole proprietor or single- |
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Sole proprietorship, or |
member LLC |
• |
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company (LLC) owned by an |
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individual and disregarded for U.S. |
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federal tax purposes. |
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LLC treated as a partnership for |
Limited liability company and enter |
U.S. federal tax purposes, |
the appropriate tax classification. |
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LLC that has filed Form 8832 or |
(P= Partnership; C= C corporation; |
2553 to be taxed as a corporation, |
or S= S corporation) |
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or |
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LLC that is disregarded as an |
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entity separate from its owner but |
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the owner is another LLC that is |
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not disregarded for U.S. federal tax |
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purposes. |
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Partnership |
Partnership |
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Trust/estate |
Trust/estate |
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Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.
Exempt payee code.
•Generally, individuals (including sole proprietors) are not exempt from backup withholding.
•Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.
•Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
•Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form
The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.