Form W-9
(Rev. December 2014)
ФОРМА W-9
(на декабрь 2014 г.)
Department of the Treasury Internal Revenue Service Министерство финансов США
Налоговое управление
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Request for Taxpayer Identification Number and Certification
Запрос об идентификационном номере налогоплательщика и сертификация
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Give Form to the requester. Do not send to the IRS.
Передайте форму запрашивающему лицу. Не отправляйте в Налоговое управление США.
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Name (as shown on your income tax return)
Фамилия, имя/наименование (как указано в вашей налоговой декларации)
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2. Business name/disregarded entity name, if different from above
Коммерческое обозначение/наименование организации, не являющейся юридическим лицом, если отличается от указанного выше
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3. Check appropriate box for federal tax classification; check only one of the following seven boxes:
Отметьте вариант в соответствии с федеральной налоговой классификацией:
Individual/sole proprietor or single-member LLC
Индивидуальный предприниматель или общество с ограниченной ответственностью с единственным владельцем
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Партнерство
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C-корпорация
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Доверительный фонд/наследственный фонд
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S-корпорация
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Other (see instructions) ▶__________
Другое лицо (см. инструкции)
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Limited liability company.
Enter the tax classification
(C=C corporation, S=S corporation, P= partnership) ______________________________
Общество с ограниченной ответственностью. Введите налоговую классификацию (C = C-корпорация, S = S-корпорация, P=Партнерство)
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.
Примечание. Не выбирайте данный вариант для общества с ограниченной ответственностью с единственным владельцем. Выберите соответствующий федеральной налоговой классификации пункт выше.
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4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
Исключения (коды применяются только для определенных лиц, не являющихся физическими; см. инструкции на стр.3)
Exempt payee code (if any) _________________________
Код получателя выплат, освобожденного от обязательного удержания налога (при наличии)
Exemption from FATCA reporting
code (if any) _________________________
Код освобождения от предоставления сведений по закону FATCA (при наличии)
(Applies to accounts maintained outside the U.S.)
(Применяется по счетам, открытым за пределами США)
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5. Address (number, street, and apt. or suite no.)
Адрес (номер дома, улица, номер квартиры или офиса)
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Requester’s name and address (optional)
Наименование и адрес запрашивающего лица (не обязательно)
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6. City, state, and ZIP code
Город, штат и почтовый индекс
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7. List account number(s) here (optional)
Укажите здесь номер(а) счета(ов) (не обязательно)
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Part I
Часть I
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Taxpayer Identification Number (TIN)
Идентификационный номер налогоплательщика (ИНН)
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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 Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see «How to get a TIN» on page 3.
Укажите ИНН в соответствующем поле. Указанный ИНН во избежание дополнительного удержания должен принадлежать тому лицу, наименование которого указано в строке 1. Для физических лиц, как правило, указывается номер социального страхования (SSN). При этом иностранному физическому лицу-резиденту США, индивидуальному предпринимателю либо организации, не являющейся юридическим лицом, следует ознакомиться с частью I инструкции на стр. 3. Иным лицам следует указывать идентификационный номер работодателя (EIN). Если у вас нет номера, см. раздел «Как получить ИНН» на стр. 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.
Примечание. Если счет открыт нескольким лицам, инструкции по указанию номера следует смотреть на стр. 4.
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Social security number
Номер социального страхования
or
или
Employer identification number
Идентификационный номер работодателя
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Part II
Часть II
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Certification
Подтверждение
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Under penalties of perjury, I certify that:
Под угрозой привлечения к ответственности за предоставление недостоверной информации, я подтверждаю, что:
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
Номер, указанный в данной форме, является моим правильным идентификационным номером налогоплательщика (либо я ожидаю присвоения мне номера), и
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
Ко мне не применимо дополнительное удержание, поскольку: (а) я освобожден от дополнительного удержания, либо (b) я не был уведомлен Налоговым управлением США (IRS), что на меня распространяется дополнительное удержание в результате несообщения обо всех процентах или дивидендах, либо (с) Налоговое управление США уведомило меня, что на меня больше не распространяется дополнительное удержание, и
I am a U.S. citizen or other U.S. person (defined below), and
Я являюсь гражданином США или иным налоговым резидентом США (см. определение ниже), и
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Указанные в данной форме код(ы) FATCA (если таковые имеются), подтверждающие освобождение меня от предоставления отчетности по Закону FATCA, указаны верно.
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 on page 3.
Инструкции относительно подтверждения. Вы должны вычеркнуть пункт 2 выше, если Налоговое управление США уведомило вас о том, что в настоящее время на вас распространяется дополнительное удержание, поскольку вы нарушили обязательство по отражению в налоговой декларации всех своих доходов, полученных в виде процентов и дивидендов. Пункт 2 не применяется к сделкам с недвижимостью. Вы не обязаны подписывать подтверждение в отношении выплаченных процентов по ипотечным кредитам, приобретения или отказа от заложенного имущества, погашения долгов, взносов по индивидуальной пенсионной программе (IRA), и в целом, по любым выплатам за исключением процентов и дивидендов, однако вы должны указать свой правильный ИНН. См. инструкции на стр. 3.
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Sign Here
Подпишите здесь
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Signature of U.S. person ▶_________________________________________
Подпись
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Date ▶____________________
Дата
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General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding on page 2.
By signing the filled-out form, you:
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? on page 2 for further information.
Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.
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 301.7701-7).
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 W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.
In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States:
• 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 W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
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 W-9 that specifies the following five items:
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 U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.
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, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
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 Part II instructions on page 3 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 on page 3 and the separate Instructions for the Requester of Form W-9 for more information.
Also see Special rules for partnerships above.
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 on page 3 and the Instructions for the Requester of Form W-9 for more information.
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 W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.
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.
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 W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9.
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 W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.
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