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 mortgage interest paid, acquisition or abandonm ent 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. If you a re an exempt payee (if you are unsure, ask us for a complete set of IRS instructions), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p withholding. BY SIGNING THIS AGREEMENT, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, LLC OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT.
Appears in 6 contracts
Sources: Account Application and Agreement, Account Application and Agreement, Account Application and Agreement
Certification instructions. You must cross out Item 2 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 of under-reporting interest and or dividends on your tax return. For mortgage interest paidHowever, acquisition or abandonm ent of secured property, cancellation of debt, contributions if after being notified by the IRS that you are subject to an individual retirement arrangement (IRA), and generally, payments other than interest and dividendsbackup withholding, you are not required to sign received another notification from the certification, but you must provide your correct TIN. If you a re an exempt payee (if IRS that you are unsureno longer subject to backup withholding, ask us for a complete set of IRS instructionsdo not cross out item (2), enter your exempt payee code (if any) here: . _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on from FATCA reporting code (if any) here: _________________________________________________________ The IRS does not require your consent SIGNATURE_______________________________ DATE ____________ , 1998 _______________________________________________________________________________ NOTE: FAILURE TO COMPLETE THIS FORM MAY RESULT IN BACKUP WITHHOLDING OF 31% OF ANY PAYMENTS MADE TO YOU. PLEASE REVIEW ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to any provision of this document other than the certifications you are required to avoid backu p withhold and pay to IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. If you give the requester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. BY SIGNING THIS AGREEMENTPayments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARINGor (2) IRS notifies the requester that you furnished an incorrect TIN, LLC OR LOANED OUT TO OTHERSor (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENTThis applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENTFor other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee.
Appears in 2 contracts
Sources: Letter of Transmittal (Laralev Inc), Letter of Transmittal (Laralev Inc)
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 abandonm ent 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. If you a re are an exempt payee (if you are unsure, ask us for a complete set of IRS instructionsplease consult your tax professional), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructionsplease consult your tax professional), enter your exempti on exemption from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p withholding. BY SIGNING THIS AGREEMENT, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, AXOS CLEARING LLC OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT, WHICH GOVERNS DISPUTES YOU MAY HAVE WITH AXOS CLEARING LLC. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT. SHOULD YOU HAVE A DISPUTE WITH YOUR ADVISOR, PLEASE REFER TO THE TERMS AND CONDITIONS OF YOUR AGREEMENT WITH YOUR ADVISOR TO DETERMINE HOW IT REQUIRES RESOLUTION OF ANY SUCH DISPUTES.
Appears in 1 contract
Sources: Account Application and Agreement
Certification instructions. You must cross out Item 2 item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of under-reporting interest or dividends on your tax return. However, if after being notified by the IRS that you have failed are subject to backup withholding, you received another notification from the IRS that you are no longer subject to backup withholding, do not cross out item (2). ------------------------------------------------------------------------------------------------------------------------- SIGNATURE DATE , 1998 -------------------------------------------------------------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE THIS FORM MAY RESULT IN BACKUP WITHHOLDING OF 31% OF ANY PAYMENTS MADE TO YOU. PLEASE REVIEW ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. 8 GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to you are required to withhold and pay to IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. If you give the requester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For mortgage interest paidother payments, acquisition you are subject to backup withholding only if (1) or abandonm ent of secured property(2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, cancellation of debt, contributions to an individual retirement arrangement (IRA)below, and generally, payments other than Exempt Payees and Payments under Specific Instructions below if you are an exempt payee. PAYEES AND PAYMENTS EXEMPT FROM BACKUP WITHHOLDING. -- The following is a list of payees exempt from backup withholding and for which no information reporting is required. For interest and dividends, you all listed payees are not required to sign the certificationexempt except item (9). For broker transactions, but you must provide your correct TIN. If you a re an exempt payee payees listed in (if you are unsure, ask us for a complete set of IRS instructions1) through (13), enter your and a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt payee code from backup withholding only if made to payees described in items (if any1) here: _______________________ If you through (7), except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting. Only payees described in items (2) through (6) are exempt from FATCA reporting (if you are unsurebackup withholding for barter exchange transactions, ask us for a complete set of IRS instructions)patronage dividends, enter your exempti on from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p withholding. BY SIGNING THIS AGREEMENT, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, LLC OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENTand payments by certain fishing boat operators.
Appears in 1 contract
Sources: Letter of Transmittal (Hudson Respiratory Care Inc)
Certification instructions. You must cross out Item 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 mortgage interest paid, acquisition or abandonm ent 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. If you a re an exempt payee (if you are unsure, ask us for a complete set of IRS instructions), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on from FATCA reporting code (if any) here: _____________________________________ .The IRS Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backu p backup withholding. Non-individual Account (including participant-directed ▇▇▇▇▇ plans and retirement accounts) ACCEPTANCE OF INVESTMENTS ON BEHALF OF ERISA PLANS OR INDIVIDUAL RETIREMENT ACCOUNTS IS IN NO RESPECT A REPRESENTATION BY SIGNING THIS AGREEMENTTHE FUND, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARINGITS INVESTMENT ADVISER, LLC ITS DISTRIBUTOR OR LOANED OUT TO OTHERS. PLEASE NOTE THE APPLICABLE FINANCIAL INTERMEDIARY THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING INVESTMENT MEETS ALL RELEVANT LEGAL REQUIREMENTS WITH RESPECT TO INVESTMENTS BY ANY PARTICULAR PLAN, OR THAT THIS ACCOUNT APPLICATION AND AGREEMENTINVESTMENT IS APPROPRIATE FOR ANY PARTICULAR PLAN. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT.The undersigned hereby certifies and warrants that: (a) if acting on behalf of a corporation, partnership, trust or otherwise, he/she has full power and authority from or on behalf of the entity named below and its shareholders, partners, beneficiaries, or members (i) to complete, execute, and deliver this application form on their behalf; and (ii) if acting on behalf of themselves or on behalf of a corporation, partnership, trust or otherwise, to make and affirm and re-affirm (as the case may be) all of the representations, warranties, certifications, agreements, acknowledgments and undertakings set forth in this application form and in any prior application form submitted by such undersigned or on their behalf connection with a subscription to purchase shares, which representations, warranties, certificates, agreements, acknowledgments, elections and undertakings shall, for the avoidance of doubt, apply to their total investment in the Fund, including the additional shares subscribed for hereby; and (b) if acting on behalf of a corporation, partnership, trust or otherwise the investment in the Fund is authorized under applicable law and the governing documents of the entity, and has been affirmatively authorized by the governing board or body, if any, of the entity, and is legally permissible.
Appears in 1 contract
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 mortgage interest paid, acquisition or abandonm ent 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. If you a re are an exempt payee (if you are unsure, ask us for a complete set of IRS instructions), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on exemption from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p backup withholding. BY SIGNING THIS AGREEMENT, AGREEMENT YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, LLC OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT.
Appears in 1 contract
Sources: Account Application and Agreement
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 mortgage interest paid, acquisition or abandonm ent 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. If you a re are an exempt payee (if you are unsure, ask us for a complete set of IRS instructions), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on exemption from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p backup withholding. BY SIGNING THIS AGREEMENT, AGREEMENT YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, LLC PERSHING ADVISOR SOLUTIONS OR PERSHING OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN SECTION III, PARAGRAPHS Y AND Z ON PAGE 6 OF THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT. By signing this agreement, you affirm that you are of full legal age in the state of jurisdiction in which you reside and have the capacity to enter into this agreement. You further affirm that you have read, understood and agree to the Terms and Conditions attached to this Account Application and Agreement. Account Holder/Trustee/Corporate Officer Signature Print Name Date — — Signature X Joint Account Holder/Trustee Signature (if applicable) Print Name Date — — Signature X Terms and Conditions of Your Cash and ▇▇▇▇▇▇ Accounts Overview This document outlines the terms and conditions that apply to the Account Application and Agreement among you (collectively, the “Agreement”), Pershing LLC (“Pershing”), and Pershing Advisor Solutions LLC (“Pershing Advisor Solutions”).
Appears in 1 contract
Sources: Account Application and Agreement
Certification instructions. You must cross out Item 2 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 of under-reporting interest and or dividends on your tax return. For mortgage interest paidHowever, acquisition or abandonm ent of secured property, cancellation of debt, contributions if after being notified by the IRS that you are subject to an individual retirement arrangement (IRA), and generally, payments other than interest and dividendsbackup withholding, you are not required to sign received another notification from the certification, but you must provide your correct TIN. If you a re an exempt payee (if IRS that you are unsureno longer subject to backup withholding, ask us for a complete set of IRS instructionsdo not cross out item (2), enter your exempt payee code (if any) here: . ----------------------------------------------------------------------------------------------------------------------------- SIGNATURE_______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent DATE________________________, 1998 ----------------------------------------------------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE THIS FORM MAY RESULT IN BACKUP WITHHOLDING OF 31% OF ANY PAYMENTS MADE TO YOU. PLEASE REVIEW ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. 8 GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to any provision of this document other than the certifications you are required to avoid backu p withhold and pay to IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. If you give the requester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. BY SIGNING THIS AGREEMENTPayments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARINGor (2) IRS notifies the requester that you furnished an incorrect TIN, LLC OR LOANED OUT TO OTHERSor (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. PLEASE NOTE THAT THIS ACCOUNT APPLICATION This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee. PAYEES AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENTPAYMENTS EXEMPT FROM BACKUP WITHHOLDING. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT-- The following is a list of payees exempt from backup withholding and for which no information reporting is required. For interest and dividends, all listed payees are exempt except item (9). For broker transactions, payees listed in (1) through (13), and a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (1) through (7), except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting. Only payees described in items (2) through (6) are exempt from backup withholding for barter exchange transactions, patronage dividends, and payments by certain fishing boat operators.
Appears in 1 contract
Sources: Letter of Transmittal (Hudson Respiratory Care Inc)
Certification instructions. You must cross out check the box in 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 mortgage interest paid, acquisition or abandonm ent 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. If you a re are an exempt payee (if you are unsure, ask us for a complete set of IRS instructions), enter your exempt payee code (if any) here: _______________________ If you are exempt from FATCA reporting (if you are unsure, ask us for a complete set of IRS instructions), enter your exempti on exemption from FATCA reporting code (if any) here: _____________________________________ The IRS does not require your consent to any provision of this document other than the certifications required to avoid backu p backup withholding. BY SIGNING THIS AGREEMENT, AGREEMENT YOU ACKNOWLEDGE THAT SECURITIES NOT FULLY PAID FOR MAY BE LOANED TO COR CLEARING, LLC OR LOANED OUT TO OTHERS. PLEASE NOTE THAT THIS ACCOUNT APPLICATION AND AGREEMENT CONTAINS A PREDISPUTE ARBITRATION AGREEMENT IN THE TERMS AND CONDITIONS ACCOMPANYING THIS ACCOUNT APPLICATION AND AGREEMENT. YOU ACKNOWLEDGE RECEIVING A COPY OF THIS ACCOUNT APPLICATION AND AGREEMENT.
Appears in 1 contract
Sources: Account Application and Agreement