Number Certification. Social Security or Tax I.D. No. Social Security or Tax I.D. No. I declare that the number shown in this Subscription Agreement is my correct taxpayer identification number and/or social security number (or I am waiting for a number to be issued to me), that I have read and understood the foregoing documents, and that I desire to purchase the shares herein under the terms set forth in this Subscription Agreement. Signature ________________________________ Signature ________________________________ Date ____________________________________ Date ____________________________________ TYPE OF OWNERSHIP (Check one) [ ] INDIVIDUAL OWNERSHIP (One signature required) [ ] COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) [ ] JOINT TENANTS WITH RIGHT OF SURVIVORSHIP (both or all parties must sign) [ ] CORPORATION [ ] PARTNERSHIP (Please include a copy of the Statement of Partnership Agreement authorizing signature) [ ] TRUST (Please include a copy of the Trust Agreement) The undersigned has executed this Subscription Agreement this _____ day of ____________________. _________________________________________________ ________________________________________________ Subscriber #1 Signature Subscriber #2 Signature _________________________________________________ ________________________________________________ Subscriber #1 Print/Type Name and Title Subscriber #2 Print/Type Name and Title Telephone ________________________________________ Telephone _______________________________________ Email address _____________________________________ Email address ____________________________________ _________________________________________________ ________________________________________________ Sxxxxx Xxxxxxx Xxxxxx Xxxxxxx _________________________________________________ ________________________________________________ City/St/Zip City/St/Zip SUBSCRIPTION ACCEPTED: K-Chain Group Inc. By: Authorized Officer Dated:
Number Certification. Social Security or Tax I.D. No. Social Security or Tax I.D. No. I declare that the number shown in this Subscription Agreement is my correct taxpayer identification number and/or social security number (or I am waiting for a number to be issued to me), that I have read and understood the foregoing documents, and that I desire to purchase the shares herein under the terms set forth in this Subscription Agreement. Signature ________________ Signature ___________________ Date: _________________ Date ___________________ TYPE OF OWNERSHIP (Check one) [ ] INDIVIDUAL OWNERSHIP [ ] COMMUNITY PROPERTY (One signature required) (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) [ ] JOINT TENANTS WITH RIGHT OF SURVIVORSHIP [X] CORPORATION (both or all parties must sign) (please include certified Corporate Resolution authorizing signature) [ ] PARTNERSHIP [ ] TRUST (Please include a copy of the Statement of Partnership Agreement authorizing signature) (please include a copy of the Trust Agreement) Xie Hong [Please print above the exact name(s) in which the Convertible is to be held]
Number Certification. Check the first box below pursuant to its instructions, unless you are a foreign investor or you are investing as a U.S. grantor trust. Note: If there is a change in circumstances which makes any of the information provided by you in your certification below incorrect, then you are under a continuing obligation so long as you own shares in the Company to notify the Company and furnish the Company a new certificate within thirty (30) days of the change. ‘ Under penalties of perjury, I certify that:
Number Certification. The Internal Revenue Service (IRS) does not require your consent to any provision of this document other than the following certification required to avoid backup withholding. Under penalties of perjury, I certify that (1) the Taxpayer Identification Number shown herein is correct (2) I am not subject to backup withholding either because I am exempt, have not been notified that I am subject to backup withholding, and (3) I am a U.S. person (including U.S. resident alien. Certification Instructions. You must cross out item 2 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 security 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. Siouxland Ethanol LLC (20-0000000) Siouxland Ethanol LLC, A Limited Liability Company By /s/ Txx Xxxxx By /s/ Sxxxxxx Xxxxxxxx Txx Xxxxx, President Sxxxxxx Xxxxxxxx, Member App #: 44098; CIF #: 138039; Note #: 151 050LM Legal Doc. Date: October 14, 2005
Number Certification. Under U.S. federal income tax law, you must report and certify your correct taxpayer identification number and further certify that you are not subject to backup withholding due to notified underreporting on Internal Revenue Service Form W-9 or a suitable substitute. This Letter of Transmittal includes a Substitute Form W-9, which you should complete and return with this Letter of Transmittal. Failure to provide the information requested on Substitute Form W-9 could result in certain penalties as well as backup withholding on payments due to you. Certain holders are not subject to backup withholding. For further information concerning backup withholding and instructions for completing Substitute Form W-9, see the attached “Important Tax Information”.
Number Certification. Social Security or Tax I.D. No. Social Security or Tax I.D. No.
Number Certification. Under U.S. federal income tax law, you must report and certify your correct taxpayer identification number and further certify that you are not subject to backup withholding due to notified underreporting of income on Internal Revenue Service (“IRS”) Form W-9 or a suitable substitute. This Letter of Transmittal includes a Form W-9, which you should complete and return with this Letter of Transmittal. Failure to provide the information requested on the Form W-9 could result in certain penalties as well as backup withholding on payments due to you. If you have been notified by the IRS that you are subject to backup withholding and the IRS has not subsequently notified you that backup withholding has terminated, you must strike out the language in clause (2) on the Form W-9. Certain holders are not subject to backup withholding. For further information concerning backup withholding and instructions for completing the Form W-9, see the “Important Tax Information” section.
Number Certification. Social Security or Tax I.D. No. Social Security or Tax I.D. No. I declare that the number shown in this Subscription Agreement is my correct taxpayer identification number and/or social security number (or I am waiting for a number to be issued to me), that I have read and understood the foregoing documents, and that I desire to purchase the shares herein under the terms set forth in this Subscription Agreement. Signature Signature Date Date TYPE OF OWNERSHIP (Check one) [ ] INDIVIDUAL OWNERSHIP (One signature required) [ ] COMMUNITY PROPERTY (one signature required if interest held in one name, i.e., managing spouse; two signatures required if interest held in both names) [ ] JOINT TENANTS WITH RIGHT OF SURVIVORSHIP (both or all parties must sign) [ ] CORPORATION [ ] PARTNERSHIP (Please include a copy of the Statement of Partnership Agreement authorizing signature) [ ] TRUST (Please include a copy of the Trust Agreement) The undersigned has executed this Subscription Agreement this _____ day of ____________________. Subscriber #1 Signature Subscriber #2 Signature Subscriber #1 Print/Type Name and Title Subscriber #2 Print/Type Name and Title Telephone Telephone Email address Email address Sxxxxx Xxxxxxx Xxxxxx Xxxxxxx City/St/Zip City/St/Zip SUBSCRIPTION ACCEPTED: TraqIQ, Inc. By: Authorized Officer Dated:
Number Certification. 4 5 Under penalties of perjury, the Subscriber certifies that the information provided in this section is true, correct, and complete and that
Number Certification. Contractors are certifying with the signature applied to this response the following,
