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FORMW-9

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FORMW-9

     Route To: W-9 FormRequest for Taxpayer (Rev. December 2000) Identification Number and Certification Payroll Department Department of the Treasury (Adapted for the University of Chicago use only) Independent Contractor Section Internal Revenue Service

    ?Are you a University of Chicago Student NO Yes, Provide Student ID# ____________________________________________ ?Have you ever been employed by the University? NO Yes, Provide Dates ________________________________________________

    If you are an individual claiming resident alien status for tax purposes, complete the Date of entry into the US _______ /_______ /_______ Visa Classification upon entry into the US ________ following:

    Name (If a joint account or changed your name, see Specific Instructions on page 2)

    Business name, if different from above. (See Specific Instructions on page2)

    Check appropriate box: Individual/Sole proprietor Partnership Not-for profit organization Corporation Rental or Leasing Agent State or Government Agency Other ? _______________________________ Address (number, street, and apt. or suite no.) Requestor’s name and address (optional) The University of Chicago, Office of the Comptroller Please Print of type 1225 E. 60thCity, State, and ZIP Code Street Chicago, IL 60637

    List account number(s) here (optional) Taxpayer Identification Number (TIN) Social Security Number Enter your TIN in the appropriate box. For individuals, this is ? ? ? ? ? ? ? ? your social security number (SSN). However, if you are a resident alien, sole proprietor or disregarded entity, see Part I instructions on page 2. For other entities, it is your or For Payees Exempt from Backup Withholding employer identification number (EIN). If you do not have a (See the instructions on page 2.) number, see How to get a TIN on page 2. Employer Identification Number ? ? ? ? ? ? ? ? Note: If the account is more than one name, see the chart on page 2 guidelines on whose number to enter. ? Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am verifying 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. person (including a U.S. resident alien).

     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.

     Sign Signature of Here U.S person ? Date ? Purpose of form. A person who is required to file What is backup withholding? Persons making certain 5. You do not certify to the requester that you are not subject to an information return with the IRS must get your correct payments to you must withhold and pay to the IRS 31% of such backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only.) taxpayer identification number (TIN) to report, for payments under certain conditions. This is called “backup example, income paid to you, real estate transactions, withholding” Payments that may be subject to backup mortgage interest you paid, acquisition or withholding include interest, dividends, broker and barter Certain payees and payments are exempt from backup abandonment of secure property, cancellation of debt, exchange transactions, rents, royalties, nonemployee pay, and withholding. See the Part II instructions and the separate or contributions you made to an IRA. certain payments from fishing boat operators. Real estate Instructions for the Requester of form W-9. transactions are not subject to backup withholding. Use form W-9, only if you are a U.S. person Penalties (including a resident alien), to give your correct TIN to If you give the requester your correct TIN, make the proper the person requesting it (the requester) and, when certifications, and report all your taxable interest and dividends Failure to furnish TIN. If you fail to furnish your correct TIN to a applicable, to: on your tax return, payments you receive will not be subject to requester, you are subject to a penalty of $50 for each such failure backup withholding. Payments you receive will be subject to unless your failure is due to reasonable cause and not to willful 1. Certify the TIN you are giving is correct (or you backup withholding if: neglect. are waiting for a number to be issued.) 2. Certify you are not subject to backup 1. You do not furnish your TIN to the requester, or Civil penalty for false information with respect to withholding withholding, or 2. You do not certify your TIN when required (see the Part III If you make a false statement with no reasonable basis that 3. Claim exemption from backup withholding if you instructions on page 2 for details) or results in no backup withholding; you are subject to a $500 are an exempt payee. 3. The IRS tells the requester that you furnished an incorrect penalty. TIN, or If you are for a foreign person, use the Form W-8BEN, 4. The IRS tells you that you are subject to backup Criminal penalty for falsifying information. Willfully falsifying Certification of Foreign Status of Beneficial Owner for withholding because you did not report all your interest and certifications or affirmations may subject you to criminal penalties US Tax Withholding. See Pub. 515, Withholding of Tax dividends on your tax return (for reportable interest and including fines and/or imprisonment. on Nonresident Aliens and Foreign Corporations. dividends only), or Misuse of TINs. If the requester discloses or uses TINS in Note: If a requester gives you a form other than Form violation of Federal law, the requester may be subject to civil and W-9 to request your Tin, you must use the requester’s criminal penalties. form if it is a substantially similar to this Form W-9.

    UC rev. 5/7/10

     W-9 Form(Rev. 12-2000)

Form W-9 (Rev. 12-2000) Page 2 Note: Writing “Applied For” means that you have already applied You must provide your TIN whether or not you are required to file a tax Specific Instructions return. Payers must generally withhold 31% of taxable interest, for a TIN or that you intend to apply for one soon. dividend, and certain other payments to a payee who does not give a Name. If you are an individual you must generally enter Tin to a payer. Certain penalties may also apply. the name shown on your social security card. However, if Part II---For payees Exempt From you have changed your last name, for instance, due to Backup Withholding marriage, without informing the Social Security Administration of the name change, enter your first name, What Name and Number To Give Individuals (including sole proprietors) are not exempt from the last name shown on your social security card, and you backup withholding Corporations are exempt from backup new last name. the Requester withholding for certain payments, such as interest and dividends. For more information on exempt payees, see the separate If the account is in join names, list first and then circle Instructions for the Requester of form W-9. For this type of account the name of the person or entity whose number you enter Give name and SSN of: in Part I of the form. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. Enter your correct TIN in Part I, write “Exempt” in Sole Proprietor. Enter your individual name as Part II, and sign and date the form. shown on your social security card on the “Name” line. 1. Individual You may enter your business, trade, or “doing business as 2. Two or more individuals (joint account) (DBA) name on the “Business name” line. If you are a nonresident alien or a foreign entity not subject to backup withholding give the requester a completed Form W-8 3. Custodian account of a minor (Uniform Gift to Minors Act) (certification of foreign status). Limited liability company (LLC. If you are a single-4. a. The usual revocable savings trust (grantor is also trustee) member LLC (including a foreign LLC with a domestic b. So called trust account that is not a legal or valid trust under owner) that is disregarded as an entity separate from its state law. owner under Treasury regulations section 301.7701-3, Part III---Certification 5. Sole proprietorship enter the owner’s name on the “Name” line. Enter the LLC’s name on the “Business name” line. To establish to the withholding agent that you are a U.S. person, The Individual or resident alien, sign Form W-9. You may be requested to sign The actual owner of the account or, if combined funds, the first Caution: A disregarded domestic entity that has a foreign by the withholding agent even if items 1, 3, and 5 below indicate individual on the accountowner must use the appropriate Form W-8. otherwise. 1 2 The minorOther entities. Enter your business name as shown For a joint account, only the person whose TIN is shown in Part I on required Federal tax documents on the “Name” line. should sign (when required). This name should match the name shown on the charter 1The grantor-trustee or other legal document creating the entity. You may enter 1. Interest, dividend, and barter exchange accounts opened any business, trade, or DBA name on the “Business before 1984 and broker accounts considered active during name” line. 1983. You must give your correct TIN, but you do not have to sign the certification. The actual owner1 Part ITaxpayer Identification Number (TIN) 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered Enter your TIN in the appropriate box. 3 inactive during 1983. You must sign the certification or The ownerbackup withholding will apply. If you are subject to backup If you are a resident alien and you do not have and are withholding and you are merely providing your correct TIN to not eligible to get an SSN, your TIN is your IRS individual For this type of account: the requester, you must cross out item 2 in the certification taxpayer identification number (ITIN). Enter it in the social Give name and EIN of: before signing the form. security number box. If you do not have an ITIN, see How to get a TIN below. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. If you are a sole proprietor and you have an EIN, 6. Sole proprietorship you may enter either your SSN or EIN. However, the IRS 7. A valid trust, estate, or pension trust 4. Other payments. You must give your correct TIN, but you do prefers that you use your SSN. 8. Corporate not have to sign the certification unless you have been notified 9. Association, club, religious, charitable, education, or other tax-that you have previously given an incorrect TIN. “Other If you are an LLC that is disregarded as an entity exempt organization payments” include payments made in the course of the separate from it owner (see Limited liability company 10. Partnership requester’s trade or business for rents, royalties, goods (other (LLC) above), and are owned by an individual, enter your 11. A broker or registered nominee than bills for merchandise), medical and health care services SSN (or “pre-LLC” EIN. If desired). If the owner of a 12. Account with the Department of Agriculture in the name of a public (including payments to corporations), payments to a disregarded LLC is a corporation, partnership, etc., enter entity (such as a state or local government, school, district, or nonemployee for services, payments to certain fishing boat the owner’s EIN. prison) that receives agricultural program payments. crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). Note: See the chart on this page for further clarification of name and TIN combinations. The owner5. Mortgage interest paid by you, acquisition or 3 abandonment of secured property, cancellation of debt, 4How to get a TIN. If you do not have a TIN, apply for one Legal entiry qualified state tuition program payments, IRA or MSA immediately. To apply for an SSN, get Form SS-5, contributions or distributions, and pension distributions. Application for a Social Security Card, from you local The corporation You must give your correct TIN, but you do not have to sign Social Security Administration office. Get Form W-7, The organization the certification. Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN for Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can get Forms W-7 and SS-4 from the IRS by calling The partnership 1-800-TAX-FORM (1-800-829-3676) or from the IRS’s The broker or nominee Internet Web Site at www.irs.gov. Privacy Act Notice The public entity If you do have a TIN, write “Applied For” in the space Section 6109 of the Internal Revenue Code requires you to give for the TIN, sign and date the form, and give it to the your correct TIN to persons who must file information returns with requester. For interest and dividend payments, and the IRS to report interest, dividends, and certain other income paid certain payments made with respect to readily tradable to you, mortgage interest you paid, the acquisition or abandonment instruments, generally you will have 60 days to get a TIN of secured property, cancellation of debt, or contributions you made and give it to the requester before you are subject to to an IRA or MSA. The IRS uses the numbers for identification backup withholding. The 60-day rule does not apply to purposes and to help verify the accuracy of y our tax return. The other types of payments. You will be subject to backup Department of Justice for civil and criminal litigation, and to cities, withholding on all such payments until you provide you states, and the District of Columbia to carry out their tax laws. TIN to the requester.

1 List first and circle the name of the person whose number you

UC rev. 5/7/10 W-9 Form(Rev. 12-2000)

Form W-9 (Rev. 12-2000) Page 2

furnish,. If only one person on a joint account has an SSN, that person’s number must be furnished. 2 Circle the minor’s name and furnish the minor’s SSN. 3 You must show your individual name, but you may also enter your business or “DBA” name. You may use either your SSN or EIN (if you have one). 4 List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

UC rev. 5/7/10 W-9 Form(Rev. 12-2000)

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