REQUESTS FOR ASSISTANCE OR ADDITIONAL COPIES. Requests for assistance or additional copies of this Letter of Transmittal may be obtained from Xxxxx Xxxxx, at Xxxx Xxxxx Xxx & Xxxxxxxx, counsel to Parent, at (000) 000-0000. SUBSTITUTEFORM W-9 Department of the TreasuryInternal Revenue Service Payer’s Request for Taxpayer Identification Number Part 1 - Please provide your taxpayer identification number in the box at right. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information on what number to enter. Social Security Number or Employer Identification Number __________________________ CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION. □ Individual/sole proprietor □ Trust/estate □ C corporation □ S corporation □ Limited liability company □ Partnership□ Other __________________________________ CHECK APPROPRIATE BOX(ES) IF APPLICABLE. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information. □ Exempt payee□ Awaiting Taxpayer Identification Number PLEASE fill in your name and address. Name Address Part 2 - certification Under penalties of perjury, I certify that: 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 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 I am a U.S. citizen or other U.S. person, including a U.S. resident alien. You must cross out item 2 above if you have been notified by the IRS that you are subject to backup withholding because you have failed to report all interest and dividends on your tax return and 2(c) does not apply to you. The Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, include the applicable definition of “U.S. person.” The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature __________________________________ Date _____________ Exhibit G-12 CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part 2 of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), 28 percent of all payments made to me pursuant to this Offer to Purchase shall be retained until I provide a Tax Identification Number to the payer and that, if I do not provide my Taxpayer Identification number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding. Signature __________________________________ Date _____________ Use Internal Revenue Service Form W-9 (available online at xxx.xxx.xxx) or the Substitute Form W-9 included in this Letter of Transmittal to (1) provide your correct taxpayer identification number to the payer, (2) certify that the taxpayer information number you are giving is correct (or you are waiting for a number to be issued), (3) certify that you are not subject to backup withholding, or (4) claim exemption from backup withholding. GUIDELINES FOR DETERMINING WHETHER YOU ARE A U.S. PERSON-For U.S. federal tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident alien, (b) a partnership, corporation, company, or association created or organized in the U.S. or under the laws of the U.S., (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Treasury Regulations section 301.7701-7). Resident aliens may be subject to special rules. Such stockholders should consult a tax advisor to determine their taxpayer identification number and the applicability of certain treaty benefits to them. If you are not a U.S. person, do not complete Internal Revenue Service Form W-9 or the Substitute Form W-9. Instead, use the appropriate Internal Revenue Service Form W-8 (a copy of which may be obtained from the Depositary or online at xxx.xxx.xxx). Internal Revenue Service Form W-8BEN is the version of the Internal Revenue Service Form W-8 that is most likely to apply to non-U.S. stockholders claiming an exemption from backup withholding, but all non-U.S. stockholders should consult a tax advisor to determine which Internal Revenue Service Form W-8 is appropriate. GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION NUMBER TO GIVE THE PAYER IN PART 1-Social Security numbers have nine digits separated by two hyphens: i.e., Exhibit G-13 000-00-0000. Employer identification numbers have nine digits separated by only one hyphen: i.e., 00-0000000. The table below will help determine the number to give the payer. 1. An individual’s account The individual 2. Joint account of two or more individuals The actual owner of the account or, if combined funds, the first individual on the account(1) 3. Custodian account of a minor (Uniform Gift to Minors Act) The minor(2) 4. a. The usual revocable savings trust account (grantor is also trustee) The grantor-trustee(1)
Appears in 1 contract
Samples: Agreement and Plan of Merger (Merit Medical Systems Inc)
REQUESTS FOR ASSISTANCE OR ADDITIONAL COPIES. Requests Questions and requests for assistance or and requests for additional copies of the Prospectus or this Letter of Transmittal may be directed to the Exchange Agent at the address specified in the Prospectus and herein. Holders may also contact their broker, dealer, commercial bank, trust company or other nominee for assistance concerning the Exchange Offer. (DO NOT WRITE IN SPACE BELOW) =============================================================================== Certificate Surrendered Original Notes Tendered Original Notes Accepted ------------------------- --------------------------- ------------------------- ------------------------- --------------------------- ------------------------- ------------------------- --------------------------- ------------------------- ------------------------- --------------------------- ------------------------- ------------------------- --------------------------- ------------------------- Delivery Prepared by Checked by Date -------------- -------------- ------------ =============================================================================== IMPORTANT TAX INFORMATION Under federal income tax laws, a Holder whose tendered Original Notes are accepted for payment is required to provide the Exchange Agent (as payer) with such Holdxx'x xorrect TIN on Substitute Form W-9 below or otherwise establish a basis for exemption from backup withholding. If such Holder is an individual, the TIN is his social security number. If the Exchange Agent is not provided with the correct TIN, a $50 penalty may be imposed by the Internal Revenue Service, and payments made with respect to Original Notes purchased pursuant to the Exchange Offer may be subject to backup withholding. Certain Holders (including, among others, all corporations and certain foreign persons) are not subject to these backup withholding and reporting requirements. Exempt Holders should indicate their exempt status on Substitute Form W-9. A foreign person may qualify as an exempt recipient by submitting to the Exchange Agent a properly completed Internal Revenue Service Form W-8, signed under penalties of perjury, attesting to that Holdxx'x xxempt status. A Form W-8 can be obtained from Xxxxx Xxxxx, at Xxxx Xxxxx Xxx & Xxxxxxxx, counsel to Parent, at (000) 000-0000. SUBSTITUTEFORM W-9 Department of the TreasuryInternal Revenue Service Payer’s Request for Taxpayer Identification Number Part 1 - Please provide your taxpayer identification number in the box at rightExchange Agent. See the enclosed "Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9" for additional instructions. If backup withholding applies, belowthe Exchange Agent is required to withhold 31% of any payments made to the Holder or other payee. Backup withholding is not an additional federal income tax. Rather, for more information on what number to enter. Social Security Number or Employer Identification Number __________________________ CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION. □ Individual/sole proprietor □ Trust/estate □ C corporation □ S corporation □ Limited the federal income tax liability company □ Partnership□ Other __________________________________ CHECK APPROPRIATE BOX(ES) IF APPLICABLE. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information. □ Exempt payee□ Awaiting Taxpayer Identification Number PLEASE fill in your name and address. Name Address Part 2 - certification Under penalties of perjury, I certify that: 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 I am not persons subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified will be reduced by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result amount 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 I am a U.S. citizen or other U.S. person, including a U.S. resident alien. You must cross out item 2 above if you have been notified by the IRS that you are subject to backup withholding because you have failed to report all interest and dividends on your tax return and 2(c) does not apply to you. The Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, include the applicable definition of “U.S. person.” The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature __________________________________ Date _____________ Exhibit G-12 CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part 2 of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), 28 percent of all payments made to me pursuant to this Offer to Purchase shall be retained until I provide a Tax Identification Number to the payer and that, if I do not provide my Taxpayer Identification number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding. Signature __________________________________ Date _____________ Use Internal Revenue Service Form W-9 (available online at xxx.xxx.xxx) or the Substitute Form W-9 included in this Letter of Transmittal to (1) provide your correct taxpayer identification number to the payer, (2) certify that the taxpayer information number you are giving is correct (or you are waiting for a number to be issued), (3) certify that you are not subject to backup withholding, or (4) claim exemption from backup withholding. GUIDELINES FOR DETERMINING WHETHER YOU ARE A U.S. PERSON-For U.S. federal tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident alien, (b) a partnership, corporation, company, or association created or organized in the U.S. or under the laws of the U.S., (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Treasury Regulations section 301.7701-7). Resident aliens may be subject to special rules. Such stockholders should consult a tax advisor to determine their taxpayer identification number and the applicability of certain treaty benefits to themwithheld. If you are not withholding results in an overpayment of taxes, a U.S. person, do not complete Internal Revenue Service Form W-9 or the Substitute Form W-9. Instead, use the appropriate Internal Revenue Service Form W-8 (a copy of which refund may be obtained from the Depositary or online at xxx.xxx.xxx). Internal Revenue Service Form W-8BEN is the version of the Internal Revenue Service Form W-8 that is most likely to apply to non-U.S. stockholders claiming an exemption from backup withholding, but all non-U.S. stockholders should consult a tax advisor to determine which Internal Revenue Service Form W-8 is appropriate. GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION NUMBER TO GIVE THE PAYER IN PART 1-Social Security numbers have nine digits separated by two hyphens: i.e., Exhibit G-13 000-00-0000. Employer identification numbers have nine digits separated by only one hyphen: i.e., 00-0000000. The table below will help determine the number to give the payerService.
1. An individual’s account The individual
2. Joint account of two or more individuals The actual owner of the account or, if combined funds, the first individual on the account(1)
3. Custodian account of a minor (Uniform Gift to Minors Act) The minor(2) 4. a. The usual revocable savings trust account (grantor is also trustee) The grantor-trustee(1)
Appears in 1 contract
Samples: Letter of Transmittal (Nortek Inc)
REQUESTS FOR ASSISTANCE OR ADDITIONAL COPIES. Requests Questions relating to the procedure for assistance or tendering, as well as requests for additional copies of the Prospectus or this Letter of Transmittal Letter, may be obtained from Xxxxx Xxxxxdirected to the Exchange Agent. IMPORTANT: THIS LETTER (OR FACSIMILE THEREOF), at Xxxx Xxxxx Xxx & XxxxxxxxTOGETHER WITH CERTIFICATES OR CONFIRMATION OF BOOK-ENTRY TRANSFER AND ALL OTHER REQUIRED DOCUMENTS, counsel to ParentMUST BE RECEIVED BY THE EXCHANGE AGENT, at (000) 000-0000OR THE NOTICE OF GUARANTEED DELIVERY MUST BE RECEIVED BY THE EXCHANGE AGENT, ON OR PRIOR TO 5:00 P.M., NEW YORK CITY TIME, ON THE EXPIRATION DATE. SUBSTITUTEFORM - 10 - 11 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION SUBSTITUTE FORM W-9 Department of the TreasuryInternal Revenue Service Payer’s Request for Taxpayer Identification Number Part 1 - DEPARTMENT OF THE TREASURY, INTERNAL REVENUE SERVICE Please provide your social security number or other taxpayer identification number in the box at right. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information on what number to enter. Social Security Number or Employer Identification Number __________________________ CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION. □ Individual/sole proprietor □ Trust/estate □ C corporation □ S corporation □ Limited liability company □ Partnership□ Other __________________________________ CHECK APPROPRIATE BOX(ES) IF APPLICABLE. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information. □ Exempt payee□ Awaiting Taxpayer Identification Number PLEASE fill in your name and address. Name Address Part 2 - certification Under penalties of perjury, I certify that: 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 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 I am a U.S. citizen or other U.S. person, including a U.S. resident alien. You must cross out item 2 above if you have been notified by the IRS that you are subject to backup withholding because you have failed to report all interest and dividends on your tax return and 2(c) does not apply to you. The Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, include the applicable definition of “U.S. person.” The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature __________________________________ Date _____________ Exhibit G-12 CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part 2 of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), 28 percent of all payments made to me pursuant to this Offer to Purchase shall be retained until I provide a Tax Identification Number to the payer and that, if I do not provide my Taxpayer Identification number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding. Signature __________________________________ Date _____________ Use Internal Revenue Service Form W-9 (available online at xxx.xxx.xxx) or the Substitute Form W-9 included in this Letter of Transmittal to (1) provide your correct taxpayer identification number to the payer, (2) certify that the taxpayer information number you are giving is correct (or you are waiting for a number to be issued), (3) certify therein that you are not subject to backup withholding. Failure to complete and return this form may result in backup withholding of 31% of any payments made to you. For assistance, or (4) claim exemption from backup withholding. GUIDELINES FOR DETERMINING WHETHER YOU ARE A U.S. PERSON-For U.S. federal tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident alien, (b) a partnership, corporation, company, or association created or organized in see the U.S. or under the laws of the U.S., (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Treasury Regulations section 301.7701-7). Resident aliens may be subject to special rules. Such stockholders should consult a tax advisor to determine their taxpayer identification number and the applicability of certain treaty benefits to them. If you are not a U.S. person, do not complete Internal Revenue Service Form W-9 or the enclosed Instructions for Substitute Form W-9. Instead================================================================================ Name(s) as shown above of registered owners of 11% Senior Secured Notes (if joint ownership, use list first and circle the appropriate Internal Revenue Service Form W-8 (a copy name of which may be obtained from the Depositary person or online at xxx.xxx.xxxentity whose taxpayer identification number you enter in Part I below). Internal Revenue Service Form W-8BEN is the version of the Internal Revenue Service Form W-8 that is most likely to apply to non-U.S. stockholders claiming an exemption from backup withholding-------------------------------------------------------------------------------- Business Name (sole proprietors, but all non-U.S. stockholders should consult a tax advisor to determine which Internal Revenue Service Form W-8 is appropriate. GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION NUMBER TO GIVE THE PAYER IN PART 1-Social Security numbers have nine digits separated by two hyphens: i.e., Exhibit G-13 000-00-0000. Employer identification numbers have nine digits separated by only one hyphen: i.e., 00-0000000. The table below will help determine the number to give the payer.
1. An individual’s account The individual
2. Joint account of two or more individuals The actual owner of the account or, if combined funds, the first individual on the account(1)
3. Custodian account of a minor (Uniform Gift to Minors Actsee enclosed Instructions for Substitute FORM W-9) The minor(2) 4. a. The usual revocable savings trust account (grantor is also trustee) The grantor-trustee(1)-------------------------------------------------------------------------------- Address:
Appears in 1 contract
REQUESTS FOR ASSISTANCE OR ADDITIONAL COPIES. Requests Questions and requests for assistance or and requests for additional copies of the Prospectus or this Letter of Transmittal may be obtained from Xxxxx Xxxxx, directed to the Exchange Agent at Xxxx Xxxxx Xxx & Xxxxxxxx, counsel to Parent, at (000) 000-0000. SUBSTITUTEFORM W-9 Department of the TreasuryInternal Revenue Service Payer’s Request for Taxpayer Identification Number Part 1 - Please provide your taxpayer identification number address specified in the box at rightProspectus and herein. See Holders may also contact their broker, dealer, commercial bank, trust company or other nominee for assistance concerning the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information on what number to enterExchange Offer. Social Security Number or Employer Identification Number ___________(DO NOT WRITE IN SPACE BELOW) ================================================================================ Certificate Surrendered Original Notes Tendered Original Notes Accepted -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Delivery Prepared By_______________ CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION. □ Individual/sole proprietor □ Trust/estate □ C corporation □ S corporation □ Limited liability company □ Partnership□ Other ___________________Checked By_______________ CHECK APPROPRIATE BOX(ES) IF APPLICABLE. See the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information. □ Exempt payee□ Awaiting Taxpayer Identification Number PLEASE fill in your name and address. Name Address Part 2 - certification Under penalties of perjury, I certify that: 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 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 I am a U.S. citizen or other U.S. person, including a U.S. resident alien. You must cross out item 2 above if you have been notified by the IRS that you are subject to backup withholding because you have failed to report all interest and dividends on your tax return and 2(c) does not apply to you. The Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, include the applicable definition of “U.S. person.” The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature ____________________Date______________ Date _____________ Exhibit G-12 CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER I certify under penalties of perjury that ================================================================================ IMPORTANT TAX INFORMATION Under federal income tax laws, a taxpayer identification number has not been issued Holder whose tendered Original Notes are accepted for payment is required to me, and either provide the Exchange Agent (aas payer) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part 2 of the with such Holder's correct TIN on Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), 28 percent of all payments made to me pursuant to this Offer to Purchase shall be retained until I provide below or otherwise establish a Tax Identification Number to the payer and that, if I do not provide my Taxpayer Identification number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding. Signature __________________________________ Date _____________ Use Internal Revenue Service Form W-9 (available online at xxx.xxx.xxx) or the Substitute Form W-9 included in this Letter of Transmittal to (1) provide your correct taxpayer identification number to the payer, (2) certify that the taxpayer information number you are giving is correct (or you are waiting basis for a number to be issued), (3) certify that you are not subject to backup withholding, or (4) claim exemption from backup withholding. GUIDELINES FOR DETERMINING WHETHER YOU ARE A U.S. PERSON-For U.S. federal tax purposesIf such Holder is an individual, you are considered the TIN is his social security number. If the Exchange Agent is not provided with the correct TIN, a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident alien$50 penalty may be imposed by the Internal Revenue Service, (b) a partnership, corporation, company, or association created or organized in and payments made with respect to Original Notes purchased pursuant to the U.S. or under the laws of the U.S., (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Treasury Regulations section 301.7701-7). Resident aliens Exchange Offer may be subject to special rulesbackup withholding. Such stockholders should consult a tax advisor to determine their taxpayer identification number Certain Holders (including, among others, all corporations and the applicability of certain treaty benefits to them. If you foreign persons) are not subject to these backup withholding and reporting requirements. Exempt Holders should indicate their exempt status on Substitute Form W-9. A foreign person may qualify as an exempt recipient by submitting to the Exchange Agent a U.S. person, do not complete properly completed Internal Revenue Service Form W-9 or W-8, signed under penalties of perjury, attesting to that Holder's exempt status. A Form W-8 can be obtained from the Exchange Agent. See the enclosed "Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9" for additional instructions. InsteadIf backup withholding applies, use the appropriate Internal Revenue Service Form W-8 (Exchange Agent is required to withhold 20% of any payments made to the Holder or other payee. Backup withholding is not an additional federal income tax. Rather, the federal income tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If withholding results in an overpayment of taxes, a copy of which refund may be obtained from the Depositary or online at xxx.xxx.xxx). Internal Revenue Service Service. PURPOSE OF SUBSTITUTE FORM W-9 To prevent backup withholding on payments made with respect to the Exchange Offer, the Holder is required to provide the Exchange Agent with either: (i) the Holder's correct TIN by completing the form below, certifying that the TIN provided on Substitute Form W-8BEN W-9 is correct (or that such Holder is awaiting a TIN) and that (A) the version of Holder has not been notified by the Internal Revenue Service Form W-8 that the Holder is most likely subject to apply backup withholding as a result of failure to non-U.S. stockholders claiming an exemption from backup withholding, but report all non-U.S. stockholders should consult a tax advisor to determine which interest or dividends or (B) the Internal Revenue Service Form W-8 has notified the Holder that the Holder is appropriateno longer subject to backup withholding; or (ii) an adequate basis for exemption. GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION WHAT NUMBER TO GIVE THE PAYER IN PART 1-Social Security numbers have nine digits separated by two hyphens: i.e., Exhibit G-13 000-00-0000. Employer identification numbers have nine digits separated by only one hyphen: i.e., 00-0000000. EXCHANGE AGENT The table below will help determine the number Holder is required to give the payer.
1. An individual’s account The individual
2. Joint account of two Exchange Agent the TIN (e.g., social security number or more individuals The actual owner employer identification number) of the account orregistered Holder of the Original Notes. If the Original Notes are held in more than one name or are held not in the name of the actual owner, if combined funds, consult the first individual enclosed "Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9" for additional guidance on which number to report. The Exchange Agent for the account(1)
3. Custodian account of a minor (Uniform Gift to Minors Act) The minor(2) 4. a. The usual revocable savings trust account (grantor is also trustee) The grantor-trustee(1)Exchange Offer is: FLEET NATIONAL BANK
Appears in 1 contract
REQUESTS FOR ASSISTANCE OR ADDITIONAL COPIES. Requests for assistance or for additional copies of the prospectus, the prospectus supplement, this Letter of Transmittal may be obtained from Xxxxx XxxxxTransmittal, at Xxxx Xxxxx Xxx & Xxxxxxxx, counsel to Parent, at (000) 000-0000. SUBSTITUTEFORM W-9 Department the Notice of the TreasuryInternal Revenue Service Payer’s Request for Taxpayer Identification Number Part 1 - Please provide your taxpayer identification number in the box at right. See Guaranteed Delivery and the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9W-9 may be directed to the Exchange Agent at its address set forth on the cover of this Letter of Transmittal. IMPORTANT — THIS LETTER OF TRANSMITTAL, belowTOGETHER WITH CERTIFICATES FOR TENDERED OLD NOTES AND ALL OTHER REQUIRED DOCUMENTS, for more information on what number to enterWITH ANY REQUIRED SIGNATURE GUARANTEES AND ALL OTHER REQUIRED DOCUMENTS MUST BE RECEIVED BY THE EXCHANGE AGENT PRIOR TO THE EXPIRATION TIME. SUBSTITUTE Form W-9 Part 1 – PLEASE PROVIDE YOUR TIN IN THE BOX AT RIGHT AND CERTIFY BY SIGNING AND DATING BELOW. Social Security Number or Employer Identification Number __________________________ CHECK APPROPRIATE BOX FOR FEDERAL TAX CLASSIFICATION. □ Individual/sole proprietor □ Trust/estate □ C corporation □ S corporation □ Limited liability company □ Partnership□ Other __________________________________ CHECK APPROPRIATE BOX(ESNumber(s) IF APPLICABLE. See OR Department of the Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, for more information. □ Exempt payee□ Awaiting Taxpayer Identification Number PLEASE fill in your name and address. Name Address Treasury Internal Revenue Service Part 2 - certification – Certification – Under penalties Penalties of perjuryPerjury, I certify that: Part 3 -
(1) The number shown on this form is my correct Taxpayer Identification Number taxpayer identification number (or I am waiting for a number to be issued to for me), and o Check if exempt from backup withholding
(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, including a U.S. resident alienPerson. Payer’s Request for Taxpayer Identification Number (“TIN”) and Certifications Certification Instructions – You must cross out item 2 (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 underreporting interest and or dividends on your tax return and 2(c) does not apply to youreturn. The Guidelines for Certification of Taxpayer Identification Number on Substitute Form W-9, below, include the applicable definition of “U.S. person.” The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature __________________________________ Date _____________ Exhibit G-12 CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER Name Address SIGNATURE DATE I certify under penalties of perjury that a taxpayer identification number has not been bee issued to me, and either (a1) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office office or (b2) I intend to mail or deliver an application in the near future. I understand thatthat if I do not provide a taxpayer identification number by the time of payment, notwithstanding the information I provided in Part 2 of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), 28 percent of federal income tax on all reportable cash payments made to me pursuant to this Offer to Purchase shall thereafter will be retained withheld until I provide a Tax Identification Number taxpayer identification number to the payer and that, if I do not provide my Taxpayer Identification taxpayer identification number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding. Signature __________________________________ Date _____________ Use Internal Revenue Service Form W-9 THE EXCHANGE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE AT 5:00 P.M., NEW YORK CITY TIME, ON , 2004 UNLESS WE EXTEND IT (available online at xxx.xxx.xxx) THE “EXPIRATION TIME”). Delivery of this instrument to an address other than as set forth above or transmission of instructions to a facsimile number other than the Substitute Form W-9 included one listed above will not constitute a valid delivery. The instructions set forth in this notice of guaranteed delivery and in the Letter of Transmittal should be read carefully before this notice of guaranteed delivery and the Letter of Transmittal are completed. As set forth in the prospectus dated , 2004 and the accompanying prospectus supplement dated , 2004 of the Bolivian Republic of Venezuela (“Venezuela”), and in the accompanying Letter of Transmittal and instructions thereto (the “Letter of Transmittal”), this form or one substantially equivalent hereto must be used to accept Venezuela’s offer (1the “Exchange Offer”) provide your correct taxpayer identification number to exchange new 10.75% Notes due 2013 (“New Notes”) that have been registered under the Securities Act of 1933, as amended (the “Securities Act”), for its unregistered 10.75% Notes due 2013 (“Old Notes”), if the Letter of Transmittal or any other documents required thereby cannot be delivered to the payerExchange Agent, or Old Notes cannot be delivered or if the procedures for book-entry transfer cannot be completed prior to the Expiration Time. This form may be delivered by an “Eligible Institution” (2as described in the prospectus supplement) certify by mail or hand delivery or transmitted, via facsimile, to the Exchange Agent as set forth above. Capitalized terms used but not defined herein shall have the meaning given to them in the prospectus, or the prospectus supplement, as applicable. THIS FORM IS NOT TO BE USED TO GUARANTEE SIGNATURES. IF A SIGNATURE ON THE LETTER OF TRANSMITTAL IS REQUIRED TO BE GUARANTEED BY AN “ELIGIBLE INSTITUTION” UNDER THE INSTRUCTIONS THERETO, SUCH SIGNATURE GUARANTEE MUST APPEAR IN THE APPLICABLE SPACE PROVIDED IN THE SIGNATURE BOX ON THE LETTER OF TRANSMITTAL. Ladies and Gentlemen: The undersigned hereby tenders to Venezuela, upon the terms and subject to the conditions set forth in the prospectus, the accompanying prospectus supplement and the related Letter of Transmittal, receipt of which is hereby acknowledged, the principal amount of Old Notes set forth below pursuant to the guaranteed delivery procedures set forth in the prospectus supplement and in Instruction 2 of the Letter of Transmittal. By so tendering, the undersigned does hereby make, at and as of the date hereof, the representations and warranties of tendering holding of Old Notes set forth in the Letter of Transmittal. The undersigned understands that tenders of Old Notes may be withdrawn if the taxpayer information number you are giving Exchange Agent receives at one of its addresses specified on the cover of this Notice of Guaranteed Delivery, not later than the Expiration Time, a facsimile transmission or letter setting forth the name of the holder, the aggregate principal amount of Old Notes the holder delivered for exchange, the certificate number(s) (if any) of the Old Notes and a statement that such holder is correct (withdrawing his election to have such Old Notes or you are waiting for a number any portion thereof exchanged, in accordance with the procedures set forth in the prospectus supplement. All authority herein conferred or agreed to be issued), (3) certify that you are not subject to backup withholding, conferred by this Notice of Guaranteed Delivery shall survive the death or (4) claim exemption from backup withholding. GUIDELINES FOR DETERMINING WHETHER YOU ARE A U.S. PERSON-For U.S. federal tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S. citizen or U.S. resident alien, (b) a partnership, corporation, company, or association created or organized in the U.S. or under the laws incapacity of the U.S., (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Treasury Regulations section 301.7701-7). Resident aliens may be subject to special rules. Such stockholders should consult a tax advisor to determine their taxpayer identification number undersigned and the applicability of certain treaty benefits to them. If you are not a U.S. person, do not complete Internal Revenue Service Form W-9 or the Substitute Form W-9. Instead, use the appropriate Internal Revenue Service Form W-8 (a copy of which may be obtained from the Depositary or online at xxx.xxx.xxx). Internal Revenue Service Form W-8BEN is the version every obligation of the Internal Revenue Service Form W-8 that is most likely to apply to non-U.S. stockholders claiming an exemption from backup withholdingundersigned under this Notice of Guaranteed Delivery shall be binding upon the heirs, but all non-U.S. stockholders should consult a tax advisor to determine which Internal Revenue Service Form W-8 is appropriate. GUIDELINES FOR DETERMINING THE PROPER IDENTIFICATION NUMBER TO GIVE THE PAYER IN PART 1-Social Security numbers have nine digits separated by two hyphens: i.e.personal representatives, Exhibit G-13 000-00-0000. Employer identification numbers have nine digits separated by only one hyphen: i.e.executors, 00-0000000administrators, successors, assigns, trustees in bankruptcy and other legal representatives of the undersigned. The table below will help determine undersigned hereby tenders the number to give the payer.
1. An individual’s account The individual
2. Joint account of two or more individuals The actual owner of the account or, if combined funds, the first individual on the account(1)
3. Custodian account of a minor (Uniform Gift to Minors Act) The minor(2) 4. a. The usual revocable savings trust account (grantor is also trustee) The grantor-trustee(1)Old Notes listed below:
Appears in 1 contract
Samples: Exchange Agent Agreement (Bolivarian Republic of Venezuela)