Tax Withholding Certifications. Please check all boxes that apply, and sign and date below: Primary Applicant Co-Applicant U.S. Person: Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number; (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; (3) I am a U.S. person (including a U.S. resident alien); and (4) the Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions: You must check this box if you cannot certify to item (2) above, meaning that 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. Non-Resident Alien: I certify that I am not a U.S. citizen, U.S. resident alien, or other U.S. person for U.S. tax purposes, and I am submitting the applicable Form W-8BEN with this form to certify my foreign status and, if applicable, claim tax treaty benefits. By signing and dating this form, all applicants authorize the disclosure of their names, security position(s) and contact information, for purposes of receiving official communications concerning municipal securities, if relevant, to (a) an issuer of municipal securities; (b) a trustee for an issue of municipal securities in For Office Use Only: Acct.# Office: Financial Professional: Name for Filing: its capacity as trustee; (c) a state or federal tax authority; or (d) a custody agent for a stripped coupon municipal securities program in its capacity as custody agent. (For additional information, please see MSRB Rules G-8(a)(xi) and G-15(g)(iii)(A).) The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup and FATCA withholding. For IRS Form W-9 instructions please use the following link: xxxx://xxx.xxx.xxx/pub/irs-pub/irs-pdf/iw9.pdf. In consideration of the firm accepting an account for me/us, I/We (“I”) acknowledge that I have read, understand and agree to be bound by the Account Agreement terms as contained in the Customer Information Brochure, that I acknowledge receiving Form CRS and the Brokerage Services Disclosure Brochure. I further acknowledge that I have read and understand the pre-dispute arbitration clause contained in the Account Agreement section of the Customer Information Brochure and agree to resolve any disputes arising out of my account by arbitration. I certify that the foregoing client information is accurate and I am aware that the information is relied upon by the financial professional in servicing my account, and as such, I agree to notify the Firm in writing of any material changes, including those to the holder’s financial situation or investment objectives. Under penalties of perjury, I certify that the above information (including my social security number and the Designated Beneficiary's and Responsible Individual's social security number) is correct. I hereby agree to participate in the Xxxxxxxxx Education Savings Custodial Account offered by the Custodian. I acknowledge receipt of a copy of the plan document under which this Xxxxxxxxx Education Savings Custodial Account is established and a copy of the Disclosure Statement with respect to this Xxxxxxxxx Education Savings Custodial Account. In the event that this is a rollover contribution, the undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. If the Responsible Individual Information is completed above, I appoint the above-named person as Responsible Individual with the rights, powers, and responsibilities set out in the Xxxxxxxxx Education Savings Custodial Account Agreement. The Custodian of this account is Hilltop Securities Inc. Notice of revocation must be delivered or mailed to Hilltop Securities Inc. / 0000 Xxx Xxxxxx, Xxxxx 0000 / Xxxxxx, XX 00000 / Phone #: (000) 000-0000.
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Samples: www.eoption.com, www.eregal.com, www.infi.biz
Tax Withholding Certifications. Please check all boxes that apply, and sign and date belowin Section 11: Primary Applicant Co-Applicant U.S. Person: Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number; (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; (3) I am a U.S. person (including a U.S. resident alien); and (4) the Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions: You must check this box if you cannot certify to item (2) above, meaning that 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. Non-Resident Alien: I certify that I am not a U.S. citizen, U.S. resident alien, or other U.S. person for U.S. tax purposes, and I am submitting the applicable Form W-8BEN with this form to certify my foreign status and, if applicable, claim tax treaty benefits. For Office Use Only: Acct. # Office#: Reg. Rep#: Name for Filing United States Financial Institution (USFI): By selecting this box you indicate that you are an USFI. You certify that you are exempt from backup withholding and certify that you are FATCA exempt. You also certify that the exempt payee code provided below is correct. Please note that exempt payee code is required. Please see xxxx://xxx.xxx.xxx/pub/irs-pdf/fw9.pdf for information on exempt payee codes. Exempt payee code By signing and dating this form, all applicants authorize the disclosure of their names, security position(s) and contact information, for purposes of receiving official communications concerning municipal securities, if relevant, to (a) an issuer of municipal securities; (b) a trustee for an issue of municipal securities in For Office Use Only: Acct.# Office: Financial Professional: Name for Filing: its capacity as trustee; (c) a state or federal tax authority; or (d) a custody agent for a stripped coupon municipal securities securit ies program in its capacity as custody agent. (For additional information, please see MSRB Rules G-8(a)(xi) and G-15(g)(iii)(A).. For Joint Tenants with Rights of Survivorship (JTWROS) accounts, on the death of one party to a joint account, all sums in the account on the date of the death vest in and belong to the surviving party as his or her separate property and estate. The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup and FATCA withholding. For IRS Form W-9 instructions please use the following link: xxxx://xxx.xxx.xxx/pub/irs-pub/irs-pdf/iw9.pdfxxxx://xxx.xxx.xxx/pub/irs-pdf/iw9.pdf. In consideration of the firm HTS accepting an account for me/us, I/We (“I”) acknowledge that I have read, understand and agree to be bound by the HTS Cash Account Agreement terms as contained in the Customer Information Brochure, that I acknowledge receiving Form CRS and at the Brokerage Services Disclosure Brochuretime the account was opened. I further acknowledge that I have read and understand the pre-dispute arbitration clause contained in the Cash Account Agreement section of the Customer Information Brochure and agree to resolve any disputes arising out of my account by arbitration. I certify that the foregoing client information is accurate and I am aware that the information is relied upon by the financial professional advisor in servicing my account, and as such, I agree to notify the Firm in writing of any material changes, including those to the holder’s financial situation or investment objectives. Under penalties of perjury, I certify that the above information (including my social security number and the Designated Beneficiary's and Responsible Individual's social security number) is correct. I hereby agree to participate in the Xxxxxxxxx Education Savings Custodial Account offered by the Custodian. I acknowledge receipt of a copy of the plan document under which this Xxxxxxxxx Education Savings Custodial Account is established and a copy of the Disclosure Statement with respect to this Xxxxxxxxx Education Savings Custodial Account. In the event that this is a rollover contribution, the undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. If the Responsible Individual Information is completed above, I appoint the above-named person as Responsible Individual with the rights, powers, and responsibilities set out in the Xxxxxxxxx Education Savings Custodial Account Agreement. The Custodian of this account is Hilltop Securities Inc. Notice of revocation must be delivered or mailed to Hilltop Securities Inc. / 0000 Xxx Xxxxxx, Xxxxx 0000 / Xxxxxx, XX 00000 / Phone #: (000) 000-0000.
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Samples: Brochure Customer Agreement and Information Brochure
Tax Withholding Certifications. Please check all boxes that apply, and sign and date below: Primary Applicant Co-Applicant U.S. Person: Under penalties of perjury, I certify that: (1) the number shown on this form is my correct taxpayer identification number; (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; (3) I am a U.S. person (including a U.S. resident alien); and (4) the Foreign Account Tax Compliance Act (FATCA) code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification Instructions: You must check this box if you cannot certify to item (2) above, meaning that 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. Non-Resident Alien: I certify that I am not a U.S. citizen, U.S. resident alien, or other U.S. person for U.S. tax purposes, and I am submitting the applicable Form W-8BEN with this form to certify my foreign status and, if applicable, claim tax treaty benefits. By signing and dating this form, all applicants authorize the disclosure of their names, security position(s) and contact information, for purposes of receiving official communications concerning municipal securities, if relevant, to (a) an issuer of municipal securities; (b) a trustee for an issue of municipal securities in For Office Use Only: Acct.# Office: Financial Professional: Name for Filing: its capacity as trustee; (c) a state or federal tax authority; or (d) a custody agent for a stripped coupon municipal securities program in its capacity as custody agent. (For additional information, please see MSRB Rules G-8(a)(xi) and G-15(g)(iii)(A).) The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup and FATCA withholding. For IRS Form W-9 instructions please use the following link: xxxx://xxx.xxx.xxx/pub/irs-pub/irs-pdf/iw9.pdf. In consideration of the firm accepting an account for me/us, I/We (“I”) acknowledge that I have read, understand and agree to be bound by the Account Agreement terms as contained in the Customer Information Brochure, that I acknowledge receiving Form CRS and the Brokerage Services Disclosure Brochure. I further acknowledge that I have read and understand the pre-dispute arbitration clause contained in the Account Agreement section of the Customer Information Brochure and agree to resolve any disputes arising out of my account by arbitration. I certify that the foregoing client information is accurate and I am aware that the information is relied upon by the financial professional in servicing my account, and as such, I agree to notify the Firm in writing of any material changes, including those to the holder’s financial situation or investment objectives. Under penalties of perjury, I certify that the above information (including my social security number and the Designated Beneficiary's and Responsible Individual's social security number) is correct. I hereby agree to participate in the Xxxxxxxxx Education Savings Custodial Account offered by the Custodian. I acknowledge receipt of a copy of the plan document under which this Xxxxxxxxx Education Savings Custodial Account is established and a copy of the Disclosure Statement with respect to this Xxxxxxxxx Education Savings Custodial Account. In the event that this is a rollover contribution, the undersigned hereby irrevocably elects to treat this contribution as a rollover contribution. If the Responsible Individual Information is completed above, I appoint the above-named person as Responsible Individual with the rights, powers, and responsibilities set out in the Xxxxxxxxx Education Savings Custodial Account Agreement. The Custodian of this account is Hilltop Securities Inc. Notice of revocation must be delivered or mailed to Hilltop Securities Inc. / 0000 Xxx Xxxxxx000 X. Xxxxxxx Street, Xxxxx 0000 Suite 3400 / XxxxxxDallas, XX 00000 TX 75201 / Phone #: (000) 000-0000.
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Samples: Customer Information Brochure