EFTA Document EFTA01392985

IV. TAX ELECTI0WDECLARATI0N OF TAX STATUS This Account Agreement is designed 10, use by both U.S. Persons and Non-U.S. Persons. Please check the box next to the applicade nem below. Ct ent certifies that Client will notify DBSI in writing Immediately it the representation certified to below ceases to be two and correct. 1.O U.S. Citizen or U.S. Resident Alien Form W9 quent for Texpayer Identikcation Number and Certification Substitute Th6g, Vle tin t" NYVA.Inr I ri X 1-1-1. Part Narne (as shown on your income tax return) Business name/disregarded entity route rl different from above Check appropriate box for federal tax classification (required) O Individual/sole proprietor O C Corporation CI S Corporation I Pennerithge O Trustleffete O Limited liability company. Enter the tax classification (CeC corporation 5.5 corporation, Priparmership) Other k li El Exempt payee Address (number. See. end apt or suite no.) City. State. and ZIP code ,Taxpayer Identification Number (T1N) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name' line to avoid backup withholding. For Individuals. this Is your social security number ISSN). For other entitles, h is your employer identification number (EINI. Pan II Sign Here Sous' Secwty Number Employer Idemillostron Number Certification Under penalties of perjury. I certify that: 1. The number shown on this form is my coifed taxpayer identilicaticn number (or I am waiting for a number to ho issued to me). and 2. am not subject to backup withholding because: (a) I am exempt from backup withholding, or WI I have not been notified by the Internal Revenue Service (IRS) that I am subject t0 bedroll withholding as a mull of e 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. crtnen or other U.S. Denton (defined In the instructions). Certification Instructions. You nnisactoss • em 2 above If you have been Te-IRS that you are currently subject to backup withholding because you have failed to report ell interest an dividends on your Signature of u.S. person ► 2.0 Non.U.S Person Dale I am not a U.S. person (including a U.S. resident alien). i am submitting the applicable Form W-8 with this form to certify my foreign status and, if applicable. claim tax treaty benefits For example: Client Is not a U.S. person 'including a U.S. resident alien). Client agrees to provide DBSI with this application the applicable Internal Revenue Service (IRS) Form W-8 to cent fy the client's foreign status. W-8 forms and instructions are avaliable on the IRS weblike at www.Irs.gov. 13-AWM-0196 6 012145 032813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0098325 CONFIDENTIAL SDNY_GM_00244509 EFTA01392985