Exhibit 99.1
NORTEK,
INC.
LETTER OF TRANSMITTAL
OFFER TO EXCHANGE
$500,000,000 AGGREGATE PRINCIPAL AMOUNT OF ITS 8.5% SENIOR
NOTES DUE
APRIL 15, 2021, WHICH HAVE BEEN REGISTERED UNDER THE SECURITIES
ACT OF 1933,
AS AMENDED, FOR ANY AND ALL OF ITS OUTSTANDING 8.5% SENIOR
NOTES
DUE APRIL 15, 2021
THE EXCHANGE OFFER AND WITHDRAWAL RIGHTS WILL EXPIRE AT
5:00 P.M.,
NEW YORK CITY TIME,
ON ,
2011 (THE EXPIRATION DATE) UNLESS
EXTENDED.
The
Exchange Agent is:
U.S. BANK
NATIONAL ASSOCIATION
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By Regular Mail or Overnight Courier:
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U.S. BANK NATIONAL ASSOCIATION
Corporate Trust Services
U.S. Bank West Side Flats Operations Center
60 Livingston Ave.
St. Paul, MN 55107
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By Registered & Certified Mail:
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In Person by Hand Only:
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For Information or
Confirmation by
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U.S. BANK NATIONAL
ASSOCIATION
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U.S. BANK NATIONAL
ASSOCIATION
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Telephone:
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Corporate Trust Services
U.S. Bank West Side Flats Operations
Center
60 Livingston Ave.
St. Paul, MN 55107
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Corporate Trust Services
60 Livingston Avenue
1st Floor Bond Drop Window
St. Paul, MN 55107
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(800) 934-6802
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Delivery of this Letter of Transmittal to an address other than
as set forth above will not constitute a valid delivery.
The undersigned acknowledges receipt of the Prospectus
dated ,
2011 (the Prospectus) of Nortek, Inc. (the
Issuer), and this Letter of Transmittal (the
Letter of Transmittal), which together describe the
Issuers offer (the Exchange Offer) to exchange
its 8.5% Senior Notes due April 15, 2021 which have
been registered under the Securities Act of 1933, as amended
(the Securities Act) (the Exchange
Notes) for its outstanding 8.5% Senior Notes due
April 15, 2021 (the Outstanding Notes and,
together with the Exchange Notes, the Notes) from
the holders thereof.
The terms of the Exchange Notes are identical in all material
respects (including principal amount, interest rate and
maturity) to the terms of the Outstanding Notes for which they
may be exchanged pursuant to the Exchange Offer, except that the
Exchange Notes are freely transferable by holders thereof
(except as provided herein or in the Prospectus).
1
The Issuer is not making the Exchange Offer to holders of the
Outstanding Notes in any jurisdiction in which the Exchange
Offer or the acceptance of the Exchange Offer would not be in
compliance with the securities or Blue Sky laws of such
jurisdiction. The Issuer also will not accept surrenders for
exchange from holders of the Outstanding Notes in any
jurisdiction in which the Exchange Offer or the acceptance of
the Exchange Offer would not be in compliance with the
securities or Blue Sky laws of such jurisdiction.
Capitalized terms used but not defined herein shall have the
same meaning given them in the Prospectus.
YOUR BANK OR BROKER CAN ASSIST YOU IN COMPLETING THIS FORM. THE
INSTRUCTIONS INCLUDED WITH THIS LETTER OF TRANSMITTAL MUST BE
FOLLOWED. QUESTIONS AND REQUESTS FOR ASSISTANCE OR FOR
ADDITIONAL COPIES OF THE PROSPECTUS AND THIS LETTER OF
TRANSMITTAL MAY BE DIRECTED TO THE EXCHANGE AGENT.
The undersigned has checked the appropriate boxes below and
signed this Letter of Transmittal to indicate the action the
undersigned desires to take with respect to the Exchange Offer.
PLEASE
READ THE ENTIRE
LETTER OF TRANSMITTAL AND THE PROSPECTUS
CAREFULLY BEFORE CHECKING ANY BOX BELOW.
List below the Outstanding Notes to which this Letter of
Transmittal relates. If the space provided below is inadequate,
the certificate numbers and aggregate principal amounts should
be listed on a separate signed schedule affixed hereto.
DESCRIPTION
OF OUTSTANDING NOTES TENDERED HEREWITH
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Aggregate Principal
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Name(s) and Address(es) of Registered Holder(s)
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Certificate
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Amount Represented by
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Principal Amount
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(Please fill in)
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Number(s)*
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Outstanding Notes*
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Tendered**
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Total:
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* Need not be completed by book-entry holders.
** Unless otherwise indicated, the holder will be deemed to
have tendered the full aggregate principal amount represented by
such Outstanding Notes. See instruction 2.
Holders of Outstanding Notes whose Outstanding Notes are not
immediately available or who cannot deliver all other required
documents to the Exchange Agent on or prior to the Expiration
Date or who cannot complete the procedures for book-entry
transfer on a timely basis, must tender their Outstanding Notes
according to the guaranteed delivery procedures set forth in the
Prospectus.
Unless the context otherwise requires, the term
holder for purposes of this Letter of Transmittal
means any person in whose name Outstanding Notes are registered
or any other person who has obtained a properly completed bond
power from the registered holder or any person whose Outstanding
Notes are held of record by The Depository Trust Company
(DTC).
o CHECK
HERE IF TENDERED OUTSTANDING NOTES ARE BEING DELIVERED
PURSUANT TO A NOTICE OF GUARANTEED DELIVERY AND COMPLETE THE
FOLLOWING:
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Name of Registered Holder(s):
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Name of Eligible Guarantor Institution that Guaranteed Delivery:
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Date of Execution of Notice of Guaranteed Delivery:
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If Delivered by Book-Entry Transfer:
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Name of Tendering Institution:
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Transaction Code Number:
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o |
CHECK HERE IF EXCHANGE NOTES ARE TO BE DELIVERED TO
PERSON OTHER THAN PERSON SIGNING THIS LETTER OF TRANSMITTAL:
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o |
CHECK HERE IF EXCHANGE NOTES ARE TO BE DELIVERED TO
ADDRESS DIFFERENT FROM THAT LISTED ELSEWHERE IN THIS LETTER OF
TRANSMITTAL:
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o |
CHECK HERE IF YOU ARE A BROKER-DEALER WHO ACQUIRED
OUTSTANDING NOTES FOR YOUR OWN ACCOUNT AS A RESULT OF MARKET
MAKING OR OTHER TRADING ACTIVITIES AND WISH TO RECEIVE 10
ADDITIONAL COPIES OF THE PROSPECTUS AND 10 COPIES OF ANY
AMENDMENTS OR SUPPLEMENTS THERETO.
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If the undersigned is not a broker-dealer, the undersigned
represents that it is not engaged in, and does not intend to
engage in, a distribution of Exchange Notes. If the undersigned
is a broker-dealer that will receive Exchange Notes for its own
account in exchange for Outstanding Notes that were acquired as
a result of market-making activities or other trading
activities, it acknowledges that it will deliver a prospectus in
connection with any resale of such Exchange Notes; however, by
so acknowledging and by delivering a prospectus, the undersigned
will not be deemed to admit that it is an
underwriter within the meaning of the Securities
Act. A broker-dealer may not participate in the Exchange Offer
with respect to Outstanding Notes acquired other than as a
result of market-making activities or other trading activities.
Any holder who is an affiliate of the Issuer or who
has an arrangement or understanding with respect to the
distribution of the Exchange Notes to be acquired pursuant to
the Exchange Offer, or any broker-dealer who purchased
Outstanding Notes from the Issuer to resell pursuant to
Rule 144A under the Securities Act or any other available
exemption under the Securities Act must comply with the
registration and prospectus delivery requirements under the
Securities Act.
PLEASE
READ THE ACCOMPANYING INSTRUCTIONS CAREFULLY
Ladies and Gentlemen:
Upon the terms and subject to the conditions of the Exchange
Offer, the undersigned hereby tenders to the Issuer the
principal amount of the Outstanding Notes indicated above.
Subject to, and effective upon, the acceptance for exchange of
all or any portion of the Outstanding Notes tendered herewith in
accordance with the terms and conditions of the Exchange Offer
(including, if the Exchange Offer is extended or amended, the
terms and conditions of any such extension or amendment), the
undersigned hereby exchanges, assigns and transfers to, or upon
the order of, the Issuer all right, title and interest in and to
such Outstanding Notes as are being tendered herewith. The
undersigned hereby irrevocably constitutes and appoints the
Exchange Agent as its true and lawful agent and attorney-in-fact
of the undersigned (with full knowledge that the Exchange Agent
also acts as the agent of the Issuer, in connection with the
Exchange Offer) to cause the Outstanding Notes to be assigned,
transferred and exchanged.
The undersigned represents and warrants that it has full power
and authority to tender, exchange, assign and transfer the
Outstanding Notes and to acquire Exchange Notes issuable upon
the exchange of such tendered Outstanding Notes, and that, when
the same are accepted for exchange, the Issuer will acquire good
and unencumbered title to the tendered Outstanding Notes, free
and clear of all liens, restrictions, charges and encumbrances
and not subject to any adverse claim. The undersigned also
warrants that it will, upon request, execute and deliver any
additional documents deemed by the Exchange Agent or the Issuer
to be necessary or desirable to complete the exchange,
assignment and transfer of the tendered Outstanding Notes or
transfer ownership of such Outstanding Notes on the account
books maintained by the book-entry transfer facility. The
undersigned further agrees that acceptance of any and all
validly tendered Outstanding Notes by the Issuer and the
issuance of Exchange Notes in exchange therefor shall constitute
performance in full by the Issuer of its obligations under the
Registration Rights Agreement dated as of April 26, 2011,
among Nortek, Inc., the Guarantors signatory thereto and UBS
Securities LLC (the Registration Rights Agreement),
and that the Issuer shall have no further obligations or
liabilities thereunder. The undersigned will comply with its
obligations under the Registration Rights Agreement. The
undersigned has read and agrees to all terms of the Exchange
Offer.
The undersigned understands that tenders of Outstanding Notes
pursuant to any one of the procedures described in the
Prospectus and in the instructions attached hereto will, upon
the Issuers acceptance for exchange of such tendered
Outstanding Notes, constitute a binding agreement between the
undersigned and the Issuer upon the terms and subject to the
conditions of the Exchange Offer. The undersigned recognizes
that, under circumstances set forth in the Prospectus, the
Issuer may not be required to accept for exchange any of the
Outstanding Notes.
By tendering shares of Outstanding Notes and executing this
Letter of Transmittal, the undersigned represents that Exchange
Notes acquired in the Exchange Offer will be obtained in the
ordinary course of business of the undersigned, that the
undersigned has no arrangement or understanding with any person
to participate in a distribution (within the meaning of the
Securities Act) of such Exchange Notes, that the undersigned is
not an affiliate of the Issuer within the meaning of
Rule 405 under the Securities Act and that if the
undersigned or the person receiving such Exchange Notes, whether
or not such person is the undersigned, is not a broker-dealer,
the undersigned represents that it is not engaged in, and does
not intend to engage in, a distribution of Exchange Notes. If
the undersigned or the person receiving such Exchange Notes,
whether or not such person is the undersigned, is a
broker-dealer that will receive Exchange Notes for its own
account in exchange for Outstanding Notes that were acquired as
a result of market-making activities or other trading
activities, it acknowledges that it will deliver a prospectus in
connection with any resale of such Exchange Notes; however, by
so acknowledging and by delivering a prospectus, the undersigned
will not be deemed to admit that it is an
underwriter within the meaning of the Securities Act.
The undersigned understands that all resales of the Exchange
Notes must be made in compliance with applicable state
securities or Blue Sky laws. If a resale does not qualify for an
exemption from these laws, the undersigned acknowledges that it
may be necessary to register or qualify the Exchange Notes in a
particular state or to make the resale through a licensed
broker-dealer in order to comply with these laws. The
undersigned further understands that the Issuer assumes no
responsibility regarding compliance with state securities or
Blue Sky laws in connection with resales.
Any holder of Outstanding Notes using the Exchange Offer to
participate in a distribution of the Exchange Notes
(i) cannot rely on the position of the staff of the
Securities and Exchange Commission enunciated in its
interpretive letter with respect to Exxon Capital Holdings
Corporation (available April 13, 1989) or similar
interpretive letters and (ii) must comply with the
registration and prospectus requirements of the Securities Act
in connection with a secondary resale transaction.
All authority herein conferred or agreed to be conferred shall
survive the death or incapacity of the undersigned and every
obligation of the undersigned hereunder shall be binding upon
the heirs, personal representatives, successors and assigns of
the undersigned. Tendered Outstanding Notes may be withdrawn at
any time prior to the Expiration Date in accordance with the
terms of this Letter of Transmittal. Except as stated in the
Prospectus, this tender is irrevocable.
Certificates for all Exchange Notes delivered in exchange for
tendered Outstanding Notes and any Outstanding Notes delivered
herewith but not exchanged, and registered in the name of the
undersigned, shall be delivered to the undersigned at the
address shown below the signature of the undersigned.
The undersigned, by completing the box entitled
Description of Outstanding Notes Tendered Herewith
above and signing this letter, will be deemed to have tendered
the Outstanding Notes as set forth in such box.
TENDERING
HOLDER(S) SIGN HERE
(Complete accompanying IRS
Form W-9
or IRS
Form W-8,
as applicable)
Must be signed by registered holder(s) exactly as name(s)
appear(s) on certificate(s) for Outstanding Notes hereby
tendered or in whose name Outstanding Notes are registered on
the books of DTC or one of its participants, or by any person(s)
authorized to become the registered holder(s) by endorsements
and documents transmitted herewith. If signature is by a
trustee, executor, administrator, guardian, attorney-in-fact,
officer of a corporation or other person acting in a fiduciary
or representative capacity, please set forth the full title of
such person. See Instruction 3.
(Signature(s)
of Holder(s))
(Please
Print)
(Including
Zip Code)
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Daytime Area Code and Telephone No. |
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Taxpayer Identification No. |
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GUARANTEE
OF SIGNATURE(S)
(If Required See Instruction 3)
(Include
Zip Code)
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Area Code and Telephone No. |
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SPECIAL
ISSUANCE INSTRUCTIONS
(See Instructions 3 and 4)
(Complete accompanying IRS
Form W-9
or IRS
Form W-8,
as applicable)
To be completed ONLY if Exchange Notes or Outstanding Notes not
tendered are to be issued in the name of someone other than the
registered holder of the Outstanding Notes whose name(s)
appear(s) above.
Issue: o Outstanding
Notes not tendered to:
o Exchange
Notes to:
(Include
Zip Code)
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Daytime Area Code and
Telephone
No.
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Taxpayer
Identification No.
SPECIAL
DELIVERY INSTRUCTIONS
(See Instructions 3 and 4)
(Complete accompanying IRS
Form W-9
or IRS
Form W-8,
as applicable)
To be completed ONLY if Exchange Notes or Outstanding Notes not
tendered are to be sent to someone other than the registered
holder of the Outstanding Notes whose name(s) appear(s) above,
or such registered holder(s) at an address other than that shown
above.
Mail: o Outstanding
Notes not tendered to:
o Exchange
Notes to:
(Include
Zip Code)
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Area Code and
Telephone
No.
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Taxpayer
Identification No.
INSTRUCTIONS
FORMING
PART OF THE TERMS AND CONDITIONS OF THE EXCHANGE
OFFER
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1.
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Delivery
of this Letter of Transmittal and Certificates; Guaranteed
Delivery Procedures.
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A holder of Outstanding Notes may tender the same by
(i) properly completing and signing this Letter of
Transmittal or a facsimile hereof (all references in the
Prospectus to the Letter of Transmittal shall be deemed to
include a facsimile thereof) and delivering the same, together
with the certificate or certificates, if applicable,
representing the Outstanding Notes being tendered and any
required signature guarantees and any other documents required
by this Letter of Transmittal, to the Exchange Agent at its
address set forth above on or prior to the Expiration Date, or
(ii) complying with the procedure for book-entry transfer
described below, or (iii) complying with the guaranteed
delivery procedures described below.
Holders of Outstanding Notes may tender Outstanding Notes by
book-entry transfer by crediting the Outstanding Notes to the
Exchange Agents account at DTC in accordance with
DTCs Automated Tender Offer Program (ATOP) and
by complying with applicable ATOP procedures with respect to the
Exchange Offer. DTC participants that are accepting the Exchange
Offer should transmit their acceptance to DTC, which will edit
and verify the acceptance and execute a book-entry delivery to
the Exchange Agents account at DTC. DTC will then send a
computer-generated message (an Agents Message)
to the Exchange Agent for its acceptance in which the holder of
the Outstanding Notes acknowledges and agrees to be bound by the
terms of, and makes the representations and warranties contained
in, this Letter of Transmittal or the DTC participant confirms
on behalf of itself and the beneficial owners of such
Outstanding Notes all provisions of this Letter of Transmittal
(including any representations and warranties) applicable to it
and such beneficial owner as fully as if it had completed the
information required herein and executed and transmitted this
Letter of Transmittal to the Exchange Agent. Delivery of the
Agents Message by DTC will satisfy the terms of the
Exchange Offer as to execution and delivery of a Letter of
Transmittal by the participant identified in the Agents
Message. DTC participants may also accept the Exchange Offer by
submitting a Notice of Guaranteed Delivery through ATOP.
The method of delivery of this Letter of Transmittal, the
Outstanding Notes and any other required documents is at the
election and risk of the holder, and except as otherwise
provided below, the delivery will be deemed made only when
actually received or confirmed by the Exchange Agent. If such
delivery is by mail, it is suggested that registered mail with
return receipt requested, properly insured, be used. In all
cases sufficient time should be allowed to permit timely
delivery. No Outstanding Notes or Letters of Transmittal should
be sent to the Issuer.
Holders whose Outstanding Notes are not immediately available or
who cannot deliver their Outstanding Notes and all other
required documents to the Exchange Agent on or prior to the
Expiration Date or comply with book-entry transfer procedures on
a timely basis must tender their Outstanding Notes pursuant to
the guaranteed delivery procedure set forth in the Prospectus.
Pursuant to such procedure: (i) such tender must be made by
or through an Eligible Guarantor Institution (as defined below);
(ii) prior to the Expiration Date, the Exchange Agent must
have received from such Eligible Guarantor Institution a letter,
telegram or facsimile transmission (receipt confirmed by
telephone and an original delivered by guaranteed overnight
courier) setting forth the name and address of the tendering
holder, the names in which such Outstanding Notes are
registered, and, if applicable, the certificate numbers of the
Outstanding Notes to be tendered; and (iii) all tendered
Outstanding Notes (or a confirmation of any book-entry transfer
of such Outstanding Notes into the Exchange Agents account
at a book-entry transfer facility) as well as this Letter of
Transmittal and all other documents required by this Letter of
Transmittal, must be received by the Exchange Agent within five
business days after the date of execution of such letter,
telegram or facsimile transmission, all as provided in the
Prospectus.
No alternative, conditional, irregular or contingent tenders
will be accepted. All tendering holders, by execution of this
Letter of Transmittal (or facsimile thereof), shall waive any
right to receive notice of the acceptance of the Outstanding
Notes for exchange.
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2.
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Partial
Tenders; Withdrawals.
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If less than the entire principal amount of Outstanding Notes
evidenced by a submitted certificate is tendered, the tendering
holder must fill in the aggregate principal amount of
Outstanding Notes tendered in the box entitled Description
of Outstanding Notes Tendered Herewith. A newly issued
certificate for the Outstanding Notes submitted but not tendered
will be sent to such holder as soon as practicable after the
Expiration Date. All Outstanding Notes delivered to the Exchange
Agent will be deemed to have been tendered unless otherwise
clearly indicated.
If not yet accepted, a tender pursuant to the Exchange Offer may
be withdrawn prior to the Expiration Date.
To be effective with respect to the tender of Outstanding Notes,
a written notice of withdrawal must: (i) be received by the
Exchange Agent at the address for the Exchange Agent set forth
above before the Issuer notifies the Exchange Agent that they
have accepted the tender of Outstanding Notes pursuant to the
Exchange Offer; (ii) specify the name of the person who
tendered the Outstanding Notes to be withdrawn;
(iii) identify the Outstanding Notes to be withdrawn
(including the principal amount of such Outstanding Notes, or,
if applicable, the certificate numbers shown on the particular
certificates evidencing such Outstanding Notes and the principal
amount of Outstanding Notes represented by such certificates);
(iv) include a statement that such holder is withdrawing
its election to have such Outstanding Notes exchanged; and
(v) be signed by the holder in the same manner as the
original signature on this Letter of Transmittal (including any
required signature guarantee). The Exchange Agent will return
the properly withdrawn Outstanding Notes promptly following
receipt of notice of withdrawal. If Outstanding Notes have been
tendered pursuant to the procedure for book-entry transfer, any
notice of withdrawal must specify the name and number of the
account at the book-entry transfer facility to be credited with
the withdrawn Outstanding Notes or otherwise comply with the
book-entry transfer facilitys procedures. All questions as
to the validity of notices of withdrawals, including time of
receipt, will be determined by the Issuer, and such
determination will be final and binding on all parties.
Any Outstanding Notes so withdrawn will be deemed not to have
been validly tendered for exchange for purposes of the Exchange
Offer. Any Outstanding Notes which have been tendered for
exchange but which are not exchanged for any reason will be
returned to the holder thereof without cost to such holder (or,
in the case of Outstanding Notes tendered by book-entry transfer
into the Exchange Agents account at the book entry
transfer facility pursuant to the book-entry transfer procedures
described above, such Outstanding Notes will be credited to an
account with such book-entry transfer facility specified by the
holder) as soon as practicable after withdrawal, rejection of
tender or termination of the Exchange Offer. Properly withdrawn
Outstanding Notes may be retendered by following one of the
procedures described under the caption The Exchange
OfferProcedures for Tendering in the Prospectus at
any time prior to the Expiration Date.
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3.
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Signature
on this Letter of Transmittal; Written Instruments and
Endorsements; Guarantee of Signatures.
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If this Letter of Transmittal is signed by the registered
holder(s) of the Outstanding Notes tendered hereby, the
signature must correspond with the name(s) as written on the
face of the certificates without alteration, enlargement or any
change whatsoever. If any of the Outstanding Notes tendered
hereby are owned of record by two or more joint owners, all such
owners must sign this Letter of Transmittal.
If a number of Outstanding Notes registered in different names
are tendered, it will be necessary to complete, sign and submit
as many separate copies of this Letter of Transmittal as there
are different registrations of Outstanding Notes.
When this Letter of Transmittal is signed by the registered
holder or holders (which term, for the purposes described
herein, shall include the book-entry transfer facility whose
name appears on a security listing as the owner of the
Outstanding Notes) of Outstanding Notes listed and tendered
hereby, no endorsements of certificates or separate written
instruments of transfer or exchange are required.
If this Letter of Transmittal is signed by a person other than
the registered holder or holders of the Outstanding Notes
listed, such Outstanding Notes must be endorsed or accompanied
by separate written instruments of transfer or exchange in form
satisfactory to the Issuer and duly executed by the registered
holder, in either case signed exactly as the name or names of
the registered holder or holders appear(s) on the Outstanding
Notes.
If this Letter of Transmittal, any certificates or separate
written instruments of transfer or exchange are signed by
trustees, executors, administrators, guardians,
attorneys-in-fact, officers of corporations or others acting in
a fiduciary or representative capacity, such persons should so
indicate when signing, and, unless waived by the Issuer, proper
evidence satisfactory to the Issuer of their authority so to act
must be submitted.
Endorsements on certificates or signatures on separate written
instruments of transfer or exchange required by this
Instruction 3 must be guaranteed by an Eligible Guarantor
Institution.
Signatures on this Letter of Transmittal must be guaranteed by
an Eligible Guarantor Institution, unless Outstanding Notes are
tendered: (i) by a holder who has not completed the box
entitled Special Issuance Instructions or
Special Delivery Instructions on this Letter of
Transmittal; or (ii) for the account of an Eligible
Guarantor Institution. In the event that the signatures in this
Letter of Transmittal or a notice of withdrawal, as the case may
be, are required to be guaranteed, such guarantees must be by an
eligible guarantor institution which is a member of a firm of a
registered national securities exchange or of the National
Association of Securities Dealers, Inc., a commercial bank or
trust company having an office or correspondent in the United
States or another eligible guarantor institution
within the meaning of
Rule 17Ad-15
under the Securities Exchange Act of 1934, as amended (an
Eligible Guarantor Institution). If Outstanding
Notes are registered in the name of a person other than the
signer of this Letter of Transmittal, the Outstanding Notes
surrendered for exchange must be endorsed by, or be accompanied
by a written instrument or instruments of transfer or exchange,
in satisfactory form as determined by the Issuer, in its sole
discretion, duly executed by the registered holder with the
signature thereon guaranteed by an Eligible Guarantor
Institution.
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4.
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Special
Issuance and Delivery Instructions.
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Tendering holders should indicate, as applicable, the name and
address to which the Exchange Notes or certificates for
Outstanding Notes not exchanged are to be issued or sent, if
different from the name and address of the person signing this
Letter of Transmittal. In the case of issuance in a different
name, the tax identification number of the person named must
also be indicated. Holders tendering Outstanding Notes by
book-entry transfer may request that Outstanding Notes not
exchanged be credited to such account maintained at the
book-entry transfer facility as such holder may designate.
Except as otherwise provided in this Instruction 5, the
Issuer shall pay or cause to be paid any transfer taxes
applicable to the transfer and exchange of Outstanding Notes to
it or its order pursuant to the Exchange Offer. If, however,
certificates representing Exchange Notes or Outstanding Notes
for principal amounts not tendered or accepted for exchange are
to be delivered to, or are to be registered or issued in the
name of, any other person other than the registered holder of
the Outstanding Notes tendered, or if tendered Outstanding Notes
are registered in the name of any person other than the person
signing the Letter of Transmittal, or if a transfer tax is
imposed for any reason other than the transfer and exchange of
Outstanding Notes to the Issuer or its order pursuant to the
Exchange Offer, the amount of any such transfer taxes (whether
imposed on the registered holder or any other person) will be
payable by the applicable holder. If satisfactory evidence of
payment of such taxes or exception therefrom is not submitted
herewith the amount of such transfer taxes will be billed
directly to such holder.
The Issuer reserve the absolute right to waive, in whole or in
part, any of the conditions to the Exchange Offer set forth in
the Prospectus.
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7.
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Mutilated,
Lost, Stolen or Destroyed Securities.
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Any holder whose Outstanding Notes have been mutilated, lost,
stolen or destroyed, should contact the Exchange Agent at the
address indicated below for further instructions.
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8.
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8. IRS
Form W-9;
IRS
Form W-8.
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Each holder of Outstanding Notes whose Outstanding Notes are
accepted for exchange (or other payee) is required to provide a
correct taxpayer identification number (TIN,
generally, the holders social security or federal employer
identification number), and certain other information on
Internal Revenue Service (IRS)
Form W-9,
or an appropriate IRS
Form W-8
certifying its exempt status, as described below.
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9.
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Requests
for Assistance or Additional Copies.
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Questions relating to the procedure for tendering, as well as
requests for additional copies of the Prospectus and this Letter
of Transmittal, may be directed to the Exchange Agent at the
address and telephone number set forth above. In addition, all
questions relating to the Exchange Offer, as well as requests
for assistance or additional copies of the Prospectus and this
Letter of Transmittal, may be directed to the Exchange Agent at
the address and telephone number indicated above.
IMPORTANT: This Letter of Transmittal or a facsimile or copy
thereof (together with certificates of Outstanding Notes or
confirmation of book-entry transfer and all other required
documents) or a Notice of Guaranteed Delivery must be received
by the Exchange Agent on or prior to the Expiration Date.
IMPORTANT
TAX INFORMATION
TO ENSURE COMPLIANCE WITH REQUIREMENTS IMPOSED BY THE IRS,
YOU ARE HEREBY NOTIFIED THAT ANY DISCUSSION OF FEDERAL TAX
ISSUES CONTAINED HEREIN (I) IS WRITTEN IN CONNECTION WITH
THE PROMOTION OR MARKETING BY US OF THE TRANSACTIONS OR MATTERS
ADDRESSED HEREIN AND (II) IS NOT INTENDED OR
WRITTEN TO BE USED, AND CANNOT BE USED, BY ANY TAXPAYER FOR
THE PURPOSE OF AVOIDING PENALTIES UNDER THE CODE. EACH TAXPAYER
SHOULD SEEK ADVICE BASED ON THE TAXPAYERS PARTICULAR
CIRCUMSTANCES FROM AN INDEPENDENT TAX ADVISOR.
Under U.S. federal income tax law, a holder of Outstanding
Notes whose Outstanding Notes are accepted for exchange may be
subject to backup withholding unless the holder or its assignee
(in either case, the Payee) provides the Exchange
Agent with the Payees correct TIN, which, in the case of a
Payee who is an individual, generally is the Payees Social
Security Number. If the Exchange Agent is not provided with the
correct TIN or an adequate basis for an exemption, the Payee may
be subject to a $50 penalty imposed by the IRS and backup
withholding (currently at a rate of 28% through 2012, and
increasing to 31% thereafter) may apply to any payments on the
Outstanding Notes or Exchange Notes made to such Payee. Backup
withholding is not an additional tax. Rather, the
U.S. federal income tax liability of a person subject to
backup withholding will be reduced by the amount withheld. If
withholding results in an overpayment of taxes, a refund may be
obtained, provided that the required information is timely
provided to the IRS.
To prevent backup withholding, each U.S. Payee must provide
such Payees correct TIN by completing the IRS
Form W-9
included herewith, certifying that (i) the TIN provided is
correct, (ii) (a) the Payee is exempt from backup
withholding, (b) the Payee has not been notified by the IRS
that such Payee is subject to backup withholding as a result of
a failure to report all interest or dividends, or (c) the
IRS has notified the payee that such Payee is no longer subject
to backup withholding, and (iii) the Payee is a
U.S. person for U.S. tax purposes (including a
U.S. resident alien).
If the Payee does not have a TIN, such Payee should consult the
enclosed instructions to IRS
Form W-9
for instructions on applying for a TIN, write Applied
For in the space for the TIN provided on the included IRS
Form W-9,
and must also complete the attached Certificate of
Awaiting Taxpayer Identification Number in order to
prevent backup withholding. Notwithstanding the foregoing, the
Exchange Agent will withhold 28% of all payments made prior to
the time a properly certified TIN is provided to the Exchange
Agent and, if the Exchange Agent is not provided with a TIN
within 60 days, such amounts will be paid over to the
Internal Revenue Service.
If the Outstanding Notes are held in more than one name or are
not held in the name of the actual owner, consult the
instructions to IRS
Form W-9
for information on which TIN to report.
Exempt Payees (including, among others, all corporations and
certain foreign individuals) are not subject to these backup
withholding and reporting requirements. To prevent possible
erroneous backup withholding, an exempt Payee should check the
Exempt from backup withholding box on the IRS
Form W-9.
See the instructions to IRS
Form W-9
for additional information. In order for a nonresident alien or
foreign entity to qualify as exempt, such person must submit an
appropriate and properly completed
Form W-8BEN,
W-8ECI,
W-8EXP or
W-8IMY, as
the case may be, signed under penalties of perjury attesting to
such exempt status. Such forms may be obtained from the Exchange
Agent or the IRS at its Internet website: www.irs.gov.
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Form W-9 (Rev. January 2011) Department of the Treasury Internal Revenue Service
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Request for Taxpayer Identification Number and Certification
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Give Form to the
requester. Do not
send to the IRS.
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Name (as shown on your income tax return)
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Business name/disregarded entity name, if different
from above
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Check
appropriate box for federal tax
classification
(required): o Individual/sole
proprietor o C Corporation o S Corporation o Partnership o Trust/estate
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o Limited
liability company. Enter the tax classification (C=C
corporation, S=S corporation,
P=partnership) ►
o Other
(see instructions) ►
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o Exempt
payee
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Address (number, street, and apt. or suite no.)
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Requesters name and address (optional)
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City, state, and ZIP code
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List account number(s) here (optional)
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Part I Taxpayer
Identification Number (TIN)
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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 (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
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Social security number
Employer identification number
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Part II Certification
Under
penalties of perjury, I certify that:
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1.
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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
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2.
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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
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3.
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I am
a U.S. citizen or other U.S. person (defined below).
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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. For real estate transactions, item 2 does
not apply. For mortgage interest paid, acquisition or
abandonment of secured 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. See the instructions on page 4.
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Sign
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Signature of
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Here
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U.S. person ►
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Date ►
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General
Instructions
Section references
are to the Internal Revenue Code unless otherwise noted.
Purpose
of Form
A
person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number
(TIN) to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use
Form W-9
only if you are a U.S. person (including a resident alien),
to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify
that the TIN you are giving is correct (or you are waiting for a
number to be issued), 2. Certify that you are
not subject to backup withholding, or
3. Claim
exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income
from a U.S. trade or business is not subject to the
withholding tax on foreign partners share of effectively
connected income.
Note. If
a requester gives you a form other than
Form W-9
to request your TIN, you must use the requesters form if
it is substantially similar to this
Form W-9.
Definition
of a
U.S. person. For
federal tax purposes, you are considered a U.S. person if
you are:
An
individual who is a U.S. citizen or U.S. resident
alien,
A
partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
An
estate (other than a foreign estate), or
A
domestic trust (as defined in Regulations
section 301.7701-7).
Special
rules for
partnerships. Partnerships
that conduct a trade or business in the United States are
generally required to pay a withholding tax on any foreign
partners share of income from such business. Further, in
certain cases where a
Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide
Form W-9
to the partnership to establish your U.S. status and avoid
withholding on your share of partnership income.
The
person who gives
Form W-9
to the partnership for purposes of establishing its
U.S. status and avoiding withholding on its allocable share
of net income from the partnership conducting a trade or
business in the United States is in the following cases:
The
U.S. owner of a disregarded entity and not the entity,
Cat.
No. 10231X
Form
W-9
(Rev.
1-2011)
Print
or type See Specific Instructions on page 2.
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Form W-9
(Rev. 1-2011)
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Page 2 |
The
U.S. grantor or other owner of a grantor trust and not the
trust, and
The
U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
Foreign
person.
If you are a foreign person, do not use
Form W-9.
Instead, use the appropriate
Form W-8
(see Publication 515, Withholding of Tax on Nonresident Aliens
and Foreign Entities).
Nonresident
alien who becomes a resident
alien.
Generally, only a nonresident alien individual may use the terms
of a tax treaty to reduce or eliminate U.S. tax on certain
types of income. However, most tax treaties contain a provision
known as a saving clause. Exceptions specified in
the saving clause may permit an exemption from tax to continue
for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If
you are a U.S. resident alien who is relying on an
exception contained in the saving clause of a tax treaty to
claim an exemption from U.S. tax on certain types of
income, you must attach a statement to
Form W-9
that specifies the following five items:
1. The
treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The
treaty article addressing the income.
3. The
article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The
type and amount of income that qualifies for the exemption from
tax.
5. Sufficient
facts to justify the exemption from tax under the terms of the
treaty article.
Example.
Article 20 of the
U.S.-China
income tax treaty allows an exemption from tax for scholarship
income received by a Chinese student temporarily present in the
United States. Under U.S. law, this student will become a
resident alien for tax purposes if his or her stay in the United
States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the
U.S.-China
treaty (dated April 30, 1984) allows the provisions of
Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2
of the first protocol) and is relying on this exception to claim
an exemption from tax on his or her scholarship or fellowship
income would attach to
Form W-9
a statement that includes the information described above to
support that exemption.
If
you are a nonresident alien or a foreign entity not subject to
backup withholding, give the requester the appropriate completed
Form W-8.
What
is backup
withholding?
Persons making certain payments to you must under certain
conditions withhold and pay to the IRS a percentage of such
payments. This is called backup withholding.
Payments that may be subject to backup withholding include
interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
You
will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the
proper certifications, and report all your taxable interest and
dividends on your tax return.
Payments
you receive will be subject to backup
withholding if:
1. You
do not furnish your TIN to the requester,
2. You
do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The
IRS tells the requester that you furnished an incorrect TIN,
4. The
IRS tells you that you are subject to backup withholding because
you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You
do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and
dividend accounts opened after 1983 only).
Certain
payees and payments are exempt from backup withholding. See the
instructions below and the separate Instructions for the
Requester of
Form W-9.
Also
see Special rules for partnerships on page 1.
Updating
Your Information
You
must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt
payee and anticipate receiving reportable payments in the future
from this person. For example, you may need to provide updated
information if you are a C corporation that elects to be an
S corporation, or if you no longer are tax exempt. In
addition, you must furnish a new Form W-9 if the name or TIN
changes for the account, for example, if the grantor of a
grantor trust dies.
Penalties
Failure
to furnish
TIN.
If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your
failure is due to reasonable cause and not to willful neglect.
Civil
penalty for false information with respect to
withholding.
If you make a false statement with no reasonable basis that
results in no backup withholding, you are subject to a $500
penalty.
Criminal
penalty for falsifying
information.
Willfully falsifying certifications or affirmations may subject
you to criminal penalties including fines
and/or
imprisonment.
Misuse
of
TINs.
If the requester discloses or uses TINs in violation of federal
law, the requester may be subject to civil and criminal
penalties.
Specific
Instructions
Name
If
you are an individual, you must generally enter the name shown
on your income tax return. However, if you have changed your
last name, for instance, due to marriage without informing the
Social Security Administration of the name change, enter your
first name, the last name shown on your social security card,
and your new last name.
If
the account is in joint names, list first, and then circle, the
name of the person or entity whose number you entered in
Part I of the form.
Sole
proprietor.
Enter your individual name as shown on your income tax return on
the Name line. You may enter your business, trade,
or doing business as (DBA) name on the
Business name/disregarded entity name line.
Partnership,
C Corporation, or S
Corporation.
Enter the entitys name on the Name line and
any business, trade, or doing business as (DBA) name
on the Business name/disregarded entity name line.
Disregarded
entity.
Enter the owners name on the Name line. The
name of the entity entered on the Name line should
never be a disregarded entity. The name on the Name
line must be the name shown on the income tax return on which
the income will be reported. For example, if a foreign LLC that
is treated as a disregarded entity for U.S. federal tax purposes
has a domestic owner, the domestic owners name is required
to be provided on the Name line. If the direct owner
of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter
the disregarded entitys name on the Business
name/disregarded entity name line. If the owner of the
disregarded entity is a foreign person, you must complete an
appropriate Form W-8.
Note.
Check
the appropriate box for the federal tax classification of the
person whose name is entered on the Name line
(Individual/sole proprietor, Partnership, C Corporation, S
Corporation, Trust/estate).
Limited
Liability Company
(LLC).
If the person identified on the Name line is an LLC,
check the Limited liability company box only and
enter the appropriate code for the tax classification in the
space provided. If you are an LLC that is treated as a
partnership for federal tax purposes, enter P for
partnership. If you are an LLC that has filed a Form 8832 or a
Form 2553 to be taxed as a corporation, enter C for
C corporation or S for S corporation. If you are an
LLC that is disregarded as an entity separate from its
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Form W-9
(Rev. 1-2011)
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Page
3 |
owner
under Regulation section 301.7701-3 (except for employment and
excise tax), do not check the LLC box unless the owner of the
LLC (required to be identified on the Name line) is
another LLC that is not disregarded for federal tax purposes. If
the LLC is disregarded as an entity separate from its owner,
enter the appropriate tax classification of the owner identified
on the Name line.
Other
entities.
Enter your business name as shown on required federal tax
documents on the Name line. This name should match
the name shown on the charter or other legal document creating
the entity. You may enter any business, trade, or DBA name
on the Business name/disregarded entity name line.
Exempt
Payee
If
you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status,
then check the Exempt payee box in the line
following the Business name/disregarded entity name,
sign and date the form.
Generally,
individuals (including sole proprietors) are not exempt from
backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.
Note.
If you are exempt from backup withholding, you should still
complete this form to avoid possible erroneous backup
withholding.
The
following payees are exempt from backup withholding:
1. An
organization exempt from tax under section 501(a), any IRA,
or a custodial account under section 403(b)(7) if the
account satisfies the requirements of section 401(f)(2),
2. The
United States or any of its agencies or instrumentalities,
3. A
state, the District of Columbia, a possession of the United
States, or any of their political subdivisions or
instrumentalities,
4. A
foreign government or any of its political subdivisions,
agencies, or instrumentalities, or
5. An
international organization or any of its agencies or
instrumentalities.
Other
payees that may be exempt from backup withholding include:
6. A
corporation,
7. A
foreign central bank of issue,
8. A
dealer in securities or commodities required to register in the
United States, the District of Columbia, or a possession of the
United States,
9. A
futures commission merchant registered with the Commodity
Futures Trading Commission,
10. A
real estate investment trust,
11. An
entity registered at all times during the tax year under the
Investment Company Act of 1940,
12. A
common trust fund operated by a bank under section 584(a),
13. A
financial institution,
14. A
middleman known in the investment community as a nominee or
custodian, or
15. A
trust exempt from tax under section 664 or described in
section 4947.
The
following chart shows types of payments that may be exempt from
backup withholding. The chart applies to the exempt payees
listed above, 1 through 15.
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IF the payment is for. . .
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THEN the payment is exempt for . . .
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Interest and dividend payments
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All exempt payees except for 9
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Broker transactions
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Exempt payees 1 through 5 and 7 through 13. Also, C corporations.
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Barter exchange transactions and patronage dividends
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Exempt payees 1 through 5
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Payments over $600 required to be reported and direct sales over
$5,000 1
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Generally, exempt payees 1 through
7 2
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1See
Form 1099-MISC,
Miscellaneous Income, and its instructions.
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2 |
However,
the following payments made to a corporation and reportable on
Form 1099-MISC
are not exempt from backup withholding: medical and health care
payments, attorneys fees, gross proceeds paid to an
attorney, and payments for services paid by a federal executive
agency.
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Part I.
Taxpayer Identification Number (TIN)
Enter
your TIN in the appropriate
box.
If you are a resident alien and you do not have and are not
eligible to get an SSN, your TIN is your IRS individual taxpayer
identification number (ITIN). Enter it in the social security
number box. If you do not have an ITIN, see How to get a TIN
below.
If
you are a sole proprietor and you have an EIN, you may enter
either your SSN or EIN. However, the IRS prefers that you use
your SSN.
If
you are a single-member LLC that is disregarded as an entity
separate from its owner (see Limited Liability Company
(LLC) on page 2), enter the owners SSN (or
EIN, if the owner has one). Do not enter the disregarded
entitys EIN. If the LLC is classified as a corporation or
partnership, enter the entitys EIN.
Note.
See the chart on page 4 for further clarification of name
and TIN combinations.
How
to get a
TIN.
If you do not have a TIN, apply for one immediately. To apply
for an SSN, get
Form SS-5,
Application for a Social Security Card, from your local Social
Security Administration office or get this form online at
www.ssa.gov. You may also get this form by calling
1-800-772-1213.
Use
Form W-7,
Application for IRS Individual Taxpayer Identification Number,
to apply for an ITIN, or
Form SS-4,
Application for Employer Identification Number, to apply for an
EIN. You can apply for an EIN online by accessing the IRS
website at www.irs.gov/businesses and clicking on
Employer Identification Number (EIN) under Starting a Business.
You can get
Forms W-7
and SS-4 from the IRS by visiting IRS.gov or by calling
1-800-TAX-FORM
(1-800-829-3676).
If
you are asked to complete
Form W-9
but do not have a TIN, write Applied For in the
space for the TIN, sign and date the form, and give it to the
requester. For interest and dividend payments, and certain
payments made with respect to readily tradable instruments,
generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The
60-day rule
does not apply to other types of payments. You will be subject
to backup withholding on all such payments until you provide
your TIN to the requester.
Note.
Entering Applied For means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution:
A disregarded domestic entity that has a foreign owner must use
the appropriate
Form W-8.
Part II.
Certification
To
establish to the withholding agent that you are a
U.S. person, or resident alien, sign
Form W-9.
You may be requested to sign by the withholding agent even if
item 1, below and items 4 and 5 on page 4 indicate
otherwise.
For
a joint account, only the person whose TIN is shown in
Part I should sign (when required). In the case of a
disregarded entity, the person identified on the
Name line must sign. Exempt payees, see Exempt
Payee on page 3.
Signature
requirements.
Complete the certification as indicated in items 1 through 3,
below, and items 4 and 5 on page 4.
1. Interest,
dividend, and barter exchange accounts opened before 1984 and
broker accounts considered active during 1983. You must give
your correct TIN, but you do not have to sign the certification.
2. Interest,
dividend, broker, and barter exchange accounts opened after 1983
and broker accounts considered inactive during 1983. You
must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely
providing your correct TIN to the requester, you must cross out
item 2 in the certification before signing the form.
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Form W-9
(Rev. 1-2011)
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Page
4 |
3. Real
estate
transactions.
You must sign the certification. You may cross out item 2
of the certification.
4. Other
payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified
that you have previously given an incorrect TIN. Other
payments include payments made in the course of the
requesters trade or business for rents, royalties, goods
(other than bills for merchandise), medical and health care
services (including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage
interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program
payments (under section 529), IRA, Coverdell ESA, Archer
MSA or HSA contributions or distributions, and pension
distributions. You must give your correct TIN, but you do
not have to sign the certification.
What Name and
Number To Give the Requester
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For this type of
account:
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Give name and SSN
of:
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1. Individual
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The individual
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2. Two or more individuals (joint account)
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The actual owner of the account or, if combined funds, the first
individual on the
account 1
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3. Custodian account of a minor
(Uniform Gift to Minors Act)
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The
minor 2
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4. a. The usual revocable savings trust (grantor is
also trustee)
|
|
The
grantor-trustee 1
|
b. So-called trust account that is not a legal or
valid trust under state law
|
|
The actual
owner 1
|
5. Sole proprietorship or disregarded entity owned by an
individual
|
|
The
owner 3
|
6. Grantor trust filing under Optional Form 1099 Filing
Method 1 (see Regulation section 1.671-4(b)(2)(i)(A))
|
|
The
grantor*
|
|
For this type of
account:
|
|
Give name and EIN of:
|
|
7. Disregarded entity not owned by an individual
|
|
The owner
|
8. A valid trust, estate, or pension trust
|
|
Legal
entity 4
|
9. Corporation or LLC electing corporate status on
Form 8832 or Form 2553
|
|
The corporation
|
10. Association, club, religious, charitable, educational,
or other tax-exempt organization
|
|
The organization
|
11. Partnership or multi-member LLC
|
|
The partnership
|
12. A broker or registered nominee
|
|
The broker or nominee
|
13. Account with the Department of Agriculture in the name
of a public entity (such as a state or local government, school
district, or prison) that receives agricultural program payments
|
|
The public entity
|
14. Grantor trust filing under the Form 1041 Filing Method
or the Optional Form 1099 Filing Method 2 (see Regulation
section 1.671 -4(b)(2)(i)(B))
|
|
The trust
|
|
|
|
|
|
|
|
1 |
|
List
first and circle the name of the person whose number you
furnish. If only one person on a joint account has an SSN, that
persons number must be furnished.
|
2 |
|
Circle
the minors name and furnish the minors SSN.
|
3 |
|
You
must show your individual name and you may also enter your
business or DBA name on the Business
name/disregarded/entity name line. You may use either your
SSN or EIN (if you have one), but the IRS encourages you to use
your SSN.
|
4 |
|
List
first and circle the name of the 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.) Also see Special rules for partnerships
on page 1.
|
*
Note.
Grantor also must provide a Form W-9 to trustee of trust.
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.
Secure Your Tax
Records from Identity Theft
Identity
theft occurs when someone uses your personal information such as
your name, social security number (SSN), or other identifying
information, without your permission, to commit fraud or other
crimes. An identity thief may use your SSN to get a job or may
file a tax return using your SSN to receive a refund.
To
reduce your risk:
|
|
|
Protect
your SSN,
|
|
Ensure
your employer is protecting your SSN, and
|
|
Be
careful when choosing a tax preparer.
|
If
your tax records are affected by identity theft and you receive
a notice from the IRS, respond right away to the name and phone
number printed on the IRS notice or letter.
If
your tax records are not currently affected by identity theft
but you think you are at risk due to a lost or stolen purse or
wallet, questionable credit card activity or credit report,
contact the IRS Identity Theft Hotline at 1-800-908-4490 or
submit Form 14039.
For
more information, see Publication 4535, Identity Theft
Prevention and Victim Assistance.
Victims
of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have
not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 1-877-777-4778 or
TTY/TDD 1-800-829-4059.
Protect
yourself from suspicious emails or phishing
schemes.
Phishing is the creation and use of email and websites designed
to mimic legitimate business emails and websites. The most
common act is sending an email to a user falsely claiming to be
an established legitimate enterprise in an attempt to scam the
user into surrendering private information that will be used for
identity theft.
The
IRS does not initiate contacts with taxpayers via emails. Also,
the IRS does not request personal detailed information through
email or ask taxpayers for the PIN numbers, passwords, or
similar secret access information for their credit card, bank,
or other financial accounts.
If
you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also
report misuse of the IRS name, logo, or other IRS property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spam@uce.gov or contact them at
www.ftc.gov/idtheft or
1-877-IDTHEFT(1-877-438-4338).
Visit
IRS.gov to learn more about identity theft and how to reduce
your risk.
Privacy Act
Notice
Section 6109
of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are
required to file information returns with the IRS to report
interest, dividends, or certain other income paid to you;
mortgage interest you paid; the acquisition or abandonment of
secured property; the cancellation of debt; or contributions you
made to an IRA, Archer MSA, or HSA. The person collecting this
form uses the information on the form to file information
returns with the IRS, reporting the above information. Routine
uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states,
the District of Columbia, and U.S. possessions for use in
administering their laws. The information also may be disclosed
to other countries under a treaty, to federal and state agencies
to enforce civil and criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism. You
must provide your TIN whether or not you are required to file a
tax return. Under section 3406, payers must generally withhold a
percentage of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or
fraudulent information.