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PROFESSIONAL SERVICES AGREEMENT
<br />Request for Taxpayer
<br />Identification Number and Certification
<br />GMI Fonn to tbIt
<br />.. quem •. Do nut
<br />.. ndto .... lRS.
<br />CIIIII::a~_IDr_" __
<br />DI~~ Oe~ DsCorpc;nllan 0 ~p 0-g fi EX .. ".,...._~...,, __ . i 0 LI'nIIDCI~"""'P"'1.--Iax--tJnlC-c~ .... _""'P"" ...... p~~.. Elfanplllln_FATCA "'P'ftJ>9
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<br />oW O!y._._ZlPcoda
<br />Ellill" ~ TIN In UlIf JlAlRlPline ~ lne ~N p11YkII!O I1\Ul!t matrln troe name gfVBn on"" "N1WlIIl-h
<br />10 avoid bt/:Iq).~ For 1rc1MduBls. tN~IS yoIIJOcIaIl5$OU1tylUTlber (SSf4.I-iQwIwIr,1'W' a
<br />I'IIlIIOOnt aI8n,lIOItI proprIetar, Of CIIiJIl!93nMId eIlllly. see the-P.IlII: I II191iuCtJonl on IMQB a. For OlnlH'
<br />entr\!8S. " yoII emplo,w ldGnllllClllCfl I1I.mber'(ElN). II yotI do not hal/&.a n\fJ1ber; tee ,.. to ,get.
<br />TIN on r-ge 3.
<br />Hcit •• If tt1e-~ IB In min' lnan 0116 DaIlliI, &ee 11M! ahin on page A lOr ~ld9InetI on whD8I!
<br />IUIIbar 10 dar.
<br />unoor p!I.~ 1:1' pRl'JLrY. r,c.m1J1)' tMt
<br />1, Thf! ~ !Ituwn On !nil 101m III my comiCIlIIXp;I)'Bf Idar1!IncIIIlOn nJI11bIIr {Ill' 'em ~ kJ' a runtIiIr 10 be ISIUICI 10 """ Ir1d
<br />2. l am nat &l-*!f1!C1 iD ~ 'foItfMoCcIIng becI!ose:{1II1 am 8l<eIT1pt IrnI:p I>atklJp ~ of (b) I M'I9 not tie.! noIIMd IIy ItIa I'I-.maJ RlIYMIUl
<br />SIiOo1Ce (IRS) hit r am ~ 0 bat:k\4) ~ng u • ,mull QI' a t11 111.nt ill report "lrbIIBi Of c:tvIlMIU&. of (I;) h IRS has ~1III(l1lM! Utall 8I1l
<br />no longer iUljotct 10 :bpdwpWlIhIl:*llI\!l-IIn£!
<br />9. I am a u.s. CIIIZIan or DII'I8r u.s. penon (dennea DEKIW). lin£!
<br />4 . 'Tille F'A"TOA Cl()d8f$)tII1b!nIO-oo!tlS IIlro1 (II any) In!.IiCdng that I am mmpllr-. FATCA~ng fIIllOIIlICI...
<br />c.raac.tJon II'IStNc:IIoftI. YOU InJst da;S out IIBm 211DO'111lr you ra~ bI!en ,nobllld by the IRS Ihal yocftre cmenily ~ 10 t.d(l4> ~dk1g
<br />beIc8l.8a 'you hllY8l81led 10 IWpOrt • IIll~ ..... a IIVfd8nds on )'IllIr lID: mum. For n!Bl8!ItBte tr.anSllCUClm. Item 11 CIOI!S ni)( apply .. Flit m.ortP'il'" .
<br />Inta'MI paid. ~ 01' '~EI1l 01 ~ prqlIeI1y. ~lIlIon Of debt, t'IOI'1t!tIuIIo 10 .... 1nc1W:Iw1 ~ ~ ~RAj • .xI
<br />~. peyrnenb OCNrnn IntenI'lI ana aI~ joou ant not ruqUnIIJ to IIIgl uw amIciaIao.-M you mtBI prt)'Iide ,o..r I:ICIITe¢ 'TlN. Stl& II'IB
<br />1'I!1nlCUOIIS on pago 9.
<br />General lnstructtQllS ___ ID ___ CDdIO ___ _
<br />_ -elOfiOI-a.. ,"",IRS _CIQIIiod.pq""'~II:r~
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<br />Purpoee 01 Form
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<br />Page 18 of 21
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