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Electronic signature

The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). I am not subject to backup withholding because: (a) lam exempt from backup withholding, or (b) | 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.

The FATCA code entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. I acknowledge that the Internal Revenue Service does not require my consent to any provision of this document other than the certifications required to avoid backup withholding. I also acknowledge that by typing my name below, as per the E-sign Act*, I am providing an e-signature that is the legal equivalent to my manual signature. By selecting this box, I consent to be legally bound by the information provided on this form. If I want to withdraw my consent, I can do so by contacting customer support. I further understand that a downloadable version of the form I am consenting to sign will also be available upon request to customer support anil/or in my account profile.

  • The Electronic Signatures in Global and National Commerce Act, 15 U.S.C. §7001, et seq., ("E-sign-Act") was signed into law on June 30, 2000, and provides a general rule for the validation of electronic records and signatures for transactions in or affecting interstate or foreign commerce.