By clicking the "Submit" button you are verifying this information is not falsified in any manner and, under penalty of perjury, certify that:
1) 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
2) I am not subject to back up 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
3) I am a U.S. Citizen or other U.S. person; and
4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.