The undersigned:        is an authorized representative of    , a Certifying Acceptance Agent under an agreement entered into with the

Internal Revenue Service dated:    The undersigned certifies with regard to Form W-7 submitted for    , that the applicant is not eligible for a

SSN and has provided the documentation checked below that sufficiently supports the applicant’s identity, foreign status and, if applicable, residency.

REMINDER:    A passport is the only stand-alone document that proves both “foreign status” and “identity”. If a passport is not provided, a combination of two or more documents must be provided to meet the documentation requirements. Note: Additional original documentation requirements may apply for some dependents. See Supporting Documentation in this form's instructions.

Check the box under each category (Identity, Foreign Status) that corresponds to the documents reviewed by you:

Supporting Documentation

Identity

Foreign Status

Passport (Stand Alone Document)*

✓

✓

National Identification Card (must be current and contain name, photograph, address, date of birth and expiration date)

✓

✓

United States Drivers License

✓

✓

Civil Birth Certificate (Required for applicants under 18 if passport is not provided)

✓

✓

Medical Records (valid only for dependents under age 6)

✓

✓

Foreign Drivers License

✓

✓

United States State Identification Card

✓

✓

Foreign Voters Registration Card

✓

✓

United States Military Identification Card

✓

✓

Foreign Military Identification Card

✓

✓

School Records (valid only for dependents under age 14 (under age 18 if a student))

✓

✓

Visa issued by United States Department of State

✓

✓

United States Citizenship and Immigration Services (USCIS) Photo Identification

✓

✓

*Passport must have a date of entry for dependents, unless they are a dependent of U.S. military personnel stationed overseas.

**May be used to establish "foreign status" only if the documents are foreign.

Check and complete the following paragraph only if the applicant is applying for an ITIN under “Exception 1(a) - Partnership Interest”.

The undersigned further certifies that the Applicant has provided a copy of the relevant pages of the Partnership Agreement of    and EIN      as documentation in support of meeting the requirements for Exception 1(a).

The undersigned further certifies that the documentation was reviewed in accordance with the procedures set forth in the Acceptance Agent Agreement and is authentic, complete, and accurate based on the information and documentation submitted by the applicant.

The Certifying Acceptance Agent shall retain copies of all relevant documents including signed copies of the Forms W-7 submitted to the IRS on behalf of the applicant upon which the Certifying Acceptance Agent has relied upon to certify the applicant’s foreign status and identity

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