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This is a simple Markdown document with no headings or paragraphs. It contains just one line of text.¶
Montpelier Trust¶
For Trust Accounts: Y1 45170 Y1 45172 Y1 45171¶
Check here if you have been notified by the IRS that you are subject to backup withholding, and therefore have crossed out paragraph 2 in the Certification below.¶
Exempt Payee Code (if any) ___¶
If your organization is tax exempt please enter the appropriate code¶
(codes 1 through 13 in the W9 instructions)¶
Exemption from FATCA reporting code (if any):___¶
W-9 Form Certification¶
Under penalties of perjury, I 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 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 and 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 (defined in the instructions), and (4) The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.¶
The Client Relationship Agreement contains a pre-dispute arbitration clause located in the final section under the title “Arbitration.”¶
Certification Instruction: 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.¶
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.¶
Address of Record¶
155 Seaport Boulevard¶
ATTN: Nutter McClennen & Fish LLP¶
Borton, MA 02310-2699¶
Boston, MA 02210-2698¶
Email Address of Record¶
Page 2 of 2¶
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This is a simple Markdown document with no headings or paragraphs. It contains just one line of text.¶