This form contains 23 fields organized into 8 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Account Number(s) (Optional)
Account Number(s) Text
Enter any account number(s) the requester uses to identify you, if applicable (optional).
Exemptions Codes
Exempt payee code Text
Enter the exempt payee code that applies to the entity, if any.
FATCA reporting exemption code Text
Enter the exemption from FATCA reporting code, if any.
Federal Tax Classification (Line 3a)
Individual/sole proprietor Checkbox
Check this box if the name entered on line 1 is an individual or a sole proprietorship.
C corporation Checkbox
Check this box if the entity on line 1 is taxed as a C corporation.
S corporation Checkbox
Check this box if the entity on line 1 is taxed as an S corporation.
Partnership Checkbox
Check this box if the entity on line 1 is taxed as a partnership.
Trust/estate Checkbox
Check this box if the entity on line 1 is a trust or an estate.
LLC Checkbox
Check this box if the entity on line 1 is a limited liability company (LLC) and you will provide its tax classification (C, S, or P) in the space provided.
LLC Tax Classification Letter Text
Enter the letter that indicates the LLC’s federal tax classification (e.g., C, S, or P) if the LLC box is selected. Fill only if 'LLC' is 'Yes'.
Max length: 1 characters
Depends on: LLC
Other (see instructions) Checkbox
Check this box if the entity’s federal tax classification is not any of the listed options and you will specify it as instructed.
Other Federal Tax Classification Text
Specify the federal tax classification if you selected the “Other” option on line 3a. Fill only if 'Other (see instructions)' is 'Yes'.
Depends on: Other (see instructions)
Foreign Partners/Owners Checkbox (Line 3b)
Has foreign partners/owners/beneficiaries (Line 3b) Checkbox
Check this box if you selected Partnership or Trust/estate on line 3a (or checked LLC and entered “P”) and the entity has any foreign partners, owners, or beneficiaries. Fill only if 'Partnership', 'Trust/estate', 'LLC', 'LLC Tax Classification Letter' meet the triggering condition (any): line 3a 'Partnership' is 'Yes' OR line 3a 'Trust/estate' is 'Yes' OR (line 3a 'LLC' is 'Yes' AND LLC tax classification is 'P').
Depends on: Partnership, Trust/estate, LLC, LLC Tax Classification Letter
Requester Name and Address (Optional)
Requester's Name and Address Text
Enter the requester's name and mailing address (optional).
Taxpayer Address
Street Address Text
Enter the taxpayer’s street address, including house or building number and any apartment or suite number.
City, State, and ZIP Code Text
Enter the taxpayer’s city, state, and ZIP code.
Taxpayer and Business Names
Name of entity/individual Text
Enter the legal name of the individual or entity requesting a taxpayer identification number.
Business name (if different) Text
Enter the business name or disregarded entity name if it is different from the name entered above. Fill only if 'Name of entity/individual' is different (business/disregarded entity name differs from line 1).
Depends on: Name of entity/individual
Taxpayer Identification Number (SSN or EIN)
SSN (first 3 digits) Text
Enter the first three digits of the taxpayer’s Social Security number.
Max length: 3 characters
SSN (middle 2 digits) Text
Enter the middle two digits of the taxpayer’s Social Security number.
Max length: 2 characters
SSN (last 4 digits) Text
Enter the last four digits of the taxpayer’s Social Security number.
Max length: 4 characters
EIN (first 2 digits) Text
Enter the first two digits of the taxpayer’s Employer Identification Number.
Max length: 2 characters
EIN (last 7 digits) Text
Enter the last seven digits of the taxpayer’s Employer Identification Number.
Max length: 7 characters