Oha Form W-9 - Request For Identification Number And Certification
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3OHA FORM W-9 – REQUEST FOR IDENTIFICATION NUMBER AND CERTIFICATION
Purpose of this form: for vendors and grantees to provide OHA a taxpayer identification number (TIN) and certification for issuance of
payment. This form is substantially similar to the IRS Form W-9 – Request for Taxpayer Identification Number and Certification. This
form is also used for obtaining volunteer information and information relating to reimbursement requests for non-employees.
All information obtained herein is confidential and will be held confidentially by Office of Hawaiian Affairs.
Return form to:
Office of Hawaiian Affairs
Attention Vendors & Grantees!
711 Kapiolani Blvd, Suite 500
See OHA NOTICE TO VENDORS & GRANTEES
Honolulu, Hawaii 96813
for further details
Attn: Accounts Payable – Admin Services
Name (as shown on your income tax return)
Business name, if different from above
Check appropriate box:
Individual/Sole Proprietor
Limited Liability Company
Corporation
(for profit)
Government Agency
Partnership
Corporation
(non‐profit)
Other (indicate)
Address (number, street, and apt. # or suite #)
City, State, and ZIP code
Mailing Address (if different from above)
Part I – Taxpayer Identification Number (TIN)
Social Security #
For Vendors and Grantees – Enter your TIN in the appropriate box. The TIN provided must
match the name given on Line 1 to avoid backup withholding. For individuals, this is your
social security number (SSN). For other entities, it is your federal identification number (FIN)
OR
or employer identification number (EIN).
Other information (optional)
Federal Identification #
Part II – Certification
For Vendors and Grantees – Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, 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 or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding,
and
I am a U.S. citizen or other U.S. person
3.
Sign Here
Title
Date
Attention Vendors & Grantees!
For Admin Services Use ONLY
See OHA NOTICE TO VENDORS & GRANTEES
OHA Vendor # _______________
for further details
Date Received: _______________
Last Revised 02/05/2010
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