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Fom, W-9 Request for Taxpayer Give form to the
<br /> (Rev.October2007) Identification Number and Certification requester. Do not
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue service
<br /> Name(as shown on your income tax return)
<br /> Viscount US Holdings
<br /> m Business name,if different from above
<br /> a
<br /> c
<br /> 0
<br /> aa Check appropriate box: ElIndividual/Sole proprietor © Corporation El Partnership ► Exempt
<br /> `u ❑ Limited liability company.Enter the tax classification(D=disregarded entity,C=corporation,P=partnership) -__-_-- p❑ P y
<br /> a ee
<br /> o ❑ Other(see instructions) ►
<br /> c c Address(number,street,and apt.or suite no.) Requester's name and address(optional)
<br /> a g 409-221 Esplanade
<br /> w
<br /> 0 City,state,and ZIP code
<br /> 02 North Vancouver BC V7M3J3 CANADA
<br /> m List account number(s)here(optional)
<br /> Taxpayer Identification Number(TIN)
<br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoid Social security number
<br /> backup withholding. For individuals,this is your social security number(SSN). However,for a resident
<br /> alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities, it is
<br /> your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or
<br /> Note. If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer idencation number
<br /> number to enter. r
<br /> Certification
<br /> Under penalties of perjury,I certify that:
<br /> 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
<br /> 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal
<br /> 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
<br /> notified me that I am no longer subject to backup withholding,and
<br /> 3. 1 am a U.S.citizen or other U.S.person(defined below).
<br /> Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
<br /> withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions,item 2 does not apply.
<br /> For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement
<br /> arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the Certification,but you must
<br /> provide your correct TIN.See the instructions on page
<br /> Sign Signature of `�
<br /> Here U.S.person ► �! a;'zj Date ► / )
<br /> General Instructio S Definition of a U.S. person. For federal tax purposes, you are
<br /> considered a U.S.person if you are:
<br /> Section references are to t Internal Revenue Code unless
<br /> otherwise noted. • An individual who is a U.S. citizen or U.S.resident alien,
<br /> • A partnership,corporation,company,or association created or
<br /> Purpose of Form organized in the United States or under the laws of the United
<br /> A person who is required to file an information return with the States,
<br /> IRS must obtain your correct taxpayer identification number(TIN) • An estate(other than a foreign estate), or
<br /> to report,for example, income paid to you,real estate • A domestic trust(as defined in Regulations section
<br /> transactions, mortgage interest you paid, acquisition or 301.7701-7).
<br /> abandonment of secured property,cancellation of debt,or Special rules for partnerships.Partnerships that conduct a
<br /> contributions you made to an IRA. trade or business in the United States are generally required to
<br /> Use Form W-9 only if you are a U.S. person(including a pay a withholding tax on any foreign partners'share of income
<br /> resident alien),to provide your correct TIN to the person from such business. Further, in certain cases where a Form W-9
<br /> requesting it(the requester)and,when applicable,to: has not been received, a partnership is required to presume that
<br /> 1. Certify that the TIN you are giving is correct(or you are a partner is a foreign person, and pay the withholding tax.
<br /> waiting for a number to be issued), Therefore,if you are a U-S. person that is a partner in a
<br /> 2. Certify that you are not subject to backup withholding,or partnership conducting a trade or business in the United States,
<br /> provide Form W-9 to the partnership to establish your U.S.
<br /> 3.Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
<br /> exempt payee. If applicable,you are also certifying that as a income.
<br /> U.S. person, your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
<br /> a U.S,trade or business is not subject to the withholding tax on purposes of establishing its U.S.status and avoiding withholding
<br /> foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
<br /> Note.If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the
<br /> request your TIN,you must use the requester's form if it is following cases:
<br /> substantially similar to this Form W-9. • The U.S.owner of a disregarded entity and not the entity,
<br /> Cat.No.10231X DECEIVED Form W-9 (Rev.10-2007)
<br /> OCT 17 2016
<br /> DIVISION OF RECLAMATION
<br /> MINING AND SAFETY
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