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• <br /> • <br /> ACCOUNT NUMBER 24457 <br /> VERIFICATION/FOLLOW-UP <br /> ADDITIONAL INSTRUCTIONS OR COMMENTS <br /> TAXPAYER IDENTIFICATION NUMBER CERTIFICATION Exempt payee code, if any: <br /> Under penalties of perjury, I certify that: Exemption from FATCA reporting code, if any: <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.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 <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 (Notice: If you are subject to backup withholding, cross out this line), and <br /> 3.I am a U.S. citizen or other U.S. person (defined in the W-9 Instructions), and <br /> 4.The F•TCA code(s)entered on this orm (if any) indicating that I am exempt from FATCA reporting is correct. <br /> Taxpayer Identification Number:81-4601941 <br /> 'flab/L-1 ///9/20/ <br /> SIGNA URE Sun•'se Mining T T,C DATE <br /> ADDITIONAL TERMS <br /> IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT <br /> To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, <br /> verify, and record information that identifies each person who opens an account. <br /> What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to <br /> identify you.We may also ask to see your driver's license or other identifying documents. <br /> ACKNOWLEDGMENT <br /> By signing this document,the undersigned,if not specified below as an Authorized Signer only,acknowledge that they have authority to open and have opened <br /> the type of account designated above.The undersigned acknowledge that they have received, understand and agree to be bound by the terms of the Account <br /> Agreement for that account type.The undersigned certify that all information provided to the institution is true and accurate.All signers acknowledge that they <br /> are acting on behalf of the business entity, and they have the authority to act on behalf of the business entity to the extent indicated in a validly executed <br /> business resolution.The undersigned acknowledge receipt of a copy of this institution's Privacy Policy, and where applicable, the Funds Availability Policy. All <br /> signers authorize this institution to make inquiries from any consumer reporting agency,including a check protection service,in connection with this account. <br /> NUMBER OF SIGNATURES REQUIRED: 1 1❑ FACSIMILE ALLOWED <br /> El Authorized Signer only. Title: Division Director ❑ Authorized Signer only.Title: <br /> X \./ <br /> J7x <br /> Virginia Brannon Date Date <br /> ❑ Authorized Signer only. Title: E Authorized Signer only. Title: <br /> X X <br /> Date Date <br /> FOR INSTITUTION USE <br /> Complence Systems,Inc.2000.2015 ITEM 61511A1.2(10120151 Paye 2 of 2 www.cotnpliancesystems.com <br />