WVU CU Member Application

TIN Certification And Backup Withholding Information

By completing and submitting this document, I certify, under penalties of perjury

1. that the Social Security Number (SSN)/Taxpayer Identification Number (TIN) shown is my/the correct number


2. that I am NOT, unless designated below, subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all dividends or interest, or because the IRS has notified me that I am no longer subject to backup withholding


3. that I am a U.S. person (including a U.S. resident alien)