Insurance Claims Packet

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Insurance Claims Packet

Insurance Claims Process

Dear Member:

To make your insurance claim process as easy as possible and to help guide you through the process, we’ve enclosed the forms you’ll need and a copy of our Frequently Asked Questions. Please review all the information carefully. The following outlines the steps you’ll need to take if you have property damage.

Step 1. Contact your insurance company. Your first step is to contact the insurance company that issued your homeowner’s policy and file a claim. Find out when an adjuster will come and when to expect any claim checks. You can find your insurance provider’s name and/or policy number by signing in to your account and clicking on your mortgage account number.

Step 2. Call us after you file a claim. Call 1-800-531-7174, ext. 46440, and choose option 1. We’ll provide you important details on how to process your claim check and how we’ll be involved in the process to restore your home. When you receive your insurance check, you’ll notice that Navy Federal Credit Union is named on it. That’s because as the mortgage provider, we have a financial interest in ensuring your property is restored. Remember—whether you have minor or significant damage or even a complete loss, we’ll work with you to review all your options.

Step 3. Sign the declaration form and return it to us. A signed declaration form is required to complete the processing of your insurance claim. Both the borrower and the co-borrower (if applicable) must sign the form, as well as all other payees (if applicable). In some cases, the contractor performing the repairs on your property will be required to sign a Contractor Declaration if the claim check is issued with the contractor’s name. We’ve enclosed both forms for your convenience.

Once completed, please mail or eMessage the signed declarations(s) to us. You may also bring any documents regarding your claim to your local Navy Federal Credit Union branch. Be sure to retain a copy for your records.

Mailing Address: Navy Federal Credit Union ATTN: Mortgage Insurance Claims Department 820 Follin Lane SE Vienna, VA 22180

Phone: (800) 531-7174, ext. 46440, option 1

If you have any questions about the insurance claims process, please contact your Navy Federal Insurance Claims Specialist or call 1-800-531-7174, ext. 46440, option 1. We’re happy to help you through this process and are here to answer any questions.

Sincerely,

Navy Federal Credit Union Mortgage Insurance Claims Department

IMPORTANT INFORMATIONHere’s what you can do to ensure a smooth claims process:

1. Send us a copy of the insurance adjuster’s report/estimate/Scope of Loss.

2. Keep track of all expenses and save your receipts.

3. Once you select a contractor, send us a copy of the signed contract and a copy of the contractor’s W-9 and business license. A copy of the W-9 form is included in this packet.

4. Once the repairs are completed, please call your Insurance Claims Specialist to set up a final inspection.

5. If you need someone else to act on your behalf, complete the Durable Power of Attorney that is included in the packet. Sections H and J must be completed.

Note: At different points during the claims process, Navy Federal may order inspections for a status update of the repairs before additional draws can be authorized. Additional member and contractor affidavits may be required.

Federally insured by NCUA.

Insurance Claims Frequently Asked Questions

How do I file an insurance claim? Contact your insurance company or agent to file the claim, and be sure to do what’s needed to prevent further damage to your property. Once you have filed your claim, please contact us so that we can guide you through the next steps.

Why is Navy Federal Credit Union a payee on my insurance claim check? As your lender, Navy Federal has a financial interest in your property and, as such, is named as a loss payee on your insurance policy. Navy Federal works closely with you to ensure that your property is restored as required in your Mortgage or Deed of Trust.

Depending on the size of your insurance claim, Navy Federal will either endorse the check and return it to you, or for larger claims, we will deposit it on your behalf into an account known as Restricted Escrow and disburse it in installments as repairs are completed.

For guidance regarding your specific claim, contact your Insurance Claims Specialist or call the Insurance Claims Department at 1-800-531-7174, ext. 46440, option 1. You may also send us a secure message.

Can I have my claim check deposited at my local branch? You may visit your local branch for assistance with your insurance claim check. When you arrive, the member service representative will work with you and an Insurance Claims Specialist to review forms and determine whether your insurance claim proceeds can be deposited into your Navy Federal checking or savings account or whether it needs to be deposited on your behalf into a Restricted Escrow Account. Alternatively, you may call the Insurance Claims Department directly at 1-800-531-7174, ext. 46440, option 1, to review your options before visiting.

Can I deposit my claim check via ATM or mobile deposit? Your insurance claim check must be endorsed by all parties, including Navy Federal, in order to be deposited via an ATM or mobile deposit. To avoid delays due to improper endorsement, please contact your Insurance Claims Specialit or the Insurance Claims Department at 1-800-531-7174, ext 46440, option 1.

Can I pay off my mortgage with the insurance claim check? Yes. You can pay off your mortgage with the insurance claim check if there are sufficient funds to pay all outstanding mortgage loans for the damaged property. You may discuss this option with your Insurance Claims Specialist.

What if my insurance claim check includes funds for personal property and/or loss-of-use coverage? Any portion of your claim designated for personal property or loss-of-use coverage will be released to you immediately.

Will I earn a dividend if my funds are held in restricted escrow? Yes. This dividend is paid monthly and deposited to the regular escrow account.

I’ve been asked to provide the Scope of Loss. What is it? The Insurance Claims Specialist will ask you to provide the Scope of Loss, which is the itemized detail of damages prepared by the insurance adjuster who inspected the damages. It’s usually provided with the insurance claim settlement check or may be available online in your claim records at your insurance company.

How long do I have to complete repairs? Repairs should be initiated as soon as possible. Completion may be based on the Scope of Loss, which is provided by your insurance company. It will depend on the severity of the damage. Some repairs take longer than others.

Do I need to hire a licensed contractor to do the repairs? To protect your interests and those of Navy Federal Credit Union, a licensed and qualified contractor may be required to complete the necessary property repairs. As individual situations differ, please contact your Insurance Claims Specialist for details.

Am I required to have an inspection completed? Depending on the extent of the damage to your property, one or more inspections may be required. If that is the case, your Insurance Claims Specialist will order the inspection(s) of the repaired damages from a third-party vendor. The vendor will contact you to set up an appointment at your convenience and will inspect and document the completed repairs. All costs associated with the inspection are paid by Navy Federal.

© 2020 Navy Federal NFCU 1998-PK (7-20)

Borrower’s Name Borrower’s Signature Date

Co-Borrower’s Name Co-Borrower’s Signature Date

MEMBER(S) NAME(S):

LOAN NUMBER:

PROPERTY ADDRESS:

CITY, STATE, ZIP:

INSURANCE CLAIM AMOUNT: $


Federally insured by NCUA.© 2018 Navy Federal NFCU 26A (11-18)

P.O. Box 3000 Merrifield, VA 22119-3000

Member Declaration

I/We certify and agree (i) that the insurance claim amount listed above (“Claim Funds”) will be used solely for the repair of the above-referenced property according to the estimate of loss provided by the insurance company; (ii) that I/we will not allow a materialman’s and/or mechanic’s lien to be filed, recorded, or placed against the above-referenced property in connection with the completed repairs; and (iii) that I/we release and indemnify Navy Federal from any liability associated with the Claim Funds including, but not limited to, workmanship of the contractor, any breach of contract, and damages caused by the contractor.

Upon receipt of this Declaration, please sign and return it to expedite the release of the Claim Funds. I/We also understand that Claim amounts greater than $10,000.00 may be subject to increased monitoring, up to and including a final inspection before all Claim Funds are released, as determined solely by Navy Federal.

_________________________ _____________________

MEMBER NAME:

LOAN NUMBER:

PROPERTY ADDRESS:

CITY, STATE, ZIP:

INSURANCE CLAIM AMOUNT: $

Authorized Representative (Printed Name) Authorized Representative Signature Date

Title Company Name

Address Street

City State Zip Code


Federally insured by NCUA. P.O. Box 3000 Merrifield, VA 22119-3000© 2018 Navy Federal NFCU 26B (11-18)

Contractor’s Final Payment Declaration

I hereby certify, affirm, and agree on behalf of the Company listed below and under the penalty of perjury that the following information is based on my personal knowledge, and is true and accurate to the best of my knowledge:

1) Company is licensed to perform work in the jurisdiction in which the above-referenced property is located. Its license number, if applicable, is ; its Tax ID Number is ; and I have the authority to sign on behalf of the Company.

2) Pursuant to a contract with the above-referenced Member, Company has furnished or caused to be furnished labor, materials, and/or services for certain improvements and/or repairs to the above-referenced real property, as set forth in said contract or the estimate of loss provided by the insurance company.

3) All work to be performed under the contract or estimate of loss has been fully completed, and all subcontractors or other entities or individuals that performed or provided work, services, or materials have been paid in full.

4) Provided Company receives final payment for the work, Company shall keep the above-referenced property free and clear of any materialman’s and/or mechanic’s liens. Company, for itself and its subcontractors, other entities, or individuals of all tiers, shall execute lien releases, as requested or required, in commercially reasonable forms to Navy Federal or as otherwise provided by applicable law.

5) The insurance claim funds listed above will be released once Navy Federal has received this signed Declaration. Company agrees such payment of funds will represent the final payment for any and all amounts due under the contract or estimate of loss, and that the payment will be made payable to the Member and Company.


Page 1© 2017 Navy Federal NFCU 94 (11-17)

Durable Power of Attorney

Carefully read any Power of Attorney (POA) before you sign the document. You should consult your own attorney regarding its purpose or legal rights that are affected by the grant of such power to another person. Your particular circumstances may indicate the need for granting either broader or more restrictive rights than are provided for in this document. If you do not understand any provisions or language in this form or have any questions, you should consult your own attorney. By signing this form, you are acknowledging that you understand the content and information provided.

Notice and InformationThis document is being provided for your convenience to use only with your Navy Federal Credit Union (NFCU) accounts. Nothing in this document should be construed as providing you with any legal advice. By this NFCU POA, you are giving another person you designate (your Attorney-in-Fact (AIF) or agent) broad powers to handle your finances and personal property with NFCU, which may include powers to encumber, sell, or otherwise dispose of any property held at NFCU without any advance notice to you or approval by you. THE POWERS GRANTED UNDER THIS POA ARE EFFECTIVE IMMEDIATELY, ARE DURABLE, AND WILL REMAIN IN EFFECT EVEN IF YOU BECOME DISABLED OR INCAPACITATED. It is important that you designate someone as your AIF that you trust with your assets and financial information. If you wish to revoke or stop your AIF from acting, you must revoke this POA and, if desired, complete a new POA. You have the right to revoke this POA form at any time by destroying it or by signing a written and dated statement expressing your intent to revoke this document. You must inform NFCU of the revocation as NFCU can permit transactions to occur pursuant to this POA until NFCU is notified of the revocation. A verbal notice of revocation is permitted, but you must confirm the revocation with a written notice to NFCU. You should also notify your AIF and anyone you provided a copy of the POA that it has been revoked. You can only have one NFCU POA in effect at any given time. If you execute and submit a subsequent NFCU POA, then you agree that by doing so you have revoked any prior NFCU POA so that only the latest one is in effect. Please note that if you subsequently execute a non-NFCU POA that revokes all previous or prior POAs and that non-NFCU POA is submitted to NFCU, then that language will also revoke this NFCU POA. This document does not authorize anyone to make medical or other health care decisions for you. If you have other assets or specialized business matters outside of NFCU, this document does not address any of those assets or matters. You will need to seek advice from your own attorney in order to address those assets or matters. The laws of the Commonwealth of Virginia shall apply to this POA without giving effect to the principles of conflict of laws as it relates to NFCU.

© 2017 Navy Federal NFCU 94 (11-17) Page 2

Navy Federal


Form Instructions

If you decide to use the NFCU Durable POA, please read and follow the instructions below:

1. Complete this form in its entirety. This includes filling out your information and the information for your AIF, and co-AIF and/or a Successor AIF, if applicable. This information is required in order for us to correctly identify your AIF(s) and you. Any reference to the AIF will include the co-AIF if you appoint a co-AIF.

2. All applicable information fields in Sections A through G of this form must be filled out. If not applicable, please mark the field as “N/A.”

3. In order to grant and/or deny powers, your initials are required in the respective “Yes” or “No” boxes in Sections H through K for each group of powers or each specific power. If a box is not initialed, then it will be deemed that the specific authority will have not been given by you.

4. There are certain notices that must be included in this document and signed by you and your AIF, if applicable, depending on the law in the state where you live.

5. Remember that this POA is only valid for powers related to financial business with NFCU. You may limit the AIF’s powers to certain accounts in Section G, if needed.

6. Your signature must be acknowledged before either a notary public or a person authorized under 10 USC § 1044a to perform a notarial act for members of the armed forces.

7. You will also need two (2) unrelated and disinterested individuals who must be at least 18 years old to witness your signature on this POA.

8. If no expiration date is specified, then this POA document will remain in effect until it is revoked by you; it is superseded by a subsequent NFCU POA or non-NFCU POA; it is superseded by a court order or the appointment of a Guardian/Custodian/Conservator; or your death.

9. You have the option of appointing a Successor AIF in case your first designation dies, becomes incapacitated or incompetent, or is unwilling to serve. If you appoint a co-AIF, then your Successor AIF designation will not become effective unless and until both the AIF and co-AIF die, become incapacitated or incompetent, or are unwilling to serve. Your Successor AIF will have the same powers and authority as your original AIF. Acceptable written notification will be required to document that the Successor AIF will be taking over in place of your original AIF, and co-AIF if applicable. Acceptable documentation includes a death certificate or court order for your original AIF, a physician’s statement that your original AIF is unable to manage his/her financial affairs, or a written, notarized resignation statement from your original AIF.

Submitting This POA to NFCU

You or the AIF can send this POA to NFCU through fax, email, or eMessage, or present it at a branch. Please note that before your AIF can take any action on your behalf using this POA, your AIF and co-AIF, if applicable, will have to provide a copy of his/her valid, government-issued photo ID or NFCU Access Number. If additional information is needed, an NFCU representative will contact you or your AIF within two (2) business days of receipt of the POA.

Fax: 703-206-1373

Email: [email protected]

Mail: Navy Federal Credit Union, Attn: RS Power of Attorney P.O. Box 36460, Pensacola, FL 32526-6460

eMessage Instructions: Log in to Navy Federal Online Banking, and then click “Messages” and “Send us a message.” Please make sure to include both the POA and a copy of a valid, government-issued photo ID for the AIF and co-AIF, if applicable.

mailto:[email protected]

Current Home Address: Cannot Be a Post Office Box

Mailing Address: If Different From Above Address

Driver’s License or Government-Issued

© 2017 Navy Federal NFCU 94 (11-17)

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Name: First MI Last Suffix

Navy Federal Access No. Social Security No. (SSN) or ITIN



Street City State Zip Code


ID No. or State ID No.

Issue Date (MM/DD/YY) Exp. Date (MM/DD/YY)

Email Address Home Phone Mobile Phone

Military Power of Attorney (If Applicable)

PREAMBLE: This is a MILITARY POWER OF ATTORNEY prepared pursuant to Title 10, United States Code, §1044b, and executed by a person authorized to receive legal assistance from the military services. Federal law exempts this power of attorney from any requirement of form, substance, formality, or recording that is prescribed for powers of attorney by the laws of a state, the District of Columbia, or a territory, commonwealth, or possession of the United States. Federal law specifies that this power of attorney shall be given the same legal effect as a power of attorney prepared and executed in accordance with the laws of the jurisdiction where it is presented.

A. Principal/Member Information (You)

OR

B. Your Attorney-in-Fact Information

OR

Contact Information








Navy Federal





Street City State Suffix











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C. Your Co-Attorney-in-Fact Information (if applicable)

OR

Contact Information

D. Your Successor Attorney-in-Fact Information (if applicable)

OR

Contact Information

Name of Attorney-in-Fact (AIF)


Navy Federal


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☐ (provide specific date).(MM/DD/YYYY)

☐

Account Number Account Number Account Number Account Number



Name of Principal (your name)

Name of Co-Attorney-in-Fact (if applicable), or N/A

_______________________________________________________ ______________________________________________________

____________________________________________________

__________________________________________Name of Successor Attorney-in-Fact (Successor AIF)

E. POA Type & Expiration Date. Please place your initials in the applicable box.

This POA is Durable (POA is still valid even if you become incapacitated, disabled, or incompetent).

Choose one of the two options below:

This POA expires on

If no expiration date is indicated, this POA will expire 12 months from the date executed.

OR

This POA does not have an expiration date.

F. Authorization

I, , hereby appoint and

as my Attorney-in-Fact (AIF), to act in my name and on my behalf with NFCU for all actions as

authorized in Sections H through K of this document on accounts identified in Section G where I have an ownership interest. This POA will be governed

by the laws of the Commonwealth of Virginia. If I have appointed an AIF and co-AIF to serve hereunder, then either one of them may act alone, and any

reference to my AIF will also apply to my co-AIF. I intend for my AIF to act for me and in my place with NFCU as necessary, pursuant to my AIF’s fiduciary

duty, as permitted by law, and as specifically designated below. Should my AIF no longer choose to or is no longer capable of acting on my behalf,

then I appoint as my Successor AIF, who may perform the same authorized actions as specified in

this document. If a co-AIF is appointed, then the Successor AIF only becomes effective if both the AIF and co-AIF can no longer act because they die,

become incapacitated or incompetent, or are unwilling to serve. By signing this document, I acknowledge that I have read this POA in its entirety and

understand the authority that I am granting my AIF, and co-AIF and Successor AIF, if any, to act on my behalf through this document until such date

that the document expires, is revoked, or is terminated, or I die, whichever shall first occur. I agree to hold NFCU and its employees, agents, directors,

management, and successors harmless from any and all liability, losses, claims, fees, costs, attorney fees, or other penalties that may arise from any

actions completed by my AIF, co-AIF, or Successor AIF, as specified in this document.

G. Navy Federal Account Information

Initial next to the accounts on which the AIF may perform authorized actions.

All my NFCU accounts where I have an ownership interest (current and future accounts)

All these types of NFCU accounts where I have an ownership interest (initial all applicable account types)

Checking Savings Certificate IRA Credit Card

Money Market Mortgage Loan Home Equity

Distinction may be made between multiple accounts within a given account type with account numbers below:

Only the account numbers specified below in Section G of this document.


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____________ ____________

Yes

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No

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No

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H. General Account Services (Please initial either the “Yes” or “No” box for each action, where “Yes” authorizes your AIF to perform that action.)

Yes NoAll actions outlined in Section H are permissible. (There is no need to initial any other boxes if “Yes” is initialed.)

Make cash withdrawals.

Write, draft, order, or stop payment on checks.

Sign, endorse, or cash checks payable to me.

Initial next to the accounts that the AIF may open (excludes consumer loan and credit card accounts–see Section I).

Checking Savings Money Market

Certificate IRA Retirement

Initial next to the accounts that the AIF may close (excludes consumer loan and credit card accounts–see Section I).

Checking Savings Money Market

Certificate IRA Retirement

Request new or replacement debit card for new or existing accounts in my name only.

Request replacement credit card for existing accounts in my name only.

Modification of original depository account terms and types (excludes consumer loans and credit cards–see Section I).

Transfer funds from NFCU accounts (this does not include online transfers–see Section K).

Transfer funds to non-NFCU accounts (this does not include online transfers–see Section K).

Access, update, or change general account information (such as phone or address).

Receive statements, notices, information, or similar documents related to savings and checking accounts.

Transfer account funds to AIF or AIF’s accounts.

Submit claim or file fraud for unauthorized charge.

Create or change survivorship rights or beneficiaries on Payable on Death (POD) accounts.

Create or change survivorship rights or beneficiaries on IRA accounts.

Enroll or un-enroll checking accounts in Optional Overdraft Protection Service (OOPS).


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____________ ____________

Yes

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No

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Yes

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No

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Yes

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No

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Yes

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No

____________ If a maximum credit limit is desired, enter amount (if no limit, enter “N/A”): _____________________________

Yes

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No

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No

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_

I. Lending Services (Please initial either the “Yes” or “No” box for each action, where “Yes” authorizes your AIF to perform that action.)

Yes NoAll actions outlined in Section I are permissible. (There is no need to initial any other boxes if “Yes” is initialed.)

Apply for a new credit card in my name.

Issue credit card in my name only.

Issue credit card in AIF’s name and/or my name.

Add my name as co-signer for credit card account to apply for a new credit card.

Add AIF as authorized user on existing credit card account.

Request a limit increase on credit card account.

Apply for a new:

collateral loan

signature/unsecured loan

loan secured by Savings/Certificate

Add my name as co-applicant for:

collateral loan

signature/unsecured loan

Apply for a new checking line of credit or request an increase on existing checking line of credit.

Modification of original consumer loan (secured or unsecured) account terms and types.

Authorization to modify payments, request extensions, or settle accounts.

Apply, enroll, change, or cancel Guaranteed Asset Protection (GAP) or Payment Protection Plan (P3) coverage, as applicable for existing coverage for any loan product.

Notice: I understand any credit card, debt, or loan established in my name as principal (as primary borrower or co-borrower) is an extension of credit to me, and I agree to all terms, conditions, and repayment obligations.


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Yes

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No

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No

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No

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J. Real Estate (Please initial either “Yes” or “No” box for each action, where “Yes” authorizes your AIF to perform that action.)

A separate POA is required for real estate transactions. Please contact an attorney if you require a POA for real estate transactions.

Yes No To access general information about my mortgage, including statements, tax documents, and any documents related to my mortgage account.

To perform modifications to my existing NFCU mortgage accounts that do not require a settlement/closing transaction.

K. Online Banking (Please initial either the “Yes” or “No” box for each action, where “Yes” authorizes your AIF to perform that action.)

Choose one of the two options below:

To add the AIF as an authorized user on my Navy Federal Online Banking for access to my accounts. Important: Selecting “Yes” for this action permits your AIF to use only features available on NFCU’s website as an Authorized User. This includes viewing Online Banking information, setting up and canceling withdrawals, transfers, payments, and Bill Pay, and updating information, loans, statements, reports, notices, disclosures, documents, correspondence, or other documents related to all accounts. If you select this option and/or grant access to your AIF through Online Banking, then this election will supersede any limitations or unselected powers that may be granted to the AIF in Sections G, H, I, or J above.

OR

To add the AIF as an authorized user on my Navy Federal Online Banking for limited access to my accounts. Important: Selecting “Yes” for this action permits your AIF to use features as an Authorized User that you select through your privileges through your Online Banking. You are responsible for selecting only those features or services available on NFCU’s website to provide to your AIF as if they were you. This includes viewing information on Online Banking, setting up and canceling withdrawals, transfers, payments, and Bill Pay, and updating information, loans, statements, reports, notices, disclosures, documents, correspondence, or other documents related to all accounts. If you do not limit access through Online Banking, then your AIF will have all available access to your accounts as an Authorized User through Online Banking.

(Notary Seal/Stamp)


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_____________________________________________ _________________________________________________ _______

_____________________________ _____ _________________________________________________

____________________________________________________

Notary Public

My commission expires on ____________________________.

__________________________________________________________________________________________

_______________________________________________________________________ ______

_________________________ ______ _____________________________________________________________Principal

Organization Duty Station

Signature of Person Authorized to Perform Notarial Act Printed Name

Grade Armed Force

Signature of Witness

▸Print Name Date (MM/DD/YY)

Signature of Witness

▸Print Name Date (MM/DD/YY)

Signature of Principal (required)

▸Date (MM/DD/YY)

L. Principal Signature (Please note that before your AIF can take any action on your behalf using this POA, your AIF will have to provide a copy of his/her valid, government-issued photo ID or Navy Federal Access Number.)

By signing below, I ratify and confirm any and all instructions, transactions, dealings, or other lawful acts done or caused to be done by my AIF pursuant to this NFCU Durable POA. I agree that any revocation or termination of this POA is ineffective until NFCU receives proper notice of such revocation or termination; and I further agree that any subsequent POA submitted to NFCU will make this POA ineffective. Notwithstanding my insertion of a specific expiration date herein, if on the specified expiration date herein I shall be, or have been, carried in a military status of “missing”, “missing-in-action”, or “prisoner of war”, then this NFCU Durable POA shall automatically remain valid and in full effect until sixty (60) days after I have returned to United States military control following termination of such status.

M. Witnesses

Due to various state laws, NFCU requires two witnesses to witness the Principal’s signature and to sign this POA. The AIF is not allowed to sign as a witness. Witnesses must be at least 18 years old, disinterested to the POA, and unrelated to the Principal and AIF(s).

N. Civilian Notary Public (Option 1)

State of: , County of: . On this day of

, 20 before me, , a Notary Public for the aforementioned

state, personally appeared , who proved to me through satisfactory, government-issued

identification, to be the person whose name is signed on this NFCU Durable POA, and acknowledged to me that this document was signed

voluntarily for its stated purposes.

O. Military Acknowledgment (Option 2) (if acknowledged before a person authorized to perform notarial acts for members of the armed forces by 10 USC § 1044a)

With the United States Armed Forces at: ,

I, , the undersigned, do hereby certify that on this day

of , 20 before me, personally appeared ,

who signed and executed the foregoing NFCU Durable POA. I do further certify that I am at the date of this certificate authorized under

10 USC § 1044a to perform notarial acts for members of the armed forces, and that by statute no seal is required on this certificate.


Navy Federal

Frequently Asked Questions About the Navy Federal Durable Power of Attorney Form

What is a POA?A Power of Attorney (POA) is a document signed by one person, known as the Principal, authorizing another person to act as an Attorney-in-Fact (AIF) on his or her behalf. Examples of NFCU Members who wish to use a POA may include those on Active Duty, preparing for deployment, or physically incapacitated, or any adult Member who wants to have someone with the ability to take actions for them. They may appoint a family member or trusted individual to care for their finances. If you have any further questions about this NFCU POA, you should contact an attorney.

How long is this POA valid?This POA will remain in effect until any one of the following situations occurs:

• The expiration date, if one is specified on this POA

• This POA is properly revoked or terminated

• This Principal is deceased

• This POA is terminated by court order, such as the appointment of a Guardian/Custodian/Conservator

How do I revoke this POA?This document may be revoked by you at any time. However, the AIF’s authority will only end once NFCU is properly notified of the revocation. To revoke this document, please fill out the POA Letter of Revocation available at any NFCU branch location or online at navyfederal.org and follow the instructions listed on the revocation form (NFCU Form 116). Once revoked or terminated, the same POA cannot be reinstated or used again; a new POA must be completed to authorize an AIF to take actions on your behalf.

Can I use this POA with other financial institutions?No, this document is only valid for business with NFCU.

Can I use this POA for any type of transaction?This POA can be used for most transactions with NFCU. This POA may not cover all situations—in some cases, a separate POA may be required for real estate transactions or items held in a trust. If you have further questions regarding this document, you should contact an attorney.

Can I use this POA with NFCU subsidiaries?No, this document cannot be used for Navy Federal Financial Group (NFFG), Navy Federal Brokerage Services (NFBS), or Navy Federal Asset Management (NFAM) business or services. A separate POA will need to be signed by you for your specific transactions with these entities.

Does this POA need to be notarized? Yes, this POA must be notarized to be valid. Virginia law applies; however, due to various state laws, we require two (2)unrelated and disinterested individuals who must be at least 18 years old to witness your signature on this POA.

As a courtesy to our Members, NFCU offers free notary services at many of our branches. This POA can also be signed with a Military Acknowledgment before those persons authorized pursuant to 10 USC § 1044a.

What is a Durable POA?A Durable POA means that the document remains effective even in the event that you become incapacitated, disabled, or incompetent. Your AIF may still conduct financial business with NFCU even after you are unable to do so. The NFCU POA form is a Durable POA.

http://navyfederal.org/


Navy Federal

Frequently Asked Questions About the Navy Federal Durable Power of Attorney Form (continued)

What is a springing POA?A springing POA means that the document does not become effective until a specific condition occurs. The condition can be a variety of options, such as a specific date or that the POA is not effective until the Principal (you) becomes incapacitated, disabled, or incompetent. The NFCU POA form does not provide for it to be a springing POA.

Does my AIF have to be a Member of NFCU?No. Your AIF can be anyone you choose, a Member or non-Member.

What is a co-AIF? Do I have to have one?A co-AIF is a second person you can designate and authorize to act on your behalf along with your original AIF. If you appoint a co-AIF, then either your AIF or co-AIF can act alone without the other’s agreement or consent. No, you do not have to appoint a co-AIF as that is optional.

What is a Successor AIF?A Successor AIF is a secondary agent that can take the place of your original AIF. This happens if your original AIF no longer wishes to act as your agent, becomes incapacitated, disabled, or incompetent, or is deceased. Appointment of a Successor AIF is optional. If you appoint a co-AIF, then your Successor AIF will only become effective if both the AIF and co-AIF no longer wish to act or they are unable to act because they are incapacitated, disabled, incompetent, or deceased.

Can I limit the use of this POA?Yes, you can limit the powers you grant to your AIF within this POA.

Can I modify this POA?No, you cannot make modifications to this POA after it is executed and notarized. In order to make changes, you must revoke this POA, provide notice to NFCU of the revocation, execute a new POA, have it notarized and witnessed, and submit it to NFCU.

Do I give up my rights by signing this POA?No, you can always contact NFCU and we will contact you if needed or required by law or regulation.

Can I use this POA for real estate transactions?No, this POA cannot be accepted for certain real estate transactions, such as a mortgage application or settlement for purchase, refinance, or equity loans. However, it may be used to allow your AIF to obtain your mortgage information, to make payments, or for other requests for servicing of the loan. Because this document is only valid with NFCU, it is not valid with settlement agencies and/or other third parties generally involved in real estate transactions. You should contact an attorney if you need a POA specific to a real estate transaction.

Does this POA grant online access through Navy Federal Online Banking?If you specifically select the section to allow online access to your AIF, then your AIF will be permitted electronic access as an Authorized User to all your current and future NFCU accounts, as well as to carry out many types of transactions permitted to an Authorized User through Online Banking, including online Bill Pay (note that some features will be restricted, such as applying for a credit card). You may limit your AIF’s access to certain services online by using the “Manage Privileges” feature in the “Authorized Users” section under “Settings” in Online Banking. If you do not limit the access, then your AIF will have access to all your accounts and most features/services as an Authorized User.

►

Pri

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1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

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►

Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)

5 Address (number, street, and apt. or suite no.) See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Social security number

– –

Employer identification number

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Signature of U.S. person ► Date ►

Form W-9 (Rev. 10-2018)Cat. No. 10231X

Form W-9(Rev. October 2018)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the requester. Do not send to the IRS.

See

Spe

cific

Inst

ruct

ions

on

pag

e 3. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the

following seven boxes.

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions)

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

(Applies to accounts maintained outside the U.S.)

Part I Taxpayer Identification Number (TIN)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 generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

or

Part II CertificationUnder penalties of perjury, I certify that:

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); and2. 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

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

http://www.irs.gov/FormW9

http://www.irs.gov/FormW9

Form W-9 (Rev. 10-2018) Page 2

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.3. The article number (or location) in the tax treaty that contains the

saving clause and its exceptions.4. The type and amount of income that qualifies for the exemption

from tax.5. Sufficient facts to justify the exemption from tax under the terms of

the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup WithholdingWhat is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the instructions for Part II for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships, earlier.

What is FATCA Reporting?The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your InformationYou must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies.

PenaltiesFailure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.


•

•

•

Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific InstructionsLine 1You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.

a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.

b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.

c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.

d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.

e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Line 2If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2.

Line 3Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3.

IF the entity/person on line 1 is a(n) . . .

THEN check the box for . . .

Corporation Corporation

• Individual • Sole proprietorship, or • Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes.

Individual/sole proprietor or single-member LLC

• LLC treated as a partnership for U.S. federal tax purposes, • LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes.

Limited liability company and enter the appropriate tax classification. (P= Partnership; C= C corporation; or S= S corporation)

Partnership Partnership

Trust/estate Trust/estate

Line 4, ExemptionsIf you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you.

Exempt payee code.• Generally, individuals (including sole proprietors) are not exempt from backup withholding.

• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.

• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.

The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.

1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2—The United States or any of its agencies or instrumentalities

3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

4—A foreign government or any of its political subdivisions, agencies, or instrumentalities

5—A corporation

6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession

7—A futures commission merchant registered with the Commodity Futures Trading Commission

8—A real estate investment trust

9—An entity registered at all times during the tax year under the Investment Company Act of 1940

10—A common trust fund operated by a bank under section 584(a)

11—A financial institution

12—A middleman known in the investment community as a nominee or custodian

13—A trust exempt from tax under section 664 or described in section 4947


The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt for . . .

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be reported and direct sales over $5,0001

Generally, exempt payees 1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, and its instructions.2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup

withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B—The United States or any of its agencies or instrumentalities

C—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities

D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)

E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)

F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G—A real estate investment trust

H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I—A common trust fund as defined in section 584(a)

J—A bank as defined in section 581

K—A broker

L—A trust exempt from tax under section 664 or described in section 4947(a)(1)

M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.

Line 5Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, write NEW at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your address in their records.

Line 6Enter your city, state, and ZIP code.

Part I. Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN.

If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

Part II. CertificationTo establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.

http://www.irs.gov/Businesses

http://www.irs.gov/Forms

http://www.irs.gov/OrderForms

http://www.SSA.gov


For this type of account: Give name and EIN of:1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.

What Name and Number To Give the RequesterFor this type of account: Give name and SSN of:

1. Individual The individual

2. Two or more individuals (joint account) other than an account maintained by an FFI

The actual owner of the account or, if combined funds, the first individual on

the account1

3. Two or more U.S. persons (joint account maintained by an FFI)

Each holder of the account

4. Custodial account of a minor (Uniform Gift to Minors Act)

The minor 2

5. a. The usual revocable savings trust (grantor is also trustee)

The grantor-trustee1

b. So-called trust account that is not a legal or valid trust under state law

The actual owner1

6. Sole proprietorship or disregarded entity owned by an individual

The owner3

7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i)(A))

The grantor*

For this type of account: Give name and EIN of:8. Disregarded entity not owned by an

individualThe owner

9. A valid trust, estate, or pension trust Legal entity4

10. Corporation or LLC electing corporate status on Form 8832 or Form 2553

The corporation

11. Association, club, religious, charitable, educational, or other tax-exempt organization

The organization

12. Partnership or multi-member LLC The partnership

13. A broker or registered nominee The broker or nominee

14. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments

The public entity

15. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B))

The trust

1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.2 Circle the minor’s name and furnish the minor’s SSN.3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier.

*Note: The grantor also must provide a Form W-9 to trustee of trust.

Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records From Identity TheftIdentity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:

• Protect your SSN,

• Ensure your employer is protecting your SSN, and

• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Pub. 5027, Identity Theft Information for Taxpayers.

Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.


The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at [email protected] or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.

Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.

Privacy Act NoticeSection 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.



http://www.ftc.gov/complaint

http://www.ftc.gov/idtheft

http://www.IdentityTheft.gov

http://www.irs.gov/IdentityTheft

Documents

Insurance Claims Packet