2021 Federal Income Tax Filing Information Request Form Personal InformationFirst Name(Required) Middle Name(Required) Last Name(Required) Email(Required) Date of Birth(Required) MM slash DD slash YYYY Country Phone Codes(Required)ChooseALASKA +1907ALBANIA +355ALGERIA +213ANDORRA +376ANGOLA +244ANGUILLA +1264ANTIGUA AND BARBUDA +1268ARGENTINA +54ARMENIA +374ARUBA +297ASCENSION +247AUSTRALIA +61AUSTRIA +43AZERBAIJAN REPUBLIC +994AZORES +351BAHAMAS +1242BAHRAIN +973BANGLADESH +880BARBADOS (W.I) +1246BELARUS +375BELGIUM +32BELIZE +501BENIN +229BERMUDA +1441BHUTAN +975BOLIVIA +591BOPUTATSWANA +27BOSNIA & HERZEGOVINA, +387BOTSWANA, REPUBLIC OF +267BRAZIL +55BRUNEI DARUSSALAM +673BULGARIA +359BURKINA FASO +226BURUNDI +257CAMBODIA +855CAMEROON +237CANADA +1CANARY ISLAND +34CAPE VERDE +238CAYMAN ISLAND +1345CENTRAL AFRICAN REP. +236CHAD +235CHILE +56CHINA +86CHRISTMAS ISLAND +-9103CISKEI +27COCOS KEELING ISLAND +672COLOMBIA +57COMOROS +269CONGO +242COOK ISLAND +682COSTA RICA +506COTE D'IVOIRE +225CROATIA +385CUBA +53CYPRUS +357CZECH REPUBLIC +420DENMARK +45DIEGO GARCIA +246DJIBOUTI +253DOMINICAN REPUBLIC +-766DOMNICA ISLAND +-766ECUADOR +593EGYPT +20EL SALVADOR +503EQUATORIAL GUINEA +240ERITREA +291ESTONIA +372ETHIOPIA +251FALKLAND ISLAND +500FAROE ISLAND +298FIJI REPUBLIC +679FINLAND +358FR.GUINEA +594FR.POLYNESIA +689FRANCE +33GABONESE REPUBLIC +241GAMBIA +220GEORGIA +995GERMANY +49GHANA +233GIBRALTAR +350GREECE +30GREENLAND +299GRENADA +-472GUADELOUPE +590GUAM +671GUATEMALA +502GUINEA +224GUINEA BISSAU +245GUYANA +592HAITI +509HAWAII +-807HONDURAS +504HONG KONG +852HUNGARY +36ICELAND +354INDIA +91INDONESIA +62IRAN +98IRAQ +964IRELAND +353ISRAEL +972ITALY +39JAMAICA +-875JAPAN +81JORDAN HASHEMITE +962KAZAKHSTAN +7KENYA +254KYRGYZSTAN +996KIRIBATI +686KOREA (NORTH) +850KOREA (SOUTH) +82KUWAIT, STATE OF +965LAOS +856LATVIA +371LEBANON +961LESOTHO +266LIBERIA +231LIBYA +218LICHTENSTEIN +423LITHUANIA +370LUXEMBORG +352MACAO +853MACEDONIA +389MADAGASCAR +261MADEIRA ISLAND +351MALAWI +265MALAYSIA +60MALDIVES +960MALI +223MALTA +356MARIANA ISLAND +670MARSHAL ISLAND +692MARTINIQUE +596MAURITANIA +222MAURITIUS +230MAYOTTE +269MEXICO +52MICRONESIA +691MOLDOVA +373MONACO +377MONGOLIA +976MONTSERRAT +1664MOROCCO +212MOZAMBIQUE +258MYANMAR +95NAMIBIA +264NAURU +674NEPAL +977NETHERLANDS +31NETHERLANDS ANTILLES +599NEW CALEDONIA +687NEW ZEALAND +64NICARAGUA +505NIGER +227NIGERIA +234NIUE ISLAND +683NORWAY +47OMAN +968PAKISTAN +92PALAU +680PALESTINE +970PANAMA +507PAPUA NEW GUINEA +675PARAGUAY +595PERU +51PHILIPPINES +63POLAND +48PORTUGAL +351PUERTO RICO +1787QATAR +974REUNION +262RODRIGUES ISLAND +230ROMANIA +40RUSSIAN FEDERATION +7RWANDESE REPUBLIC +250SAMOA AMERICAN +684SAMOA WESTERN +685SAN MARINO +378SAO TOME & PRINCIPE +239SAUDI ARABIA +966SENEGAL +221SEYCHELLES +248SIERRA LEONE +232SINGAPORE +65SLOVAK REPUBLIC +421SLOVENIA +386SOLOMON ISLAND +677SOMALIA DEMOCRATIC REP. +252SOUTH AFRICA +27SPAIN +34SRI LANKA +94ST.HELENA +290ST.KITTS - NEVIS +1869ST.LUCIA +1758ST.PIERRE & MIQUELON +508ST.VINCENT & THE GRENADINES +1809SUDAN +249SURINAME +597SWAZILAND +268SWEDEN +46SWITZERLAND +41SYRIA +963TAJIKISTAN +992TAIWAN +886TANZANIA +255THAILAND +66TOGOLESE REPUBLIC +228TONGA +676TRANSKEI +27TRINIDAD & TOBAGO +1868TUNISIA +216TURKEY +90TURKMENISTAN +993TURKS & CAICOS ISLAND +1649TUVALU +688UGANDA +256UKRAINE +380UNITED ARAB EMIRATES +971UNITED KINGDOM +44UNITED STATES OF AMERICA +1URUGUAY +598UZBEKISTAN +998VANUATU +678VATICAN CITY STATE +39VENDA +27VENEZUELA +58VIETNAM +84VIRGIN ISLAND (A) +339VIRGIN ISLAND (B) +283WALLIS & FUTUNA ISLAND +681YEMEN (SANA'A) +967YUGOSLAVIA +381ZAIRE +243ZAMBIA +260ZIMBABWE +263Phone(Required)Country of Residency(Required)ChooseAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePassport Number(Required) If you do not have one, type NOT HAVEWhich Tax ID do you have?(Required) SSN ITIN Applying for ITIN SSN(Required) ITIN(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you a US Citizen or Resident ?(Required)ChooseYesNoFiling Status(Required)ChooseSingleMarried Filing JointlyMarried Filing SeperatelyHead of HouseholdQualifiying Widow(er)Filing Status(Required)ChooseSingle Non-Resident AlienMarried Non-Resident AlienQualifiying Widow(er)Do you Have a Business in the US?(Required)ChooseYesNoType of the Business(Required)ChooseLLC (single Member)LLC (Multi Member - Partnership)CorporationBusiness DetailsName of the Business(Required) EIN of the Company(Required) Nature of Business(Required) We will find the NAICS code of your nature of the business. Please describe your business clearly.Business Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Total Number of Shareholders(Required)Choose23456789102nd Shareholder InformationFirst Name(Required) Middle Name(Required) Last Name(Required) Email(Required) Date of Birth(Required) MM slash DD slash YYYY Country Phone Codes(Required)ChooseALASKA +1907ALBANIA +355ALGERIA +213ANDORRA +376ANGOLA +244ANGUILLA +1264ANTIGUA AND BARBUDA +1268ARGENTINA +54ARMENIA +374ARUBA +297ASCENSION +247AUSTRALIA +61AUSTRIA +43AZERBAIJAN REPUBLIC +994AZORES +351BAHAMAS +1242BAHRAIN +973BANGLADESH +880BARBADOS (W.I) +1246BELARUS +375BELGIUM +32BELIZE +501BENIN +229BERMUDA +1441BHUTAN +975BOLIVIA +591BOPUTATSWANA +27BOSNIA & HERZEGOVINA, +387BOTSWANA, REPUBLIC OF +267BRAZIL +55BRUNEI DARUSSALAM +673BULGARIA +359BURKINA FASO +226BURUNDI +257CAMBODIA +855CAMEROON +237CANADA +1CANARY ISLAND +34CAPE VERDE +238CAYMAN ISLAND +1345CENTRAL AFRICAN REP. +236CHAD +235CHILE +56CHINA +86CHRISTMAS ISLAND +-9103CISKEI +27COCOS KEELING ISLAND +672COLOMBIA +57COMOROS +269CONGO +242COOK ISLAND +682COSTA RICA +506COTE D'IVOIRE +225CROATIA +385CUBA +53CYPRUS +357CZECH REPUBLIC +420DENMARK +45DIEGO GARCIA +246DJIBOUTI +253DOMINICAN REPUBLIC +-766DOMNICA ISLAND +-766ECUADOR +593EGYPT +20EL SALVADOR +503EQUATORIAL GUINEA +240ERITREA +291ESTONIA +372ETHIOPIA +251FALKLAND ISLAND +500FAROE ISLAND +298FIJI REPUBLIC +679FINLAND +358FR.GUINEA +594FR.POLYNESIA +689FRANCE +33GABONESE REPUBLIC +241GAMBIA +220GEORGIA +995GERMANY +49GHANA +233GIBRALTAR +350GREECE +30GREENLAND +299GRENADA +-472GUADELOUPE +590GUAM +671GUATEMALA +502GUINEA +224GUINEA BISSAU +245GUYANA +592HAITI +509HAWAII +-807HONDURAS +504HONG KONG +852HUNGARY +36ICELAND +354INDIA +91INDONESIA +62IRAN +98IRAQ +964IRELAND +353ISRAEL +972ITALY +39JAMAICA +-875JAPAN +81JORDAN HASHEMITE +962KAZAKHSTAN +7KENYA +254KYRGYZSTAN +996KIRIBATI +686KOREA (NORTH) +850KOREA (SOUTH) +82KUWAIT, STATE OF +965LAOS +856LATVIA +371LEBANON +961LESOTHO +266LIBERIA +231LIBYA +218LICHTENSTEIN +423LITHUANIA +370LUXEMBORG +352MACAO +853MACEDONIA +389MADAGASCAR +261MADEIRA ISLAND +351MALAWI +265MALAYSIA +60MALDIVES +960MALI +223MALTA +356MARIANA ISLAND +670MARSHAL ISLAND +692MARTINIQUE +596MAURITANIA +222MAURITIUS +230MAYOTTE +269MEXICO +52MICRONESIA +691MOLDOVA +373MONACO +377MONGOLIA +976MONTSERRAT +1664MOROCCO +212MOZAMBIQUE +258MYANMAR +95NAMIBIA +264NAURU +674NEPAL +977NETHERLANDS +31NETHERLANDS ANTILLES +599NEW CALEDONIA +687NEW ZEALAND +64NICARAGUA +505NIGER +227NIGERIA +234NIUE ISLAND +683NORWAY +47OMAN +968PAKISTAN +92PALAU +680PALESTINE +970PANAMA +507PAPUA NEW GUINEA +675PARAGUAY +595PERU +51PHILIPPINES +63POLAND +48PORTUGAL +351PUERTO RICO +1787QATAR +974REUNION +262RODRIGUES ISLAND +230ROMANIA +40RUSSIAN FEDERATION +7RWANDESE REPUBLIC +250SAMOA AMERICAN +684SAMOA WESTERN +685SAN MARINO +378SAO TOME & PRINCIPE +239SAUDI ARABIA +966SENEGAL +221SEYCHELLES +248SIERRA LEONE +232SINGAPORE +65SLOVAK REPUBLIC +421SLOVENIA +386SOLOMON ISLAND +677SOMALIA DEMOCRATIC REP. +252SOUTH AFRICA +27SPAIN +34SRI LANKA +94ST.HELENA +290ST.KITTS - NEVIS +1869ST.LUCIA +1758ST.PIERRE & MIQUELON +508ST.VINCENT & THE GRENADINES +1809SUDAN +249SURINAME +597SWAZILAND +268SWEDEN +46SWITZERLAND +41SYRIA +963TAJIKISTAN +992TAIWAN +886TANZANIA +255THAILAND +66TOGOLESE REPUBLIC +228TONGA +676TRANSKEI +27TRINIDAD & TOBAGO +1868TUNISIA +216TURKEY +90TURKMENISTAN +993TURKS & CAICOS ISLAND +1649TUVALU +688UGANDA +256UKRAINE +380UNITED ARAB EMIRATES +971UNITED KINGDOM +44UNITED STATES OF AMERICA +1URUGUAY +598UZBEKISTAN +998VANUATU +678VATICAN CITY STATE +39VENDA +27VENEZUELA +58VIETNAM +84VIRGIN ISLAND (A) +339VIRGIN ISLAND (B) +283WALLIS & FUTUNA ISLAND +681YEMEN (SANA'A) +967YUGOSLAVIA +381ZAIRE +243ZAMBIA +260ZIMBABWE +263Phone(Required)Country of Residency(Required)ChooseAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePassport Number(Required) If you do not have one, type NOT HAVEWhich Tax ID do you have?(Required) SSN ITIN Applying for ITIN SSN(Required) ITIN(Required) Shareholder Percentage(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 3rd Shareholder InformationFirst Name(Required) Middle Name(Required) Last Name(Required) Email(Required) Date of Birth(Required) MM slash DD slash YYYY Country Phone Codes(Required)ChooseALASKA +1907ALBANIA +355ALGERIA +213ANDORRA +376ANGOLA +244ANGUILLA +1264ANTIGUA AND BARBUDA +1268ARGENTINA +54ARMENIA +374ARUBA +297ASCENSION +247AUSTRALIA +61AUSTRIA +43AZERBAIJAN REPUBLIC +994AZORES +351BAHAMAS +1242BAHRAIN +973BANGLADESH +880BARBADOS (W.I) +1246BELARUS +375BELGIUM +32BELIZE +501BENIN +229BERMUDA +1441BHUTAN +975BOLIVIA +591BOPUTATSWANA +27BOSNIA & HERZEGOVINA, +387BOTSWANA, REPUBLIC OF +267BRAZIL +55BRUNEI DARUSSALAM +673BULGARIA +359BURKINA FASO +226BURUNDI +257CAMBODIA +855CAMEROON +237CANADA +1CANARY ISLAND +34CAPE VERDE +238CAYMAN ISLAND +1345CENTRAL AFRICAN REP. +236CHAD +235CHILE +56CHINA +86CHRISTMAS ISLAND +-9103CISKEI +27COCOS KEELING ISLAND +672COLOMBIA +57COMOROS +269CONGO +242COOK ISLAND +682COSTA RICA +506COTE D'IVOIRE +225CROATIA +385CUBA +53CYPRUS +357CZECH REPUBLIC +420DENMARK +45DIEGO GARCIA +246DJIBOUTI +253DOMINICAN REPUBLIC +-766DOMNICA ISLAND +-766ECUADOR +593EGYPT +20EL SALVADOR +503EQUATORIAL GUINEA +240ERITREA +291ESTONIA +372ETHIOPIA +251FALKLAND ISLAND +500FAROE ISLAND +298FIJI REPUBLIC +679FINLAND +358FR.GUINEA +594FR.POLYNESIA +689FRANCE +33GABONESE REPUBLIC +241GAMBIA +220GEORGIA +995GERMANY +49GHANA +233GIBRALTAR +350GREECE +30GREENLAND +299GRENADA +-472GUADELOUPE +590GUAM +671GUATEMALA +502GUINEA +224GUINEA BISSAU +245GUYANA +592HAITI +509HAWAII +-807HONDURAS +504HONG KONG +852HUNGARY +36ICELAND +354INDIA +91INDONESIA +62IRAN +98IRAQ +964IRELAND +353ISRAEL +972ITALY +39JAMAICA +-875JAPAN +81JORDAN HASHEMITE +962KAZAKHSTAN +7KENYA +254KYRGYZSTAN +996KIRIBATI +686KOREA (NORTH) +850KOREA (SOUTH) +82KUWAIT, STATE OF +965LAOS +856LATVIA +371LEBANON +961LESOTHO +266LIBERIA +231LIBYA +218LICHTENSTEIN +423LITHUANIA +370LUXEMBORG +352MACAO +853MACEDONIA +389MADAGASCAR +261MADEIRA ISLAND +351MALAWI +265MALAYSIA +60MALDIVES +960MALI +223MALTA +356MARIANA ISLAND +670MARSHAL ISLAND +692MARTINIQUE +596MAURITANIA +222MAURITIUS +230MAYOTTE +269MEXICO +52MICRONESIA +691MOLDOVA +373MONACO +377MONGOLIA +976MONTSERRAT +1664MOROCCO +212MOZAMBIQUE +258MYANMAR +95NAMIBIA +264NAURU +674NEPAL +977NETHERLANDS +31NETHERLANDS ANTILLES +599NEW CALEDONIA +687NEW ZEALAND +64NICARAGUA +505NIGER +227NIGERIA +234NIUE ISLAND +683NORWAY +47OMAN +968PAKISTAN +92PALAU +680PALESTINE +970PANAMA +507PAPUA NEW GUINEA +675PARAGUAY +595PERU +51PHILIPPINES +63POLAND +48PORTUGAL +351PUERTO RICO +1787QATAR +974REUNION +262RODRIGUES ISLAND +230ROMANIA +40RUSSIAN FEDERATION +7RWANDESE REPUBLIC +250SAMOA AMERICAN +684SAMOA WESTERN +685SAN MARINO +378SAO TOME & PRINCIPE +239SAUDI ARABIA +966SENEGAL +221SEYCHELLES +248SIERRA LEONE +232SINGAPORE +65SLOVAK REPUBLIC +421SLOVENIA +386SOLOMON ISLAND +677SOMALIA DEMOCRATIC REP. +252SOUTH AFRICA +27SPAIN +34SRI LANKA +94ST.HELENA +290ST.KITTS - NEVIS +1869ST.LUCIA +1758ST.PIERRE & MIQUELON +508ST.VINCENT & THE GRENADINES +1809SUDAN +249SURINAME +597SWAZILAND +268SWEDEN +46SWITZERLAND +41SYRIA +963TAJIKISTAN +992TAIWAN +886TANZANIA +255THAILAND +66TOGOLESE REPUBLIC +228TONGA +676TRANSKEI +27TRINIDAD & TOBAGO +1868TUNISIA +216TURKEY +90TURKMENISTAN +993TURKS & CAICOS ISLAND +1649TUVALU +688UGANDA +256UKRAINE +380UNITED ARAB EMIRATES +971UNITED KINGDOM +44UNITED STATES OF AMERICA +1URUGUAY +598UZBEKISTAN +998VANUATU +678VATICAN CITY STATE +39VENDA +27VENEZUELA +58VIETNAM +84VIRGIN ISLAND (A) +339VIRGIN ISLAND (B) +283WALLIS & FUTUNA ISLAND +681YEMEN (SANA'A) +967YUGOSLAVIA +381ZAIRE +243ZAMBIA +260ZIMBABWE +263Phone(Required)Country of Residency(Required)ChooseAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePassport Number(Required) If you do not have one, type NOT HAVEWhich Tax ID do you have?(Required) SSN ITIN Applying for ITIN SSN(Required) ITIN(Required) Shareholder Percentage(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 4th Shareholder InformationFirst Name(Required) Middle Name(Required) Last Name(Required) Email(Required) Date of Birth(Required) MM slash DD slash YYYY Country Phone Codes(Required)ChooseALASKA +1907ALBANIA +355ALGERIA +213ANDORRA +376ANGOLA +244ANGUILLA +1264ANTIGUA AND BARBUDA +1268ARGENTINA +54ARMENIA +374ARUBA +297ASCENSION +247AUSTRALIA +61AUSTRIA +43AZERBAIJAN REPUBLIC +994AZORES +351BAHAMAS +1242BAHRAIN +973BANGLADESH +880BARBADOS (W.I) +1246BELARUS +375BELGIUM +32BELIZE +501BENIN +229BERMUDA +1441BHUTAN +975BOLIVIA +591BOPUTATSWANA +27BOSNIA & HERZEGOVINA, +387BOTSWANA, REPUBLIC OF +267BRAZIL +55BRUNEI DARUSSALAM +673BULGARIA +359BURKINA FASO +226BURUNDI +257CAMBODIA +855CAMEROON +237CANADA +1CANARY ISLAND +34CAPE VERDE +238CAYMAN ISLAND +1345CENTRAL AFRICAN REP. +236CHAD +235CHILE +56CHINA +86CHRISTMAS ISLAND +-9103CISKEI +27COCOS KEELING ISLAND +672COLOMBIA +57COMOROS +269CONGO +242COOK ISLAND +682COSTA RICA +506COTE D'IVOIRE +225CROATIA +385CUBA +53CYPRUS +357CZECH REPUBLIC +420DENMARK +45DIEGO GARCIA +246DJIBOUTI +253DOMINICAN REPUBLIC +-766DOMNICA ISLAND +-766ECUADOR +593EGYPT +20EL SALVADOR +503EQUATORIAL GUINEA +240ERITREA +291ESTONIA +372ETHIOPIA +251FALKLAND ISLAND +500FAROE ISLAND +298FIJI REPUBLIC +679FINLAND +358FR.GUINEA +594FR.POLYNESIA +689FRANCE +33GABONESE REPUBLIC +241GAMBIA +220GEORGIA +995GERMANY +49GHANA +233GIBRALTAR +350GREECE +30GREENLAND +299GRENADA +-472GUADELOUPE +590GUAM +671GUATEMALA +502GUINEA +224GUINEA BISSAU +245GUYANA +592HAITI +509HAWAII +-807HONDURAS +504HONG KONG +852HUNGARY +36ICELAND +354INDIA +91INDONESIA +62IRAN +98IRAQ +964IRELAND +353ISRAEL +972ITALY +39JAMAICA +-875JAPAN +81JORDAN HASHEMITE +962KAZAKHSTAN +7KENYA +254KYRGYZSTAN +996KIRIBATI +686KOREA (NORTH) +850KOREA (SOUTH) +82KUWAIT, STATE OF +965LAOS +856LATVIA +371LEBANON +961LESOTHO +266LIBERIA +231LIBYA +218LICHTENSTEIN +423LITHUANIA +370LUXEMBORG +352MACAO +853MACEDONIA +389MADAGASCAR +261MADEIRA ISLAND +351MALAWI +265MALAYSIA +60MALDIVES +960MALI +223MALTA +356MARIANA ISLAND +670MARSHAL ISLAND +692MARTINIQUE +596MAURITANIA +222MAURITIUS +230MAYOTTE +269MEXICO +52MICRONESIA +691MOLDOVA +373MONACO +377MONGOLIA +976MONTSERRAT +1664MOROCCO +212MOZAMBIQUE +258MYANMAR +95NAMIBIA +264NAURU +674NEPAL +977NETHERLANDS +31NETHERLANDS ANTILLES +599NEW CALEDONIA +687NEW ZEALAND +64NICARAGUA +505NIGER +227NIGERIA +234NIUE ISLAND +683NORWAY +47OMAN +968PAKISTAN +92PALAU +680PALESTINE +970PANAMA +507PAPUA NEW GUINEA +675PARAGUAY +595PERU +51PHILIPPINES +63POLAND +48PORTUGAL +351PUERTO RICO +1787QATAR +974REUNION +262RODRIGUES ISLAND +230ROMANIA +40RUSSIAN FEDERATION +7RWANDESE REPUBLIC +250SAMOA AMERICAN +684SAMOA WESTERN +685SAN MARINO +378SAO TOME & PRINCIPE +239SAUDI ARABIA +966SENEGAL +221SEYCHELLES +248SIERRA LEONE +232SINGAPORE +65SLOVAK REPUBLIC +421SLOVENIA +386SOLOMON ISLAND +677SOMALIA DEMOCRATIC REP. +252SOUTH AFRICA +27SPAIN +34SRI LANKA +94ST.HELENA +290ST.KITTS - NEVIS +1869ST.LUCIA +1758ST.PIERRE & MIQUELON +508ST.VINCENT & THE GRENADINES +1809SUDAN +249SURINAME +597SWAZILAND +268SWEDEN +46SWITZERLAND +41SYRIA +963TAJIKISTAN +992TAIWAN +886TANZANIA +255THAILAND +66TOGOLESE REPUBLIC +228TONGA +676TRANSKEI +27TRINIDAD & TOBAGO +1868TUNISIA +216TURKEY +90TURKMENISTAN +993TURKS & CAICOS ISLAND +1649TUVALU +688UGANDA +256UKRAINE +380UNITED ARAB EMIRATES +971UNITED KINGDOM +44UNITED STATES OF AMERICA +1URUGUAY +598UZBEKISTAN +998VANUATU +678VATICAN CITY STATE +39VENDA +27VENEZUELA +58VIETNAM +84VIRGIN ISLAND (A) +339VIRGIN ISLAND (B) +283WALLIS & FUTUNA ISLAND +681YEMEN (SANA'A) +967YUGOSLAVIA +381ZAIRE +243ZAMBIA +260ZIMBABWE +263Phone(Required)Country of Residency(Required)ChooseAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePassport Number(Required) If you do not have one, type NOT HAVEWhich Tax ID do you have?(Required) SSN ITIN Applying for ITIN SSN(Required) ITIN(Required) Shareholder Percentage(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country 5th Shareholder InformationFirst Name(Required) Middle Name(Required) Last Name(Required) Email(Required) Date of Birth(Required) MM slash DD slash YYYY Country Phone Codes(Required)ChooseALASKA +1907ALBANIA +355ALGERIA +213ANDORRA +376ANGOLA +244ANGUILLA +1264ANTIGUA AND BARBUDA +1268ARGENTINA +54ARMENIA +374ARUBA +297ASCENSION +247AUSTRALIA +61AUSTRIA +43AZERBAIJAN REPUBLIC +994AZORES +351BAHAMAS +1242BAHRAIN +973BANGLADESH +880BARBADOS (W.I) +1246BELARUS +375BELGIUM +32BELIZE +501BENIN +229BERMUDA +1441BHUTAN +975BOLIVIA +591BOPUTATSWANA +27BOSNIA & HERZEGOVINA, +387BOTSWANA, REPUBLIC OF +267BRAZIL +55BRUNEI DARUSSALAM +673BULGARIA +359BURKINA FASO +226BURUNDI +257CAMBODIA +855CAMEROON +237CANADA +1CANARY ISLAND 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KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePassport Number(Required) If you do not have one, type NOT HAVEWhich Tax ID do you have?(Required) SSN ITIN Applying for ITIN SSN(Required) ITIN(Required) Shareholder Percentage(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and 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RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Income DetailsGross Income (in US Dollars) Did you received 1099 in 2019?(Required)YesNoPlease, Upload the 1099s you received(Required) Drop files here or Select files Max. file size: 8 MB. Amount of Returns Please provide the amount you did not get the payment for the services you provided.Amount of Cost of Goods Sold Please provide amount you paid for the products your business has bought during 2019. You can leave as ZERO if you do not have.Business Expenses DetailsAdvertising Car and truck Expenses Car and truck Expenses Car and truck Expenses Contract labor (see instructions) Insurance (other than health) Legal and professional services Office expense Rent or lease (Vehicles, machinery, and equipment) Rent or lease (Other business property) Repairs and maintenance Taxes and licenses You can add Franchise Tax amount you paid and sales taxes you have collected.Travel Only business related business needs to be providedMeals Only business related business needs to be providedOther ExpensesIf your business began in 2019, you can provide the amount you spent for your business formation