W-7 (COA) Certificate of Accuracy for IRS Individual Taxpayer Iden

Form W-7(COA)
(January 2011)

Certificate of Accuracy for IRS Individual
Taxpayer Identification Number

Department of the Treasury
Internal Revenue Service

See Publication 4520
Form use only by IRS Certifying Acceptance Agents when submitting Form W-7

OMB No.
1545-0074

Certificate of Accuracy
The undersigned
(Business Name)

is a principal, partner or owner/authorized representative of
, a Certifying Acceptance Agent under an agreement entered into with the
/

Internal Revenue Service dated

/20

. The undersigned certifies with regard to Form W-7 submitted for (W- 7
, that the applicant is not eligible for a SSN and has
Applicant’s Name)
provided the documentation checked below that sufficiently supports the applicant’s identity and foreign status.
Check the box under the category (identity, foreign status) that corresponds to the documents reviewed by you.

Supporting Document

Identity

Foreign
Status

Passport (Stand Alone Document)
National Identification Card (must be current and contain
name, photograph, address, date of birth and expiration date)
U.S. Drivers License
Civil Birth Certificate

*

Medical Records (valid only for dependents under age 14
(under age 18 if a student))

*

Foreign Drivers License
U.S. State Identification Card
Foreign Voters Registration Card
U.S. Military Identification Card
Foreign Military Identification Card
School Records (valid only for dependents under age 14
(under age 18 if a student))

*

Visa issued by U. S. Department of State
United States Citizenship and Immigration Services (USCIS)
Photo Identification
*May be used to establish “foreign status” only if the documents are foreign

Check and complete the following paragraph only if the applicant is applying for an ITIN
under “Exception 1(a) - Partnership Interest”.
The undersigned further certifies that the Applicant has provided a copy of the relevant pages of the Partnership
Agreement of (Name of Partnership)
and
EIN

as documentation in support of meeting the requirements for Exception 1(a).

The undersigned further certifies that the documentation was reviewed in accordance with the procedures set forth in
the Acceptance Agent Agreement and is authentic, complete, and accurate based on the information and documentation
submitted by the applicant.
The Certifying Acceptance Agent shall retain copies of all relevant documents including signed copies of the Forms
W-7 submitted to the IRS on behalf of the applicant upon which the Certifying Acceptance Agent has relied upon to certify
the applicant’s foreign status and identity.
(Signature of Principal, Partner or Owner/
Authorized Representative)

Date:
(Signature Date)

Acceptance Agent EIN and Office Code
Form 14194 (11-2010)

Catalog Number 56020G

Department of the Treasury – Internal Revenue Service