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Ubmitting Form W-7 Department of the Treasury Internal Revenue Service OMB Number 1545-0074 Certificate of Accuracy The undersigned is an authorized representative of , a Certifying Acceptance Agent under an agreement entered into with (CAA Business Name) / the Internal Revenue Service dated /20 . The undersigned certifies with regard to Form W-7 submitted for , that the applicant is not eligible for a SSN and has (Form W-7 Applicant s Name) provided the documentation checked below t.

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