EX-99.A1D 5 genmills081106_ex99a1d.htm FORM OF SUBSTITUTE FORM W-9 GENERAL MILLS, INC. EX-99.a1D

Exhibit 99(a)(1)(D)

 

SUBSTITUTE

Form W-9

Department of the
Treasury
Internal Revenue Service

Part 1—PLEASE PROVIDE YOUR TIN IN THE BOX AT RIGHT AND CERTIFY BY SIGNING AND DATING BELOW.




______________________
Social Security Number

OR

______________________
Employer Identification Number

Payer’s Request for
Taxpayer Identification
Number (TIN)

Part 2—Certification

Under 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), and

(2)   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 (the “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. person (including a U.S. resident alien).

 

Certification Instructions—You must cross out item (2) in Part 2 above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. However, if after being notified by the IRS that you are subject to backup withholding you received another notification from the IRS stating that you are no longer subject to backup withholding, do not cross out item (2).

 

 

SIGNATURE

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

 

 

 

 

 

 

 

 

CITY

 

 

 

 

STATE

 

ZIP CODE

 

 

 

 

 

 

NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN A $50 PENALTY IMPOSED BY THE IRS AND BACKUP WITHHOLDING OF FEDERAL INCOME TAX ON ANY CASH PAYMENTS MADE TO YOU PURSUANT TO AN OFFER. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS.

 




GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION

NUMBER ON SUBSTITUTE FORM W-9

Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security Number (“SSN”). SSNs have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification Number (“EIN”). EINs have nine digits separated by one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.

For this type of
account:

Give the NAME and
SSN of:

 

For this type of
account:

Give the NAME and
EIN of:

1.

Individual

The individual

 

6.

Disregarded entity not owned by an individual

The owner

2.

Two or more individuals (joint account)

The actual owner of the account or, if combined funds, the first individual on the account(1)

 

7.

A valid trust, estate or pension trust

The legal entity(4)

3.

Custodian account of a minor (Uniform Gift to Minors Act)

The minor(2)

 

8.

Corporate or LLC electing corporate status on Form 8832

The corporation

4.

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

The grantor-trustee(1)

 

9.

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

The organization

 

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

The actual owner(1)

 

10.

Partnership or multi-member LLC which has not elected corporate status on Form 8832

The partnership

5.

Sole proprietorship or disregarded entity owned by an individual

The owner(3)

 

11.

A broker or registered nominee

The broker or nominee

 

 

 

 

12.

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

(1)

List first and circle the name of the person whose number you furnish. If only one person on a joint account has a SSN, that person’s number must be furnished.

(2)

Circle the minor’s name and furnish the minor’s social security number.

(3)

You must show your individual name, but you may also enter your business or “doing business as” name. You may use either your SSN or TIN (if you have one), but the IRS encourages you to use your SSN.

(4)

List first and circle the name of the legal 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.)

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.

 

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GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION

NUMBER ON SUBSTITUTE FORM W-9

(Section references are to the Internal Revenue Code)

Obtaining a Number

If you do not have a taxpayer identification number (“TIN”) or you don’t know your number, obtain Form SS-5, Application for a Social Security Number Card, or Form SS-4, Application for Employer Identification Number, at the local office of the Social Security Administration or the Internal Revenue Service (the “IRS”) and apply for a number.

In some cases, individuals who become U.S. resident aliens for tax purposes are not eligible to obtain a Social Security Number (“SSN”). This includes certain resident aliens who must receive information returns but who cannot obtain an SSN. These individuals must apply for an Individual Taxpayer Identification Number (“ITIN”) on Form W-7, Application for IRS Individual Taxpayer Identification Number, unless they have an application pending for an SSN. Individuals who have an ITIN must provide it on Form W-9.

To complete the Substitute Form W-9, if you do not have a TIN, write “Applied For” in the space for the taxpayer identification number, sign and date the Form, and give it to the requester. Notwithstanding that you comply with the foregoing, the Depositary will withhold federal income tax on any purchase price and any accrued and unpaid interest paid to you or other payee with respect to the Debentures prior to the time a properly certified TIN is provided to the Depositary.

Payees Exempt from Backup Withholding

Backup withholding is not required on any payments made to the following payees:

 

An organization exempt from tax under section 501(a), any individual retirement plan (“IRA”) where the payor is also the trustee or custodian, or a custodial account under 403(b)(7), if the account satisfies the requirements of section 401(f)(2).

 

 

The United States or any of its agencies or instrumentalities.

 

 

A State, the District of Columbia, a possession of the United States or any of their political subdivisions or instrumentalities.

 

 

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

 

 

An international organization or any of its agencies or instrumentalities.

 

Other payees that may be exempt from backup withholding include:

 

 

A corporation.

 

 

A foreign central bank of issue.

 

 

A dealer in securities or commodities required to register in the United States, the District of Columbia or a possession of the United States.

 

 

A futures commission merchant registered with the Commodity Futures Trading Commission.

 

 

A real estate investment trust.

 

 

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

 

 

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

 

 

A financial institution.

 

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

 

 

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

 

Payments Exempt from Backup Withholding

 

Dividends and patronage dividends that are generally exempt from backup withholding include:

 

 

Payments to nonresident aliens subject to withholding under section 1441.

 

 

Payments to partnerships not engaged in a trade or business in the United States and that have at least one nonresident alien partner.

 

 

Payments of patronage dividends not paid in money.

 

 

Payments made by certain foreign organizations.

 

 

Section 404(k) distributions made by an ESOP.

 

Interest payments that generally are exempt from backup withholding include:

 

 

Payments of interest on obligations issued by individuals. However, you may be subject to backup withholding if the interest is $600 or more and is paid in the course of the payer’s trade or business and you have not provided your correct taxpayer identification number to the payer.

 

 

Payments of tax-exempt interest (including exempt interest dividends under section 852).

 

 

Payments described in section 6049(b)(5) to nonresident aliens.

 

 

Payments on tax-free covenant bonds under section 1451.

 

 

Payments made by certain foreign organizations.

 

 

Mortgage or student loan interest paid to you.

 

Payments that are not subject to information reporting are also not subject to backup withholding. For details see sections 6041, 6041A(a), 6042, 6044, 6045, 6049, 6050A and 6050N and the regulations under such sections.

Exempt payees described above should file Substitute Form W-9 to avoid possible erroneous backup withholding. ENTER YOUR TAXPAYER IDENTIFICATION NUMBER. WRITE “EXEMPT” ON THE FACE OF THE FORM, SIGN AND DATE THE FORM AND RETURN IT TO THE PAYER.

Privacy Act Notices

Section 6109 requires you to give your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt or contributions you made to an IRA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation and to cities, states and the District of Columbia to carry out their tax laws. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other payments to a payee that does not furnish a TIN to a payer. Certain penalties may also apply.

Penalties

 

(1)

Penalty for Failure to Furnish TIN. If you fail to furnish your correct TIN to a payer, 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.

 

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(2)

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.

 

 

(3)

Criminal Penalty for Falsifying Information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

 

FOR ADDITIONAL INFORMATION CONTACT YOUR TAX ADVISOR OR THE IRS.

 











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