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NENG » Topics » Indemnification Representative Tax Certification:

This excerpt taken from the NENG 8-K filed Oct 15, 2007.
Indemnification Representative Tax Certification: Taxpayer Identification Number (TIN):                             Date:                       

 

Name & Address:

 

                             

 

 

 

 

 

                             

 

 

 

 

 

                             

 

The Indemnification Representative is a (check one):

 

o Corporation

 

o Partnership

 

 

o Individual/sole proprietor

 

o Trust

 

o Other                  

 

The Indemnification Representative is (check if applicable):

 

o Exempt from backup withholding

 

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