Why we ask:

 If you answer “No,” you are outside all settlement criteria do not need to complete the rest of this questionnaire.

Note: You are not required to provide tax information. However, if you do not provide it, you may be subject to additional tax withholding from your settlement payment.

Substitute IRS Form W-9
Taxpayer Identification Number Certification
Tax Certifications
You are not required to complete this verification however, if your tax information is not verified, you may be subject to additional withholding:

To ensure that the Qualified Settlement Fund can comply with its reporting and/or withholding obligations, you must complete and provide the Fund Administrator with one (1) of the following forms, as applicable:

• IRS Form W-9; OR
• IRS Form W-8BEN, W-8BEN-E, or other W-8 series form

If you are a U.S. person, as that term is defined below, then you should complete the Substitute IRS Form W-9 below.

If you are NOT a U.S. person, then you should NOT complete the Substitute IRS Form W-9 below. Instead, you should complete IRS Form W-8BEN, W-8BEN-E, or other W-8 series form, which can be found by visiting the following IRS website: https://www.irs.gov/forms-instructions

The term “U.S. person” means:

• A citizen or resident of the United States,
• A partnership created or organized in the United States or under the law of the United States or of any State, or the District of Columbia
• A corporation created or organized in the United States or under the law of the United States or of any State, or the District of Columbia
• Any estate or trust other than a foreign estate or foreign trust (see Internal Revenue Code § 7701(a)(31) for the definition of a foreign estate and a foreign trust), or
• Any other person that is not a foreign person

If the Fund Administrator does not receive a valid and complete Form W-9 or W-8 from you, the Qualified Settlement Fund may be required under the Internal Revenue Code to make certain presumptions about you for purposes of tax reporting and, as applicable, withholding. The Qualified Settlement Fund may be required, assume: (1) a payee subject to 30% withholding under the Foreign Account Tax Compliance Act (“FATCA”) and reporting on Form 1042-S; (2) a nonresident alien of the U.S. (“NRA”) subject to reporting and 30% NRA withholding and reporting on Form 1042-S; or (3) a U.S. person subject to 24% backup withholding and reporting on Forms 1099.

Please provide one of the following:

A copy of an official photo identification (e.g., driver’s license or company-issued employee ID), OR
A copy of at least one paycheck or paystub from your time working at one of the covered poultry companies.
If you do not have either of these:

You may still be able to access payroll records or pay history for some employers through their payroll service provider.
The Law Shed will assist you in locating this information if needed.

Disclaimers

- This form is provided by T.K. Sheth Law LLC dba The Law Shed dba The Law Shed, acting as a third-party claims filer for the Poultry Wages Settlement.
- Class members are not required to use a third-party filer to participate in the settlement. Free help is available from Class Counsel and the Class Administrator. Additional information is available on the Court-approved Settlement website at www.PoultryWages.com.
- Completion of this form does not guarantee eligibility for a settlement claim. Eligibility is determined by the Settlement Administrator.
- All information provided will be used solely for claim processing purposes and is subject to confidentiality obligations under applicable laws.

⚖️ Engagement Reminder 
Important Notice:
Completing this intake form is only the first step. In order to become a client of T.K. Sheth Law LLC d/b/a The Law Shed, you must also review and sign a separate Engagement Agreement.

No attorney-client relationship is formed until both of the following occur:

You complete this intake form; and
The Engagement Agreement is signed by you and accepted by the attorney.
The attorney will not accept representation without a completed intake form on file.