Application for Taxpayer Identification Number 
Form   W-7A                                                                                                                                        OMB No. 1545-0074
(Rev. October 2017)                                                  for Pending U.S. Adoptions
Department of the Treasury  
Internal Revenue Service                          ▶  Go to www.irs.gov/FormW7A for instructions and the latest information.
Note: Don't file this form if you are eligible to obtain a U.S. social security number (SSN) for your adoptive child. 
1 Adoptive                                  1a   Parent’s last name                  First name                         Social security number 
  parent(s)  
  information                               1b   Parent’s last name                  First name                         Social security number 
  (see instructions) 
2 Adoptive                                  Street address, apartment number, or rural route number. If you have a P.O. box, see the instructions. 
  parent(s)  
  address                                   City or town, state, and ZIP code 
  (see instructions) 
3 Child’s name:                             3a  Last name                            First name                         Middle name 
                                     
    As it will appear  on your tax return ▶ 3b  Last name                            First name                         Middle name 
  Birth name if different  
  and known  .           .   ▶
4 Child’s birth                             Date of birth (month, day, year)  Female Place of birth (city or town, and state) (If foreign address, see instructions) 
  information                                                                 Male 
                                            Name                                     Address                                                       Date child   
5 Placement                                                                                                                                        was placed   
  agency                                                                                                                                           with adoptive   
                                                                                                                                                   parents 
  information 

                                            Note: Be sure to attach the required documentation to Form W-7A. See instructions. 
  Sign   
                                            Under penalties of perjury, I declare that I have examined this application, including accompanying documentation and statements, and to 
  Here                                      the best of my knowledge and belief, it is true, correct, and complete. 
                                            ▲    Signature of parent                            Date (month, day, year) Daytime phone number 
  Keep a copy of this  
  form for your  
  records.
                                            ▲    Signature of parent                            Date (month, day, year) Daytime phone number 

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.                                  Cat. No. 24309E                Form W-7A (Rev. 10-2017)