1021 Form W-8ECI (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/fw8eci.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Form

(Rev. October 2021)

Department of the Treasury Internal Revenue Service

Certificate of Foreign Person's Claim That Income Is Effectively Connected With the Conduct of a Trade or Business in the United States

• Section references are to the Internal Revenue Code.

^▶ Go to www.irs.gov/FormW8ECI for instructions and the latest information.

• Give this form to the withholding agent or payer. Do not send to the IRS.

OMB No. 1545-1621

Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business. See instructions.

Do not use this form for: Instead, use Form:

• A beneficial owner solely claiming foreign status or treaty benefits . . . . . . . . . . . . . . . . . W-8BEN or W-8BEN-E

• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) . . . . W-8EXP

Note: These entities should use Form W-8ECI if they received effectively connected income and are not eligible to claim an exemption for chapter 3 or 4 purposes on Form W-8EXP.

• A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States) . . . . . . . . . . . . . . . . . . . . . W-8BEN-E or W-8IMY

• A person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY Note: See instructions for additional exceptions. Part I Identification of Beneficial Owner (see instructions)

1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization

3 Name of disregarded entity receiving the payments (if applicable)

4 Type of entity (check the appropriate box):

Partnership

Foreign Government - Controlled Entity Foreign Government - Integral Part Private foundation

Simple trust

Grantor trust International organization

Individual

Complex trust

Central bank of issue Corporation Estate

Tax-exempt organization

5 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state or province. Include postal code where appropriate. Country

6 Business address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state, and ZIP code

7 U.S. taxpayer identification number (required—see instructions) SSN or ITIN EIN

8a Foreign tax identifying number (FTIN) 8b Check if FTIN not legally required . . . . . . . . . . .

9 Reference number(s) (see instructions) 10 Date of birth (MM-DD-YYYY)

11 Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or business in the United States (attach statement if necessary).

12 Check here to certify that: you are a dealer in securities (as defined in section 475(c)(1)); you are a transferor of an interest in a publicly traded partnership (PTP) claiming an exception from withholding under Regulations section 1.1446(f)-4(b)(6); and any gain from the transfer of the PTP interest associated