SECTION 4. APPLICATION FOR QI

STATUS AND WITHHOLDING AGREEMENT

.01 Where to Apply and Pre-submission Conferences. To apply for QI status and a withholding agreement, an eligible person must submit a written request to:

Assistant Commissioner (International), CP:IN:OO:WT 950 L’Enfant Plaza South, SW Washington DC 20024 FAX: (202) 874-1797 An eligible person may request one or more pre-submission conferences by contacting the Office of the Assistant Commissioner (International) at (202) 8741800 (not a toll-free number). .02 Content of Application. The application must establish to the satisfaction of the IRS that the applicant has adequate resources and procedures to comply with the terms of a withholding agreement. An application must include the information specified in this section 4.02, and any additional information and documentation requested by the IRS.

(1) A statement that the applicant is an eligible person and that it requests a QI withholding agreement with the IRS.

(2) The applicant’s name, address, and employer identification number (EIN), if any.

(3) The country in which the applicant was created or organized and a description of the applicant’s business.

(4) A list of the applicant’s officers and directors and a list of the employees who are responsible parties for performance under the agreement.

(5) A list of the branches that the agreement will cover and their location.

(6) An explanation and sample of the account opening agreements and other documents used to open and maintain the accounts at each location covered by the agreement.

(7) The type of account holders (e.g., U.S., foreign, treaty benefit claimant, or intermediary), the approximate number of account holders within each type, and the estimated value of U.S. investments that the QI-Form W–8 will cover.

(8) An explanation of the applicant’s “know-your-customer” practices and procedures (under its local money-laundering laws) for opening accounts, and identifying and communicating with customers at each location covered by the agreement. The explanation should include whether local law mandates the “know-your-customer” procedures and the manner in which local authorities verify compliance. The applicant should also describe the governmental or other supervisory authorities that regulate the “know-your-customer” procedures, and the sanctions that apply under local law for failing to comply with the procedures. The applicant must include supporting documentation.

(9) A list of assets in the United States from which amounts owed to the IRS can be collected, if necessary.

(10) A completed Form SS–4 (Application for Employer Identification Number) to apply for a QI Employer Identification Number (QI-EIN) to be used solely for QI reporting and filing purposes. An applicant must apply for a QI-EIN even if it already has another EIN.

(11) A proposed QI withholding agreement drafted in accordance with section 5 of this revenue procedure.