Part I – Identification of Beneficial Owner

Line 1. Enter your name. If you are a disregarded entity or branch, do not enter your business name. Instead, enter the legal name of your owner (or, if you are a branch, the entity that you form a part of) (looking through multiple disregarded entities if applicable). If you are a disregarded entity that is a hybrid entity filing a treaty claim, however, see Hybrid Entity Making a Claim of Treaty Benefits under Special Instructions , later.

If you are an account holder providing this form to

TIP an FFI solely for purposes of documenting

yourself as an account holder and you are not receiving a withholdable payment or reportable amount (as defined in Regulations section 1.1441-1(e)(3)(vi)), you should complete Part I by substituting the references to “beneficial owner” with “account holder.”

The named holder on the account is not