Part X – Owner-Documented FFI

Line 24a. If you are an owner-documented FFI, you must check the box to certify that you meet all of the requirements for this status and are providing this form to a U.S. financial institution, participating FFI, reporting Model 1 FFI, or reporting Model 2 FFI that agrees to act as a designated withholding agent with respect to you. See Regulations section 1.1471-5(f)(3) for more information about an owner-documented FFI, including with respect to a designated withholding agent.

Line 24b. Check the box to certify that you have provided or will provide the documentation set forth in the certifications, including the FFI owner reporting statement and the valid documentation for each person identified on the FFI owner reporting statement described on line 24b.

Line 24c. Check the box to certify that you have provided or will provide the auditor’s letter (in lieu of the information required by line 24b) that satisfies the requirements reflected on this line.

TIP

Check either line 24b or line 24c. Do not check both boxes.

Instructions for Form W-8BEN-E (Rev. 10-2021) -13-

each subsequent calendar year preceding the payment, applying the account aggregation rules of Regulations section 1.1471-5(b)(4)(iii).