Part XXIX – Substantial U.S. Owners of Passive NFFE

If you identified yourself as a passive NFFE (including an investment entity that is a territory NFFE but is not an excepted territory NFFE under Regulations section 1.1472-1(c)) with one or more substantial U.S. owners in Part XXVI, you must identify each substantial U.S. owner. Provide the name, address, and TIN of each substantial U.S. owner in the relevant column. You may attach this information on a separate statement, which remains subject to the same perjury statement and other certifications made in Part XXX. If you are reporting controlling U.S. persons (as defined in an applicable IGA) to a Model 1 FFI or reporting Model 2 FFI with which you maintain an account that requests such ownership information with this form, you may use this space or attach a separate statement to report such persons.