Part III – Claim of Tax Treaty

E Entities Providing Alternate or

Benefits 10 Limitation on benefits treaty

Additional Certifications Under Regulations 17 Entities Providing Certifications

Under an Applicable IGA 17

provisions 11 Line 14a 10 Line 14b 10 Line 14c 12 Line 15 12 Part IV – Sponsored FFI 13

F FFIs Covered by an IGA and Related

Entities 8 Foreign Reverse Hybrid Entities 17

Line 16 13 Line 17 13 Part IX – Certain Investment Entities

That Do Not Maintain Financial Accounts 13 Line 23 13 Parts IV Through XXVIII –

Certification of Chapter 4 Status 13 IGA 13 Part V – Certified Deemed-Compliant

D Definitions 4

Account holder 4 Amount realized 4 Beneficial owner 4 Chapter 3 5 Chapter 4 5 Chapter 4 status 5 Deemed-compliant FFI 5 Disregarded entity 5 Financial account 5 Financial institution 5 Fiscally transparent entity 5 Flow-through entity 6 Foreign financial institution (FFI) 5 Foreign person 6 GIIN 6 Hybrid entity 6 Intergovernmental agreement

G General Instructions 1

Purpose of Form 1

N Non-Profit Organizations Covered by

an IGA 8

H Hybrid Entity Making a Claim of

Treaty Benefits: Line 1 16 Line 10 17 Line 2 16 Line 3 16 Line 4 17 Line 5 17 Line 9b 17 Lines 6, 7, and 8 17

Nonregistering Local Bank 13 Line 18 13 Part VI – Certified

Deemed-Compliant Sponsored, Closely Held Investment Vehicle 13 Line 20 13 Line 21 13 Part VIII – Certified

Deemed-Compliant FFI With Only Low-Value Accounts 13 Line 19 13 Part VII – Certified

Deemed-Compliant Limited Life Debt Investment Company 13 Line 22 13 Part XIII – Foreign Government,

(IGA) 6 Nonparticipating FFI 6 Nonreporting IGA FFI 6 Participating FFI 6 Participating payee 6 Payee 6 Payment settlement entity

P Paperwork Reduction Act Notice. 17 Part I Identification

Government of a U.S. Possession, or Foreign Central Bank of Issue 14 Line 27 14 Part XII – Nonreporting IGA FFI 14

Line 26 14 Part XI – Restricted Distributor 14

(PSE) 6 PTP interest 6 Publicly Traded Partnership

of Beneficial Owner 7 Part I Identification of Beneficial

(PTP) 6 Qualified intermediary (QI) 6 Recalcitrant account holder. 6 Reverse hybrid entity 7 Specified U.S. person 7 Substantial U.S. owner 7 Transfer 7 Transferee 7 Transferor 7 U.S. person 7 Withholdable payment 7

Owner: Line 1 7 Line 2 7 Line 3 8 Line 4 8 Line 5 8 Part II – Disregarded Entity

Line 25a 14 Lines 25b and 25c 14 Part XIV – International

or Branch Receiving Payment 10 Line 12 10 Line 13 10

Organization 14 Line 28a 14 Line 28b. 14 Part XIX – Excepted Nonfinancial

Start-Up Company 14 Line 33 14 Part X – Owner-Documented FFI 13

Line 24a 13 Line 24b. 13

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