Part IV — Nonqualified Intermediary

Line 17a. If you are providing Form W-8IMY as a nonqualified intermediary (NQI), you must check the box on line 17a. By checking this box, you are certifying to all of the statements on line 17a.

Line 17b. Check the box on line 17b if you are using this form to transmit withholding certificates or other

• You receive U.S. source income reportable on a Form 1042-S associated with this form; and

• This form is treated as a beneficial owner withholding certificate under Regulations section 1.1441-1(e)(2)(i).

-16- Instructions for Form W-8IMY (Rev. 10-2021)

documentation along with a withholding statement that satisfies the requirements of chapters 3 and 4 (including for purposes of section 1446(a) and including if you are providing pooled information for purposes of chapter 61 under the alternative procedure for U.S. non-exempt recipients, or chapter 4 withholding rate pools (as applicable) for a withholdable payment).

If you are required to provide a chapter 4 status on

TIP line 5 and are acting as an intermediary for a

withholdable payment, you must provide your chapter 4 status on line 5 or as otherwise permitted in these instructions to avoid withholding at the chapter 4 rate of 30% being applied to any withholdable payment you receive from the withholding agent regardless of whether you check the box on line 17b (except for documentation provided with respect to exempt beneficial owners).

Line 17c. Check the box on line box 17c to certify that you are permitted under Regulations section 1.6049-4(c)(4) to provide a chapter 4 withholding rate pool of U.S. payees to which a payment is allocated on a withholding statement associated with the Form W-8IMY. This checkbox does not apply to a PTP distribution. You may check this box with respect to U.S. source substitute dividends you receive as a QSL regardless of whether you act as an intermediary or principal for those amounts. See the instructions to line 8 for a QSL's requirement to provide a U.S. TIN.

Line 17d. Check the box on line 17d to certify that you are acting as a QSL with respect to the accounts identified on this line or in a withholding statement associated with this form with respect to a payment that is a U.S. source substitute dividend. You may check this box with respect to U.S. source substitute dividends you receive as a QSL regardless of whether you act as an intermediary or principal for those amounts. See the instructions for line 8 for a QSL's requirement to provide a U.S. TIN.

If you are acting on behalf of another NQI or on behalf of a foreign partnership or foreign trust that is not a withholding foreign partnership or a withholding foreign trust, you must attach to your Form W-8IMY the Form W-8IMY of the other NQI, foreign partnership, or foreign trust together with the withholding certificates and other documentation attached to that Form W-8IMY that are required for both chapter 3 and chapter 4 purposes.

If you are an NQI receiving an amount realized from