Part I — Identification of Entity

Line 1. Enter your name. By doing so, you are representing to the payer or withholding agent that you are not the beneficial owner of the amounts that will be paid to you (unless you are acting as a QDD or QSL for certain payments associated with this form or you are a QI acting with respect to payments of substitute interest, as permitted by the QI agreement). If you are a disregarded entity, do not enter the business name of the disregarded entity here. Instead, enter the legal name of the entity that owns the disregarded entity (looking through multiple disregarded entities, if applicable).

Line 2. If you are a corporation, enter the country of incorporation. If you are another type of entity, enter the country under whose laws you are created, organized, or governed.

Line 3. If you are a disregarded entity receiving a payment, enter your name (if required). You are required to complete line 3 if you are a disregarded entity receiving a withholdable payment or hold an account with an FFI requesting this form and you:

• Have registered with the IRS and been assigned a GIIN associated with the legal name of the disregarded entity; and

• Are a reporting Model 1 FFI or reporting Model 2 FFI. If you are a disregarded entity that is a QDD, identify the QDD by the name used by the QDD for the QI application. For instructions for identifying the names of multiple QDDs, see QDD withholding statement , later.

If you are not required to provide the legal name of