Part IX — Nonparticipating FFI With Exempt Beneficial Owners

TIP

You are not required to complete this part unless you are a nonparticipating FFI providing documentation on behalf of an exempt beneficial owner.

Line 22. Check the box on line 22 to certify that you are transmitting withholding certificates or other documentation for exempt beneficial owners for chapter 4 purposes on whose behalf you are receiving a payment that is a withholdable payment. See Regulations section 1.1471-6. You must also certify that you have provided or will provide a withholding statement (as required) allocating a portion of the payment to the exempt beneficial owners as required under Regulations section 1.1471-3(d)(8)(ii). The withholding statement must include the name, address, TIN (if any), entity type, and chapter 4 status of each exempt beneficial owner on behalf of which you are receiving the payment, the amount of the payment allocable to each exempt beneficial owner, a valid withholding certificate or other documentation sufficient to establish the chapter 4 status of each exempt beneficial owner under the requirements of chapter 4, and any other information the withholding agent reasonably requests in order to fulfill its obligations under chapter 4. Additionally, the withholding statement must provide all information required for purposes of chapter 3 with respect to each exempt beneficial owner if the payment is an amount subject to chapter 3 withholding. The withholding statement must allocate the remainder of the payment that is not allocated to an exempt beneficial owner to you.