Part X (Owner-Documented FFI), line 24. You may
Publication 1281 — Backup Withholding for Missing and Incorrect Name/TINs (including instructions for reading tape cartridges and CD/DVD formats) · 2026-10-03 edition · updated 2026-10-04 · United States
accept this certificate and treat an entity as an owner-documented FFI only if you are a designated withholding agent under the chapter 4 regulations. Also, an owner-documented FFI that is a nonreporting IGA FFI must check “Owner-Documented FFI” (and not “Nonreporting IGA FFI”) on line 5 and complete Part X. You may accept a Form W-8BEN-E from an entity claiming status as an Owner-Documented FFI that does not check box 24d in Part X regardless of whether you know that the entity is a trust that has one or more contingent beneficiaries.
Form W-8ECI You should request Form W-8ECI from any foreign person or organization to which you are making a payment subject to withholding under chapter 3 or 4 if it is the beneficial owner of the income (or an entity engaged in a U.S. trade or business submitting the form on behalf of its owners, partners, or beneficiaries) and claims that the income is effectively connected with the conduct of a trade or business in the United States. However, if you are a partnership (or nominee for a PTP interest), you should
Inst. for the Requester of Forms W-8 (Rev. June 2022) -11-
request a Form W-8BEN or W-8BEN-E (as applicable) from a foreign partner that is allocated income that is ECTI for purposes of withholding under section 1446(a). Nevertheless, a foreign partner that has made an election under section 871(d) or section 882(d) must provide that election to the partnership along with a Form W-8ECI.
An exception from section 1446(f) withholding applies to a foreign dealer that transfers a PTP interest if the foreign dealer provides Form W-8ECI and makes the certifications set forth on line 12 of such form. See Regulations section 1.1446(f)-4(b)(6). You may rely on the certifications made by the dealer for this purpose unless you have actual knowledge they are unreliable or incorrect.
If you receive a Form W-8ECI without a U.S. TIN entered on line 7, you may not rely on Form W-8ECI to treat the income as effectively connected with a U.S. trade or business and you must apply the appropriate presumption rules or obtain another Form W-8 for the payee that you may rely upon. If you receive a Form W-8ECI without an FTIN on line 8a when required and the account holder has not checked line 8b, or provided a reasonable (or other) explanation for why the account holder has not been issued an FTIN on a separate statement when required (see Foreign TINs , earlier), you must treat the form as invalid for payments of U.S. source income reportable on Form 1042-S (as determined before the application of this requirement).
Your receipt of Form W-8ECI serves as a representation by the payee or beneficial owner that the items of income identified on line 11 are effectively connected with the conduct of a trade or business within the United States. Therefore, if a beneficial owner provides you with a Form W-8ECI, you may treat all of the U.S. source income identified on line 11 paid to that beneficial owner as effectively connected with the conduct of a trade or business within the United States and not as a withholdable payment for purposes of chapter 4. Accordingly, a chapter 4 status is not required for a payee who provides a valid Form W-8ECI unless you are an FFI requesting a Form W-8ECI from an account holder for purposes of your chapter 4 due diligence requirements.
amount under section 871(m)). However, if the income is effectively connected with the conduct of a U.S. trade or business, it is reportable by you on Form 1042-S (regardless of whether the payment is U.S. source income). You must treat income as effectively connected with the conduct of a U.S. trade or business, even if a Form W-8ECI has not been received, if the income is paid to a qualified business unit of a foreign person located in the United States or if the income is paid to a qualified business unit of a foreign person located outside the United States and you know, or have reason to know, that the payment is income effectively connected with the conduct of a U.S. trade or business. However, a payment is not treated as income effectively connected with the conduct of a U.S. trade or business if the payee provides a Form W-8BEN-E representing that the payment is not income effectively connected with a U.S. trade or business or makes a representation in a master agreement that governs the transactions in notional principal contracts between the parties (for example, an International Swaps and Derivatives Association agreement), or in the confirmation on the particular notional principal contract transaction, that the payee is a U.S. person or a non-U.S. branch of a foreign person.
Payments to certain U.S. branches treated as effec- tively connected income. If you make a payment to a U.S. branch of a foreign bank or insurance company that does not provide a withholding certificate but has provided an employer identification number (EIN), the payment is presumed to be effectively connected with the conduct of a trade or business within the United States even if the foreign person (or its U.S. branch) does not give you a Form W-8ECI. If you do not obtain a Form W-8ECI or the U.S. branch’s EIN, the income paid cannot be treated as income effectively connected with a U.S. trade or business.
If you pay items of income that are not identified on line 11 by the beneficial owner as effectively connected with the conduct of a trade or business within the United States, you are generally required to obtain another type of Form W-8 from the beneficial owner.
Generally, you may not treat an amount otherwise subject to withholding under chapter 3 or 4 as income effectively connected with the conduct of a trade or business within the United States unless the beneficial owner gives you a valid Form W-8ECI. However, there are exceptions (described below) for income paid on notional principal contracts and payments made to certain U.S. branches.
Form W-8EXP You should request Form W-8EXP from any foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession to which you are making a payment of an amount subject to chapter 3 withholding if such person is claiming an exemption from withholding under sections 1441, 1442, and 1443 pursuant to section 115(2), 501(c), 892, or 895, or claiming a rate of withholding under section 1443(b). Except as provided below, you should request Form W-8EXP from a person claiming an exemption from withholding under chapter 4 as an exempt beneficial owner or tax-exempt organization under section 501(c) or that is claiming any other chapter 4 status shown on the form when also claiming a chapter 3 status described in the preceding sentence. In certain cases, a GIIN may be required based on the chapter 4 status claimed on the form. See Requirements for Obtaining and Verifying a Global Intermediary Identification Number (GIINs) , earlier.
If you are an FFI documenting an account holder that is a tax-exempt organization or exempt beneficial owner (each as defined for chapter 4 purposes) to which you do not pay amounts subject to withholding under chapter 3, you may require that the account holder complete Form
Notional principal contracts reportable on Form 1042-S. Withholding at a 30% rate is not required on amounts paid under the terms of a notional principal contract whether or not a Form W-8ECI is provided (except when a payment made under such contract is U.S. source income, such as a dividend equivalent
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W-8BEN-E (rather than Form W-8EXP) to establish its status for chapter 4 purposes.
A Form W-8EXP submitted by a foreign person that is a partner in a partnership for purposes of withholding under sections 1441 through 1443 will also establish that partner's foreign status for purposes of section 1446. However, except as provided in Regulations section 1.1446-3(c)(3) (regarding certain tax-exempt organizations described in section 501(c)), the submission of Form W-8EXP will have no effect on whether the partner is subject to withholding under section 1446(a).
You may treat a payee as an international organization without requiring a Form W-8EXP if the payee is designated as an international organization by an executive order (pursuant to 22 U.S.C. 288 through 288(f)) and other facts surrounding the payment reasonably indicate that the beneficial owner of the payment is an international organization. With regard to amounts derived from bankers' acceptances for chapter 3 purposes, you may treat a payee as a foreign central bank of issue without requiring a Form W-8EXP if the name of the payee and other facts surrounding the payment reasonably indicate that the beneficial owner of the payment is a foreign central bank of issue.
A U.S. TIN is required if the beneficial owner is claiming an exemption or reduced rate of withholding based solely on a claim of tax-exempt status under section 501(c) or private foundation status. However, a U.S. TIN is not required from a foreign private foundation that is subject to the 4% excise tax on gross investment income (under section 4948(a)) that would be exempt from withholding except for section 4948(a) (for example, portfolio interest).
If you receive a Form W-8EXP without an FTIN (or a reasonable explanation for why the account holder has not been issued an FTIN) on line 8b (or on a separate statement) when required (see Foreign TINs , earlier), you must treat the form as invalid for payments of U.S. source income reportable on Form 1042-S (as determined before the application of this requirement).
Form W-8IMY For purposes of chapter 3 and 4, you should request Form W-8IMY from any entity that is a QI (including a QI acting as a QDD), an NQI (including certain U.S. branches and territory financial institutions), a withholding foreign partnership (WP), a withholding foreign trust (WT), or a flow-through entity to which you make a withholdable payment or pay a reportable amount. A flow-through entity for purposes of chapters 3 and 4 includes a foreign partnership (other than a WP), a foreign simple or grantor trust (other than a WT), and, for any payments for which a treaty benefit is claimed, any entity to the extent it is treated as fiscally transparent under the laws of the treaty jurisdiction, as provided in section 894 and the regulations thereunder (without regard to whether it is fiscally transparent under the laws of the United States). See Section 1446 Requirements, later, for when an intermediary, partnership or trust is required to provide a Form W-8IMY for purposes of sections 1446(a) and (f). As provided in Notice 2020-2, Form W-8IMY may also be provided by an entity to claim chapter 3 status as a QSL
with respect to payments of U.S. source substitute dividends made in 2022 and may be relied upon regardless of whether the QSL acts as an intermediary with respect to substitute dividends associated with the form. You may accept a Form W-8IMY from an individual acting as an agent or intermediary (as appropriately amended to account for individual status), but you are not required to obtain such form if you are able to associate payments you make to the person(s) for whom the individual acts.
You may accept multiple Forms W-8IMY from an intermediary that is acting in multiple capacities (for example, as a QI for one account but an NQI or QDD for another account). However, a QI may provide you with a single Form W-8IMY that covers more than one category of QI shown on the form, provided that it properly identifies to you the accounts and/or transactions on a withholding statement. Thus, for example, a QI may provide a single Form W-8IMY when acting as both an intermediary and as a QDD with respect to payments you make to the QI (by checking each applicable box in Part III of the form). You may accept a single Form W-8IMY, including a withholding statement with the required information. For multiple branches of the entity providing the form if the information in Part I is the same for each branch and a separate schedule is attached that includes all of the Part II information on each branch and sufficient information to associate the payments with each branch and any other required information.
The chapter 4 status of an intermediary or flow-through entity is required on Part I of the form if the form is associated with a withholdable payment. Part II must be completed when a withholdable payment is made to a branch or disregarded entity described in Part II of the form.
Generally, for purposes of both chapters 3 and 4, except to the extent otherwise provided in the Regulations under section 1441 or 1471, a Form W-8IMY must be associated with a withholding statement and withholding certificates (or documentary evidence, where permitted) for the beneficial owners. Generally, the withholding statement must allocate the payment to each payee (or pool of payees, where permitted, as described later), provide the rate of withholding for each payee (or pool of payees), and provide certain identification information on each payee that is not included in a pool. See, however, Regulations section 1.1441-1(e)(3)(iv)(C)(3) for the allowance for a withholding agent to accept an alternative withholding statement from an NQI (which also applies to a flow-through entity) for purposes of chapter 3 or 4. Also see the Instructions for Form W-8IMY for information on the box that an NQI may check on the form when providing an alternative withholding statement.
If you are a participating FFI or registered deemed-compliant FFI, you may also request Form W-8IMY from an intermediary or flow-through entity that is an account holder to establish its chapter 4 status or status under an applicable IGA even when no payments subject to withholding or domestic information reporting under chapter 61 are made to the account. In such a case, a withholding statement is not required.
Inst. for the Requester of Forms W-8 (Rev. June 2022) -13-
Notes for Validating Form W-8IMY
In addition to the validation requirements for Forms W-8IMY described directly below with respect to QIs (including QDDs), flow-through entities, NQIs, U.S. branches, territory financial institutions, and QSLs providing the form (requirements that apply for chapters 3 and 4 and Form 1099 reporting), see Section 1446 Requirements, later, if you pay an amount realized or an amount distributed by a PTP (PTP distribution) to any of these entities, or are otherwise a partnership determining its withholding under section 1446(a).
QIs, WPs, and WTs (in general). A QI, WP, or WT acting in its capacity as such must provide the EIN that was issued to the entity in such capacity (that is, its QI-EIN, WP-EIN, or WT-EIN) on Form W-8IMY and not any other EIN it may have in its NQI, nonwithholding foreign partnership, or nonwithholding foreign trust capacity. Because status as a QI, WP, or WT for a financial institution is limited to certain classes of FFIs, if you are making a withholdable payment to a QI, WP, or WT that is a financial institution, you must verify that the QI, WP, or WT certifies its status as one of the permitted classes in Regulations sections 1.1441-1(e)(5)(ii) (for a QI), 1.1441-5(c)(2)(ii) (for a WP), or 1.1441-5(e)(5)(v) (for a WT) and provides its GIIN (except in the case of certain foreign central banks of issue and retirement funds).
If a QI checks line 15f of Part III of the form to certify that it assumes primary Form 1099 reporting and backup withholding responsibility, you may accept the form even if you do not know if there are any U.S. accounts receiving reportable payments at the time of the certification. If a QI does not check line 15f or 15g of Part III of the form, you must confirm that the QI is not receiving payments for U.S. accounts that are reportable on Form 1099, and the QI must provide an updated Form W-8IMY or must provide a withholding statement if it allocates payments to such accounts for which it does not assume primary withholding responsibility. A QI may check line 15i of Part III of the form to indicate that it allocates a portion of the payment to a chapter 4 withholding rate pool of U.S. payees that includes account holders of another intermediary or flow-through entity even if the withholding statement does not show any intermediaries or flow-through entities at the time the certification is provided. However, a QI is not required to check line 15i of Part III of the form until it provides a withholding statement identifying an intermediary or flow-through entity that receives a payment allocated to a chapter 4 withholding rate pool of U.S. payees.
QIs acting as QDDs. You should only accept a Form W-8IMY from a QI acting as a QDD to the extent you are making payments with respect to potential section 871(m) transactions or underlying securities to the QDD when the entity claims QDD status in Part III of the form. A QDD must indicate its entity classification on line 16b of the form. If you are making such payment that is an amount subject to chapter 3 withholding to a QI that is acting as a QDD and the QDD is claiming treaty benefits applicable to the status identified on line 16b on the payment, you may treat the Form W-8IMY as a beneficial owner withholding certificate and provide such benefits if the QDD provides a statement associated to the Form W-8IMY that includes
the necessary information with respect to the treaty claim required in Part III of Form W-8BEN-E and its FTIN (when otherwise required) on a QDD withholding statement or separate statement. In such case, the portion of the certificate making a claim for treaty benefits is valid until the end of the third calendar year following the year in which the Form W-8IMY is signed (unless a change in circumstances occurs sooner), and the validation rules for a treaty claim apply. A QDD may instead provide a separate Form W-8BEN-E to make the treaty claim. You may otherwise treat a Form W-8IMY provided by a QDD (other than a flow-through entity or disregarded entity) as a beneficial owner withholding certificate for establishing foreign status of the QDD for a payment of U.S. source FDAP income (as long as the QDD provides its FTIN (when otherwise required) on a QDD withholding statement or a separate statement). A QDD that is receiving payments that it beneficially owns that are not covered by its QI agreement should provide the appropriate Form W-8 based on its status (and not Form W-8IMY). The QDD must provide to you a withholding statement to identify the home office or branch that is treated as the owner for U.S. income tax purposes and, in certain circumstances (described in the Instructions for Form W-8IMY), the QDD’s FTIN (or a reasonable explanation for why it has not been issued an FTIN, if required). Notwithstanding the preceding sentence, a QDD withholding statement need not identify the branch or home office of the QDD if the form is provided only for payments beneficially owned by the QDD (and an FTIN is provided when required). See Foreign TINs, earlier, for when you must treat the form as invalid if an FTIN or reasonable explanation is not provided.
QIs assuming withholding on payments of substitute interest. If a QI represents its status as a QI on a Form W-8IMY with respect to payments of interest and substitute interest and checks line 15e of Part III of the form, you may treat the QI as assuming withholding for payments of interest and substitute interest it receives from you in connection with a sale-repurchase or similar agreement, a securities lending transaction, or collateral that the QI holds in connection with its activities as a dealer in securities. You may accept this representation regardless of whether the QI represents it acts as a QDD (by checking line 16a in Part III). The representation on Line 15e does not apply to payments made to a QI when acting as a QDD.
QSLs. If you make payment of a U.S. source substitute dividend to a QSL (prior to January 1, 2023), the QSL is required to provide its U.S. TIN. If you make a payment to a QSL (prior to January 1, 2023) that is a withholdable payment, you must collect a Form W-8IMY that includes the QSL’s chapter 4 status and GIIN (as applicable) to avoid withholding under chapter 4. A QSL that is a QI should check line 15d of Part III of the form and a QSL that is an NQI should check line 17d of Part IV of the form regardless of whether the QSL acts as an intermediary. You may not associate a Form W-8IMY from a QSL with a payment of a substitute dividend on or after January 1, 2023, and you should obtain a revised withholding certificate.
-14- Inst. for the Requester of Forms W-8 (Rev. June 2022)
For information on transition rules that apply until 2023 for withholding agents to apply with respect to QSLs, see Notice 2020-2 .
U.S. branches. If you make a payment to a U.S. branch of a foreign bank or insurance company that represents that it is acting as an intermediary and has agreed to be treated as a U.S. person, for chapter 3 and 4 for payments associated with this form (by checking line 19a in Part VI of this form) you are not required to obtain the GIIN or chapter 4 status of the entity, but you must obtain the U.S. branch’s EIN. If you make a withholdable payment to a U.S. branch of an FFI that is acting as an intermediary and that does not agree to be treated as a U.S. person, the branch must provide its EIN (but does not need to provide a GIIN or chapter 4 status) and certify that the branch is applying the rules described in Regulations section 1.1471-4(d)(2)(iii)(C) by checking the box on line 19c in Part VI of the form. If you do not obtain the certification from a U.S. branch described in the preceding sentence, you must treat the branch as a nonparticipating FFI and withhold under chapter 4 on withholdable payments made to the branch. You are not required to treat as invalid a Form W-8IMY from an account holder that completes Part VI of the form (to the extent required) but does not complete Part II of the form.
Territory financial institutions acting as intermedia- ries. If you make a payment to a territory financial institution acting as an intermediary, you must obtain the territory financial institution’s EIN if it agrees to be treated as a U.S. person for chapters 3 and 4 for payments associated with this form (by checking line 18b of Part V of the form). You are not required to obtain a GIIN from a territory financial institution.
Participating FFIs and registered deemed-compliant FFIs that are flow-through entities or acting as inter- mediaries. If a participating FFI or registered deemed-compliant FFI that is an intermediary or flow-through entity provides you with a withholding statement and documentation for its account holders or payees, you are not required to verify the information on the account holders or payees provided in the documentation for chapter 4 purposes unless the information in the documentation is facially incorrect, and you are not required to obtain additional documentation for an account holder or payee in addition to the withholding certificate unless you are obtaining the documentation for purposes of chapter 3 or 61, or unless you know that the documentation review conducted by the participating FFI or registered deemed-compliant FFI was not adequate for purposes of chapter 4. See Regulations section 1.1441-7(b)(10) for the due diligence requirements for indirect account holders for purposes of chapter 3 and see Regulations section 1.1471-3(e)(4)(vi) (B) for standards that apply in such case to determine whether chapter 4 withholding applies. You may rely on documentation that does not include a chapter 4 status for an account holder of an intermediary or flow-through entity that is an FFI when the withholding statement provided by such entity indicates that the payment is made to an account excluded as a financial account under Regulations section 1.1471-5(b)(2).
Section 1446 Requirements
Section 1446(a) requirements in general. You should request Form W-8IMY for purposes of section 1446(a) only from a foreign upper-tier partnership or foreign grantor trust or from a simple trust if you do not obtain a Form W-8BEN-E from the trust. You may also accept a Form W-8IMY from a foreign intermediary holding a partnership interest for a partner (including a partner that is an upper-tier partnership or trust) for determining your withholding under section 1446(a). Generally, for purposes of section 1446(a), the Form W-8IMY submitted by these entities is used to transmit the forms of the owners of these entities (excluding a partnership that is a PTP and a simple trust when a Form W-8IMY is provided). The other forms should be accompanied with the information necessary to reliably
An intermediary or flow-through entity that is a participating FFI or registered deemed-compliant FFI may provide a status for chapter 4 purposes found under the requirements of (and documentation or information that is publicly available that determines the chapter 4 status of the payee permitted under) an applicable IGA for an account holder, and you may rely upon such status and documentation, provided that you have the information necessary to report on Form 1042-S. Additionally, see Alternative Certifications Under an Applicable IGA, earlier, for further details on alternative certifications.
In general, if you make a withholdable payment to an intermediary or flow-through entity that is a participating FFI or registered deemed-compliant FFI, the FFI may provide an FFI withholding statement that allocates a portion of the payment to a chapter 4 withholding rate pool. If an intermediary provides with its Form W-8IMY an FFI withholding statement that allocates a portion of the payment to a chapter 4 withholding rate pool of U.S. payees, the FFI must provide a chapter 4 status on line 5. If the intermediary described in the preceding sentence is an NQI, it must provide the certification required in Part IV with respect to its compliance with the requirements of Regulations section 1.6049-4(c)(4) (or similar requirements under chapter 61 for a payment other than interest). If the intermediary is a QI, it must certify that it meets the requirements of Regulations section 1.6049-4(c)(4)(iii) and, to the extent the U.S. payees are account holders of an intermediary or flow-through entity receiving a payment from the QI, the QI has obtained or will obtain documentation sufficient to establish each such intermediary or flow-through entity status as a participating FFI, registered deemed-compliant FFI, or FFI that is a QI. An allocation of a payment shown on a withholding statement and made on or after April 1, 2017, to an NQI, nonwithholding foreign partnership, or nonwithholding foreign trust of an amount subject to chapter 3 withholding to a chapter 4 withholding rate pool of U.S. payees must identify the payees consistent with the description in Regulations section 1.1471-3(c)(3)(iii) (B)(2)(iii) (describing account holders of an FFI that is a non-U.S. payor that are not subject to withholding under chapter 3 or 4 or under section 3406, and that are holders of U.S. accounts reported by the FFI under its Foreign Account Tax Compliance Act (FATCA) requirements as a participating FFI or registered deemed-compliant FFI).
Inst. for the Requester of Forms W-8 (Rev. June 2022) -15-
associate your effectively connected partnership items with the upper-tier partners, in the case of a foreign upper-tier partnership, and the grantor or other owner, in the case of a foreign grantor trust. Then you must look through these entities to the beneficial owners when determining your section 1446(a) tax obligation. A domestic upper-tier partnership may also provide you this information by attaching it to a Form W-9 with a statement that it is electing to apply these look through rules. Under those circumstances you may, but are not required to, pay the section 1446(a) withholding tax of the foreign partners of the domestic upper-tier partnership. See Regulations section 1.1446-5.
Section 1446(a) (PTP Distributions). Notwithstanding the preceding paragraph, for an amount subject to section 1446(a) withholding on a PTP distribution, you may accept a Form W-8IMY from a QI that acts as a nominee for the distribution by checking lines 14 and 15c. In such a case, you must treat the QI as assuming all withholding on the distribution (that is, amounts subject to chapters 3 and 4 withholding on the distribution in addition to amounts subject to sections 1446(a) and (f) withholding on the distribution). You may accept this representation regardless of whether the QI assumes primary withholding for other payments subject to chapters 3 and 4 withholding by checking line 15a. You may also accept a Form W-8IMY that is associated with a PTP distribution from any entity that represents its status as a QI on line 14 but that does not check line 15c for purposes of your relying on chapters 3 and 4 withholding rate pool information provided by the QI (similar to a case in which a QI does not assume primary withholding for chapters 3 and 4 purposes except that each U.S. partner must be disclosed). A QI that represents its status as a QI on line 14 of a Form W-8IMY that is associated with a PTP distribution may instead, however, act as a disclosing QI for the distribution by not acting as a nominee and providing specific payee information to you with its withholding statement with respect to its account holders that are partners in the PTP (and may only provide chapter 4 withholding rate pool information when permitted under chapter 4 for a withholdable payment). You may not, however, rely on an allocation of a PTP distribution made to a chapter 4 withholding rate pool of U.S. payees (that is, each U.S. partner must be disclosed). Regardless of whether the QI acts as a disclosing QI, you must determine each amount subject to withholding on the PTP distribution by reference to the qualified notice issued for the distribution (or, if you receive the distribution from a nominee, the nominee's determination) rather than relying on a determination of those amounts by the QI (to avoid withholding under the default rule in Regulations section 1.1446-4).
If the entity checks its status as an NQI in box 17a of Part IV, you must treat the entity as an NQI for a PTP distribution that is associated with the form. For determining your withholding on the distribution, you may rely on specific payee information provided by the NQI with respect to the partners allocated the distribution on a withholding statement provided with the form and chapter 4 withholding rate pool information to the extent permitted for a QI (as described directly above), but may not rely on that information and withholding statement for
purposes of withholding on an amount realized on the distribution (that is, you must withhold at the 10% rate on an amount to which section 1446(f) applies without regard to underlying payee information).
You may also accept a Form W-8IMY that is associated with a PTP distribution from a U.S. branch that acts as nominee for a PTP distribution by checking line 19e. If the U.S. branch does not act as a nominee for the distribution by checking line 19f, you may rely on specific payee documentation provided by the U.S. branch with the form to the same extent described in the preceding paragraph with respect to an NQI to which you pay a PTP distribution. You must apply similar rules in the case of a Form W-8IMY associated with the distribution that is provided by a territory financial institution.
Although you may accept a Form W-8IMY that is associated from a PTP distribution from an entity that represents its status as a WP or WT, you may not treat the entity as a WP or WT except for the amount of the distribution subject to withholding under chapter 3 or 4. For a nonwithholding partnership or trust to which you pay a PTP distribution that checks line 21b, see Section 1446 Requirements , earlier. See the requirements of chapters 3, 4 and section 1446(f) for when you can rely on partner, owner or beneficiary information for amounts subject to withholding under those provisions on a PTP distribution.
Section 1446(f) (PTP interest transfer). For purposes of section 1446(f), you should request a Form W-8IMY from a partner that is a foreign partnership that transfers an interest in a partnership if you are either the transferee of the interest (for a partnership other than a PTP) or a broker for the partner that sells a PTP interest. You should request the Form W-8IMY from the foreign partnership regardless of whether the partnership provides with the form the partner information for allowing withholding on a modified amount realized under Regulations section 1.1446(f)-2(c) or 1.1446(f)-4(c). See the Instructions for Form W-8IMY for requirements regarding a withholding statement for purposes of the modified amount realized procedures (which requires a withholding statement allocating gain from the transfer). For a partner that is a foreign grantor trust, you should request a Form W-8IMY from the trust and either a Form W-8 or W-9 with respect to each grantor or owner of the trust (as the grantor/owner is the transferor). Alternatively, you may request the Form W-8 or W-9 directly from each grantor or owner. For a partner that is a foreign simple trust, you may request either a Form W-8IMY or W-8BEN-E from the trust; you do not need to request a withholding statement or underlying documentation for the trust beneficiaries, however, as the simple trust is the transferor and may not use the modified amount realized procedures described earlier in this paragraph.
If you are a broker paying an amount realized from the sale of a PTP interest to a broker that is a foreign person, you should request a Form W-8IMY from the broker when withholding under section 1446(f) may apply (or otherwise obtain a Form W-9 from a U.S. broker when required). If the foreign broker is a QI (by checking line 14), you may accept a Form W-8IMY when the QI represents that it assumes primary withholding for the amount realized by checking line 15b. You may also accept a Form W-8IMY
-16- Inst. for the Requester of Forms W-8 (Rev. June 2022)
that is associated with an amount realized from the sale of a PTP interest from any entity that represents its status as a QI on line 14 that does not check line 15c for purposes of relying on chapter 3 withholding rate pool information provided by the QI (similar to a case in which a QI does not assume primary withholding for a PTP distribution). You may instead rely on specific payee information provided by a QI that acts as a disclosing QI for an amount realized (or a chapter 4 withholding rate pool when permitted for chapter 4). If the foreign broker is an NQI, you may accept a Form W-8IMY associated with an amount realized when the NQI checks box 17a, although you must determine your withholding under section 1446(f) without regard to whether the NQI provides specific payee information with respect to the partners allocated the amount. See the Instructions for Form W-8IMY for when you may rely on payee information provided by an NQI solely for purposes of reporting on the payees on Form 1042-S. This same withholding requirement (and reporting allowance) applies to a broker that is a U.S. branch or territory financial institution that provides a Form W-8IMY for an amount realized from the sale of a PTP interest and does not act as a U.S. person for the amount by checking line 19d (for a U.S. branch) or line 18d (for a territory financial institution).
In the case of a PTP distribution, you need not
TIP withhold under section 1446(f) in any case
described in Section 1446(a) (PTP distributions) above (or on any other transferor) when the PTP does not indicate on the qualified notice for the distribution an amount that is in excess of its cumulative net income. See Regulations section 1.1446(f)-4(c)(2). See, however, Regulations section 1.1446-4(d)(1) for withholding requirements when a nominee does not receive a qualified notice or the notice does not specify an amount included in a distribution.
Requirements for Hybrid and Reverse Hybrid Entities A hybrid entity is an entity that is treated as fiscally transparent under the Code but is not treated as fiscally transparent under the tax laws of a country with which the United States has an income tax treaty.
If you are making a payment to a foreign hybrid entity that is making a claim for treaty benefits on its own behalf, the hybrid entity should provide a Form W-8BEN-E to claim treaty benefits. If the hybrid entity is a flow-through entity (not a disregarded entity) claiming treaty benefits on its own behalf on a payment that is a withholdable payment, it should also provide you a Form W-8IMY (including its chapter 4 status) along with a withholding statement (if required) establishing the chapter 4 status of each of its partners or owners to determine whether withholding applies to any portion of the payment. Allocation information is not required on this withholding statement unless one or more partners or owners are subject to chapter 4 withholding. If the hybrid entity is a disregarded entity claiming treaty benefits on a payment that is a withholdable payment, unless the disregarded entity is treated as the payee for chapter 4 purposes and has its own GIIN, the single owner should provide a Form W-8BEN-E or Form W-8BEN (as applicable) to you along
with the Form W-8BEN-E for the hybrid entity. Line 10 of the Form W-8BEN-E may be used by the hybrid entity to associate the Forms W-8.
A foreign reverse hybrid entity is an entity that is a corporation for U.S. tax purposes but is fiscally transparent under the tax laws of a country with which the United States has an income tax treaty. If a foreign reverse hybrid entity is receiving a payment for which the entity is claiming a reduced rate of withholding for its owners, you must obtain from the entity a Form W-8IMY (including its chapter 4 status if the payment is a withholdable payment) along with a withholding statement and documentation for each owner for which the entity claims treaty benefits. If a foreign reverse hybrid entity is receiving a withholdable payment and is not claiming treaty benefits on behalf of any of its owners, you should obtain only a Form W-8BEN-E from the entity to establish its chapter 4 status.
Substitute Forms W-8 for Payments of Reportable Amounts and Withholdable Payments You may develop and use your own Form W-8 (a substitute form) for chapters 3 and 4 purposes and for section 1446(a) and (f) purposes if its content is substantially similar to the IRS's official Form W-8 (to the extent required by these instructions), it satisfies certain certification requirements, and it includes a signature under a penalties of perjury statement that is identical to the one stated on the official form. You may develop and use a substitute form that is in a foreign language, provided that you make an English translation of the form and its contents available to the IRS upon request. You may combine multiple Forms W-8 into a single substitute form.
A form that satisfies these substitute forms requirements may be treated as a similar agreed form for purposes of an applicable IGA unless the partner jurisdiction declines such treatment.
A substitute form does not need to contain all of the provisions contained on the official form, so long as it contains those provisions that are relevant to the transaction for which it is furnished. You may omit the chapter 4 certifications on your substitute form if such certifications are not required based on the payments made to the payees. If you are an FFI documenting the chapter 4 status of your account holders under your chapter 4 requirements or an applicable IGA, however, you may not omit the chapter 4 certifications. If you are making a withholdable payment, you may choose to provide a substitute form that does not include all of the chapter 4 statuses provided on the Form W-8, but the substitute form must include any chapter 4 status for which withholding may apply.
You may incorporate a substitute Form W-8 into other business forms you customarily use, such as account signature cards, provided the required certifications are clearly set forth. However, you may not:
Inst. for the Requester of Forms W-8 (Rev. June 2022) -17-
Use a substitute form that requires the payee, by signing, to agree to provisions unrelated to the required certifications; or
Imply that a person may be subject to 30% withholding or backup withholding unless that person agrees to provisions on the substitute form that are unrelated to the required certifications.
A substitute Form W-8 is valid only if it contains the same penalties of perjury statement and certifications as the official forms and the required signature. However, if the substitute form is contained in some other business form, the words “information on this form” may be modified to refer to that portion of the business form containing the substitute form information. The design of the substitute form must be such that the information and certifications that are being attested to by the penalties of perjury statement clearly stand out from any other information contained in the form.
Content of Substitute Form
Substitute Form W-8BEN. The substitute Form W-8BEN must contain all of the information required in Part I, lines 1 through 8. The certifications in Part II must be included in a substitute form only if treaty benefits are claimed, and then only to the extent that the certifications are required. For example, Form W-8BEN, line 10 (Special rates and conditions), is not required if the form is being requested from an individual receiving a payment of U.S. source dividends from stocks that are actively traded on an established securities market. The substitute Form W-8BEN must include a statement that if the person providing the form is a resident in a FATCA partner jurisdiction (that is, a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to the jurisdiction of residence.
The substitute form must contain the penalties of perjury statement identical to the statement on the official Form W-8BEN. Additionally, if the substitute form is incorporated into other business forms, the following statement must be presented in the same manner as the penalties of perjury statement and must appear immediately above the single signature line: “The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-U.S. individual and, if applicable, obtain a reduced rate of withholding.”
Substitute Form W-8BEN-E. The substitute Form W-8BEN-E must contain all of the information required in Part I, lines 1 through 6, and lines 8 and 9 if a U.S. or an FTIN or a GIIN is required. See, however, Substitute Forms W-8 for Payments of Reportable Amounts and Withholdable Payments , earlier, for when you may omit a chapter 4 certification on a substitute Form W-8. The certifications in Part II must be included in a substitute form if you are making a withholdable payment to a disregarded entity or a branch that must be reported in Part II. The certifications in Part III must be included only if treaty benefits are claimed, and then only to the extent that the certifications are required. See Alternative Certifications Under an Applicable IGA , earlier, for circumstances in which the chapter 4 certifications may be replaced with alternative certifications.
If the substitute form is incorporated into other business forms, the following statement must be presented in the same manner as the penalties of perjury statement and must appear immediately above the single signature line: “The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-U.S. person, establish your chapter 4 status (if required), and, if applicable, obtain a reduced rate of withholding.”
Substitute Form W-8ECI. The substitute Form W-8ECI must contain all of the information required in Part I other than line 9. The certifications in Part II of Form W-8ECI must be included in a substitute form.
If the substitute form is incorporated into other business forms, the following statement must be presented in the same manner as the penalties of perjury statement and must appear immediately above the single signature line: “The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-U.S. person and that the income for which this form is provided is effectively connected with the conduct of a trade or business within the United States.”
Substitute Form W-8EXP. The substitute Form W-8EXP must contain all of the information required in Part I, lines 1 through 5, line 7 (if a U.S. TIN is required), and line 8. See, however, Substitute Forms W-8 for Payments of Reportable Amounts and Withholdable Payments , earlier, for when you may omit a chapter 4 certification on a substitute Form W-8. The substitute Form W-8EXP must also contain all of the statements and certifications contained in Parts II and III, as applicable, with respect to the purpose for which the form is provided, but a specific statement or certification needs to be included (in its entirety) only if it is relevant to the type of entity providing the form. For example, if a withholding agent is documenting a beneficial owner that is a foreign government for purposes of both chapters 3 and 4, the withholding agent may use a substitute Form W-8EXP that contains the required information in Part I, plus the required statements and certifications from Parts II and III that are related to foreign governments, and does not need to include the statements and certifications for other types of entities that would otherwise be providing the Form W-8EXP.
If the substitute form is incorporated into other business forms, the following statement must be presented in the same manner as the penalties of perjury statement and must appear immediately above the single signature line: “The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession, and your chapter 4 status (if required).”
Substitute Form W-8IMY. The substitute Form W-8IMY must contain all of the information required in Part I, lines 1 through 6, line 8 (if a U.S. TIN is required), and line 9 (if a GIIN is required). See, however, Substitute Forms W-8
-18- Inst. for the Requester of Forms W-8 (Rev. June 2022)
for Payments of Reportable Amounts and Withholdable Payments , earlier, for when you may omit a chapter 4 certification on a substitute Form W-8. The information required in Part II must be included in a substitute form if you are making a withholdable payment to a disregarded entity that has its own GIIN or a branch (including a branch that is a disregarded entity that does not have its own GIIN) operating in a jurisdiction other than the jurisdiction of residence of the entity named in Part I of the form. The substitute Form W-8IMY must also contain all of the statements and certifications relevant to chapter 3 contained in Parts III through VIII if you are making a payment subject to withholding under chapter 3 and the statements and certifications relevant to the chapter 4 status contained in Parts IX through XXVIII for the intermediary or flow-through entity providing the form if you are making a withholdable payment or if you are an FFI documenting your account holders for purposes of chapter 4 or an applicable IGA. For example, if the only intermediaries to which a U.S. withholding agent makes payments are QIs that are participating FFIs, the withholding agent may use a substitute Form W-8IMY that contains only the required information from Part I (including line 9 to collect the intermediaries’ GIINs), plus the statements and certifications from Part III. A substitute Form W-8IMY must also incorporate the same attachments as the official form (such as a withholding statement and beneficial owner documentation, to the extent otherwise required). You may also include any information on a substitute Form W-8IMY, or require any information to be associated with the form, that is reasonably related to your obligation to withhold and correctly report payments.
If the substitute form is incorporated into other business forms, the following statement must be presented in the same manner as the penalties of perjury statement and must appear immediately above the single signature line: “The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish: (1) your status as a QI,
an NQI, a specific type of U.S. branch, a withholding foreign partnership, a withholding foreign trust, a nonwithholding foreign partnership, a nonwithholding foreign simple trust, or a nonwithholding foreign grantor trust; (2) your chapter 4 status; and/or (3) your status as a QSL (for the period such status is permitted).”
Non-IRS Form for Individuals Not Receiving Reportable Amounts If you are an FFI documenting an account holder that is an individual and you are not making a payment of a reportable amount to such account holder, you may use a non-IRS form rather than a substitute Form W-8BEN. The form must include the name and address of the individual that is the payee or beneficial owner; all countries in which the individual is resident for tax purposes; the individual’s country of birth; a TIN, if any, for each country of residence; and the individual’s date of birth. The form may also request other information required for purposes of tax or anti-money laundering (AML) due diligence in the United States or in other countries. A form that satisfies these requirements may be treated as a similar agreed form for purposes of an applicable IGA unless the partner jurisdiction declines such treatment.
Generally, a non-IRS form for individuals must contain a signed and dated certification made under penalties of perjury that the information provided on the form is accurate and will be updated by the individual within 30 days of a change in circumstances that causes the form to become incorrect. However, the signed certification provided on a form need not be signed under penalties of perjury if the form is accompanied by documentary evidence that supports the individual’s claim of foreign status. Such documentary evidence may be the same documentary evidence that is used to support foreign status in the case of a payee whose account has U.S. indicia as described in Regulations sections 1.1471-3(e) and 1.1471-4(c)(4)(i)(A).
Inst. for the Requester of Forms W-8 (Rev. June 2022) -19-
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Form W-8BEN
(Rev. October 2021)
Department of the Treasury Internal Revenue Service
Certificate of Foreign Status of Beneficial Owner for United
States Tax Withholding and Reporting (Individuals)
- For use by individuals. Entities must use Form W-8BEN-E.
Go to www.irs.gov/FormW8BEN for instructions and the latest information.
Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Do NOT use this form if: Instead, use Form:
You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E
You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9
You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the United States (other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4
You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
Note: If you are resident in a FATCA partner jurisdiction (that is, a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.
Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 Country of citizenship
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate. Country
4 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions)
6a Foreign tax identifying number (see instructions) 6b Check if FTIN not legally required . . . . . . . . . . .
7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)
Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
9 I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. 10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income):
.
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
Part III Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income or proceeds to which this form relates or am using this form to document myself for chapter 4 purposes;
• The person named on line 1 of this form is not a U.S. person;
• This form relates to:
(a) income not effectively connected with the conduct of a trade or business in the United States;
(b) income effectively connected with the conduct of a trade or business in the United States but is not subject to tax under an applicable income tax treaty;
(c) the partner’s share of a partnership’s effectively connected taxable income; or
(d) the partner’s amount realized from the transfer of a partnership interest subject to withholding under section 1446(f);
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country; and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
Sign Here
I certify that I have the capacity to sign for the person identified on line 1 of this form.
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
Print name of signer
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 10-2021)
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Form W-8ECI
(Rev. October 2021)
Department of the Treasury Internal Revenue Service
Certificate of Foreign Person's Claim That Income Is Effectively Connected With the Conduct of a Trade or Business in the United States
- Section references are to the Internal Revenue Code.
▶ Go to www.irs.gov/FormW8ECI for instructions and the latest information.
- Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business. See instructions.
Do not use this form for: Instead, use Form:
A beneficial owner solely claiming foreign status or treaty benefits . . . . . . . . . . . . . . . . . W-8BEN or W-8BEN-E
A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) . . . . W-8EXP
Note: These entities should use Form W-8ECI if they received effectively connected income and are not eligible to claim an exemption for chapter 3 or 4 purposes on Form W-8EXP.
A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively connected with the conduct of a trade or business in the United States) . . . . . . . . . . . . . . . . . . . . . W-8BEN-E or W-8IMY
A person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY Note: See instructions for additional exceptions. Part I Identification of Beneficial Owner (see instructions)
1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization
3 Name of disregarded entity receiving the payments (if applicable)
4 Type of entity (check the appropriate box):
Partnership
Foreign Government - Controlled Entity Foreign Government - Integral Part Private foundation
Simple trust
Grantor trust International organization
Individual
Complex trust
Central bank of issue Corporation Estate
Tax-exempt organization
5 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate. Country
6 Business address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state, and ZIP code
7 U.S. taxpayer identification number (required—see instructions) SSN or ITIN EIN
8a Foreign tax identifying number (FTIN) 8b Check if FTIN not legally required . . . . . . . . . . .
9 Reference number(s) (see instructions) 10 Date of birth (MM-DD-YYYY)
11 Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or business in the United States (attach statement if necessary).
12 Check here to certify that: you are a dealer in securities (as defined in section 475(c)(1)); you are a transferor of an interest in a publicly traded partnership (PTP) claiming an exception from withholding under Regulations section 1.1446(f)-4(b)(6); and any gain from the transfer of the PTP interest associated
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Form W-8BEN-E
(Rev. October 2021)
Department of the Treasury Internal Revenue Service
- Give this form to the withholding agent or payer. Do not send to the IRS.
Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)
- For use by entities. Individuals must use Form W-8BEN. - Section references are to the Internal Revenue Code.
OMB No. 1545-1621
▶ Go to www.irs.gov/FormW8BENE for instructions and the latest information.
Do NOT use this form for: Instead use Form:
U.S. entity or U.S. citizen or resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-9
A foreign individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN (Individual) or Form 8233
A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the United States (unless claiming treaty benefits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions) . . W-8IMY
A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions for other exceptions) . . . . . . . . . W-8ECI or W-8EXP
Any person acting as an intermediary (including a qualified intermediary acting as a qualified derivatives dealer) . . . . . . . . . W-8IMY
Part I Identification of Beneficial Owner 1 Name of organization that is the beneficial owner 2 Country of incorporation or organization
3 Name of disregarded entity receiving the payment (if applicable, see instructions)
4 Chapter 3 Status (entity type) (Must check one box only): Corporation Partnership
Simple trust Tax-exempt organization Complex trust Foreign Government - Controlled Entity Central Bank of Issue Private foundation Estate Foreign Government - Integral Part Grantor trust Disregarded entity International organization
If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty claim? If “Yes,” complete Part III. Yes No
5 Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status.)
Nonparticipating FFI (including an FFI related to a Reporting IGA FFI other than a deemed-compliant FFI, participating FFI, or exempt beneficial owner).
Participating FFI.
Reporting Model 1 FFI. Reporting Model 2 FFI. Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII). See instructions.
Sponsored FFI. Complete Part IV.
Certified deemed-compliant nonregistering local bank. Complete Part V.
Certified deemed-compliant FFI with only low-value accounts. Complete Part VI.
Certified deemed-compliant sponsored, closely held investment vehicle. Complete Part VII.
Certified deemed-compliant limited life debt investment entity. Complete Part VIII.
Nonreporting IGA FFI. Complete Part XII. Foreign government, government of a U.S. possession, or foreign central bank of issue. Complete Part XIII.
International organization. Complete Part XIV.
Exempt retirement plans. Complete Part XV.
Entity wholly owned by exempt beneficial owners. Complete Part XVI. Territory financial institution. Complete Part XVII.
Excepted nonfinancial group entity. Complete Part XVIII. Excepted nonfinancial start-up company. Complete Part XIX.
Excepted nonfinancial entity in liquidation or bankruptcy. Complete Part XX.
501(c) organization. Complete Part XXI. Nonprofit organization. Complete Part XXII.
Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIII.
Excepted territory NFFE. Complete Part XXIV.
Active NFFE. Complete Part XXV. Passive NFFE. Complete Part XXVI. Excepted inter-affiliate FFI. Complete Part XXVII.
Certain investment entities that do not maintain financial accounts. Complete Part IX.
Complete Part IX. Direct reporting NFFE.
Owner-documented FFI. Complete Part X. Sponsored direct reporting NFFE. Complete Part XXVIII. Restricted distributor. Complete Part XI. Account that is not a financial account.
6 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address) .
Owner-documented FFI. Complete Part X. Restricted distributor. Complete Part XI.
City or town, state or province. Include postal code where appropriate. Country
7 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 59689N Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 2 Part I Identification of Beneficial Owner (continued)
8 U.S. taxpayer identification number (TIN), if required
9a GIIN b Foreign TIN c Check if FTIN not legally required. . . . . .
10 Reference number(s) (see instructions)
Note: Please complete remainder of the form including signing the form in Part XXX.
Part II Disregarded Entity or Branch Receiving Payment. (Complete only if a disregarded entity with a GIIN or a branch of an FFI in a country other than the FFI’s country of residence. See instructions.)
11 Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment
Branch treated as nonparticipating FFI.
Participating FFI.
Reporting Model 1 FFI.
Reporting Model 2 FFI.
U.S. Branch.
12 Address of disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address) .
City or town, state or province. Include postal code where appropriate.
Country
13 GIIN (if any)
Part III Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only.)
14 I certify that (check all that apply): a The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. b The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the requirements of the treaty provision dealing with limitation on benefits. The following are types of limitation on benefits provisions that may be included in an applicable tax treaty (check only one; see instructions):
Government
Tax-exempt pension trust or pension fund Other tax-exempt organization Publicly traded corporation
Company that meets the ownership and base erosion test
Company that meets the derivative benefits test Company with an item of income that meets active trade or business test Favorable discretionary determination by the U.S. competent authority received
Subsidiary of a publicly traded corporation No LOB article in treaty
Other (specify Article and paragraph): c The beneficial owner is claiming treaty benefits for U.S. source dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign corporation and meets qualified resident status (see instructions).
15 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 14a above to claim a % rate of withholding on (specify type of income): Explain the additional conditions in the Article the beneficial owner meets to be eligible for the rate of withholding:
Part IV Sponsored FFI
16 Name of sponsoring entity: 17 Check whichever box applies.
I certify that the entity identified in Part I:
Is an investment entity;
Is not a QI, WP (except to the extent permitted in the withholding foreign partnership agreement), or WT; and
Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity.
I certify that the entity identified in Part I:
Is a controlled foreign corporation as defined in section 957(a);
Is not a QI, WP, or WT;
Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this entity; and
Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all
account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not limited to, customer identification information, customer documentation, account balance, and all payments made to account holders or payees.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 3 Part V Certified Deemed-Compliant Nonregistering Local Bank
18 I certify that the FFI identified in Part I:
- Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country of
incorporation or organization;
- Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to such
bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than 5% interest in such credit union or cooperative credit organization;
Does not solicit account holders outside its country of organization;
Has no fixed place of business outside such country (for this purpose, a fixed place of business does not include a location that is not
advertised to the public and from which the FFI performs solely administrative support functions);
- Has no more than $175 million in assets on its balance sheet and, if it is a member of an expanded affiliated group, the group has no more
than $500 million in total assets on its consolidated or combined balance sheets; and
- Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institution that
is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements set forth in this part.
Part VI Certified Deemed-Compliant FFI with Only Low-Value Accounts
19 I certify that the FFI identified in Part I:
- Is not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional
principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security, partnership interest, commodity, notional principal contract, insurance contract or annuity contract;
- No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of
$50,000 (as determined after applying applicable account aggregation rules); and
- Neither the FFI nor the entire expanded affiliated group, if any, of the FFI, have more than $50 million in assets on its consolidated or
combined balance sheet as of the end of its most recent accounting year. Part VII Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle
20 Name of sponsoring entity: 21 I certify that the entity identified in Part I:
Is an FFI solely because it is an investment entity described in Regulations section 1.1471-5(e)(4);
Is not a QI, WP, or WT;
Will have all of its due diligence, withholding, and reporting responsibilities (determined as if the FFI were a participating FFI) fulfilled by the
sponsoring entity identified on line 20; and
- 20 or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial institutions,
participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an entity if that entity owns 100% of the equity interests in the FFI and is itself a sponsored FFI).
Part VIII Certified Deemed-Compliant Limited Life Debt Investment Entity
22 I certify that the entity identified in Part I:
Was in existence as of January 17, 2013;
Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and
Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the
restrictions with respect to its assets and other requirements under Regulations section 1.1471-5(f)(2)(iv)).
Part IX Certain Investment Entities that Do Not Maintain Financial Accounts
23 I certify that the entity identified in Part I:
- Is a financial institution solely because it is an investment entity described in Regulations section 1.1471-5(e)(4)(i)(A), and
• Does not maintain financial accounts. Part X Owner-Documented FFI Note: This status only applies if the U.S. financial institution, participating FFI, or reporting Model 1 FFI to which this form is given has agreed that it will treat the FFI as an owner-documented FFI (see instructions for eligibility requirements). In addition, the FFI must make the certifications below.
24a (All owner-documented FFIs check here) I certify that the FFI identified in Part I:
Does not act as an intermediary;
Does not accept deposits in the ordinary course of a banking or similar business;
Does not hold, as a substantial portion of its business, financial assets for the account of others;
Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to
a financial account;
- Is not owned by or in an expanded affiliated group with an entity that accepts deposits in the ordinary course of a banking or similar
business, holds, as a substantial portion of its business, financial assets for the account of others, or is an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to a financial account;
Does not maintain a financial account for any nonparticipating FFI; and
Does not have any specified U.S. persons that own an equity interest or debt interest (other than a debt interest that is not a financial
account or that has a balance or value not exceeding $50,000) in the FFI other than those identified on the FFI owner reporting statement.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 4 Part X Owner-Documented FFI (continued)
Check box 24b or 24c, whichever applies.
b I certify that the FFI identified in Part I:
- Has provided, or will provide, an FFI owner reporting statement that contains:
(i) The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified U.S. person that owns a direct or indirect equity interest in the owner-documented FFI (looking through all entities other than specified U.S. persons);
(ii) The name, address, TIN (if any), and chapter 4 status of every individual and specified U.S. person that owns a debt interest in the
owner-documented FFI (including any indirect debt interest, which includes debt interests in any entity that directly or indirectly owns the payee or any direct or indirect equity interest in a debt holder of the payee) that constitutes a financial account in excess of $50,000 (disregarding all such debt interests owned by participating FFIs, registered deemed-compliant FFIs, certified deemedcompliant FFIs, excepted NFFEs, exempt beneficial owners, or U.S. persons other than specified U.S. persons); and
(iii) Any additional information the withholding agent requests in order to fulfill its obligations with respect to the entity.
- Has provided, or will provide, valid documentation meeting the requirements of Regulations section 1.1471-3(d)(6)(iii) for each person identified in the FFI owner reporting statement.
c I certify that the FFI identified in Part I has provided, or will provide, an auditor's letter, signed within 4 years of the date of payment, from an independent accounting firm or legal representative with a location in the United States stating that the firm or representative has reviewed the FFI’s documentation with respect to all of its owners and debt holders identified in Regulations section 1.1471-3(d)(6)(iv)(A)(2), and that the FFI meets all the requirements to be an owner-documented FFI. The FFI identified in Part I has also provided, or will provide, an FFI owner reporting statement of its owners that are specified U.S. persons and Form(s) W-9, with applicable waivers.
Check box 24d if applicable (optional, see instructions).
d I certify that the entity identified on line 1 is a trust that does not have any contingent beneficiaries or designated classes with unidentified beneficiaries. Part XI Restricted Distributor
25a (All restricted distributors check here) I certify that the entity identified in Part I:
Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;
Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to each other;
Is required to perform AML due diligence procedures under the anti-money laundering laws of its country of organization (which is an FATFcompliant jurisdiction);
Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same
country of incorporation or organization as all members of its affiliated group, if any;
Does not solicit customers outside its country of incorporation or organization;
Has no more than $175 million in total assets under management and no more than $7 million in gross revenue on its income statement for
the most recent accounting year;
- Is not a member of an expanded affiliated group that has more than $500 million in total assets under management or more than $20 million
in gross revenue for its most recent accounting year on a combined or consolidated income statement; and
- Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantial U.S.
owners, or nonparticipating FFIs.
Check box 25b or 25c, whichever applies. I further certify that with respect to all sales of debt or equity interests in the restricted fund with respect to which this form is furnished that are made after December 31, 2011, the entity identified in Part I:
b Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S. resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.
c Is currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI and, for all sales made prior to the time that such a restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures identified in Regulations section 1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any, or caused the restricted fund to transfer the securities to a distributor that is a participating FFI or reporting Model 1 FFI securities which were sold to specified U.S. persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 5 Part XII Nonreporting IGA FFI
26 I certify that the entity identified in Part I:
- Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States and
. The applicable IGA is a Model 1 IGA or a Model 2 IGA; and
is treated as a under the provisions of the applicable IGA or Treasury regulations (if applicable, see instructions);
- If you are a trustee documented trust or a sponsored entity, provide the name of the trustee or sponsor .
The trustee is: U.S. Foreign
Part XIII Foreign Government, Government of a U.S. Possession, or Foreign Central Bank of Issue
27 I certify that the entity identified in Part I is the beneficial owner of the payment, and is not engaged in commercial financial activities of a type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)).
Part XIV International Organization
Check box 28a or 28b, whichever applies.
28a I certify that the entity identified in Part I is an international organization described in section 7701(a)(18). b I certify that the entity identified in Part I:
Is comprised primarily of foreign governments;
Is recognized as an intergovernmental or supranational organization under a foreign law similar to the International Organizations Immunities
Act or that has in effect a headquarters agreement with a foreign government;
- The benefit of the entity’s income does not inure to any private person; and
- Is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)).
Part XV Exempt Retirement Plans
Check box 29a, b, c, d, e, or f, whichever applies.
29a I certify that the entity identified in Part I:
Is established in a country with which the United States has an income tax treaty in force (see Part III if claiming treaty benefits);
Is operated principally to administer or provide pension or retirement benefits; and
Is entitled to treaty benefits on income that the fund derives from U.S. sources (or would be entitled to benefits if it derived any such income)
as a resident of the other country which satisfies any applicable limitation on benefits requirement.
b I certify that the entity identified in Part I:
- Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former
employees of one or more employers in consideration for services rendered;
No single beneficiary has a right to more than 5% of the FFI’s assets;
Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operated; and
(i) Is generally exempt from tax on investment income under the laws of the country in which it is established or operates due to its status as a retirement or pension plan;
(ii) Receives at least 50% of its total contributions from sponsoring employers (disregarding transfers of assets from other plans described
in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, other retirement funds described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A));
(iii) Either does not permit or penalizes distributions or withdrawals made before the occurrence of specified events related to retirement,
disability, or death (except rollover distributions to accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), to retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or to other retirement funds described in this part or in an applicable Model 1 or Model 2 IGA); or
(iv) Limits contributions by employees to the fund by reference to earned income of the employee or may not exceed $50,000 annually. c I certify that the entity identified in Part I:
- Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former
employees of one or more employers in consideration for services rendered;
- Has fewer than 50 participants;
Is sponsored by one or more employers each of which is not an investment entity or passive NFFE;
Employee and employer contributions to the fund (disregarding transfers of assets from other plans described in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A)) are limited by reference to earned income and compensation of the employee, respectively;
Participants that are not residents of the country in which the fund is established or operated are not entitled to more than 20% of the fund’s assets; and
Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the country in which the fund is established or operates.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 6 Part XV Exempt Retirement Plans (continued)
d I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other than the requirement that the plan be funded by a trust created or organized in the United States. e I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds
described in this part or in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
f I certify that the entity identified in Part I:
- Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession
(each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons designated by such employees); or
- Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession
(each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in consideration of personal services performed for the sponsor.
Part XVI Entity Wholly Owned by Exempt Beneficial Owners
30 I certify that the entity identified in Part I:
Is an FFI solely because it is an investment entity;
Each direct holder of an equity interest in the investment entity is an exempt beneficial owner described in Regulations section 1.1471-6 or in
an applicable Model 1 or Model 2 IGA;
Each direct holder of a debt interest in the investment entity is either a depository institution (with respect to a loan made to such entity) or an exempt beneficial owner described in Regulations section 1.1471-6 or an applicable Model 1 or Model 2 IGA.
Has provided an owner reporting statement that contains the name, address, TIN (if any), chapter 4 status, and a description of the type of documentation provided to the withholding agent for every person that owns a debt interest constituting a financial account or direct equity interest in the entity; and
Has provided documentation establishing that every owner of the entity is an entity described in Regulations section 1.1471-6(b), (c), (d), (e), (f) and/or (g) without regard to whether such owners are beneficial owners.
Part XVII Territory Financial Institution
31 I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under
the laws of a possession of the United States. Part XVIII Excepted Nonfinancial Group Entity
32 I certify that the entity identified in Part I:
- Is a holding company, treasury center, or captive finance company and substantially all of the entity’s activities are functions described in
Regulations section 1.1471-5(e)(5)(i)(C) through (E);
Is a member of a nonfinancial group described in Regulations section 1.1471-5(e)(5)(i)(B);
Is not a depository or custodial institution (other than for members of the entity’s expanded affiliated group); and
Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any
investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
Part XIX Excepted Nonfinancial Start-Up Company
33 I certify that the entity identified in Part I:
- Was formed on (or, in the case of a new line of business, the date of board resolution approving the new line of business)
(date must be less than 24 months prior to date of payment);
- Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of
business other than that of a financial institution or passive NFFE;
Is investing capital into assets with the intent to operate a business other than that of a financial institution; and
Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any
investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes. Part XX Excepted Nonfinancial Entity in Liquidation or Bankruptcy
34 I certify that the entity identified in Part I:
Filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy on ;
During the past 5 years has not been engaged in business as a financial institution or acted as a passive NFFE;
Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a nonfinancial entity; and
Has, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in bankruptcy or liquidation for more than 3 years.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 7 Part XXI 501(c) Organization
35 I certify that the entity identified in Part I is a 501(c) organization that:
- Has been issued a determination letter from the IRS that is currently in effect concluding that the payee is a section 501(c) organization that is
dated ; or
- Has provided a copy of an opinion from U.S. counsel certifying that the payee is a section 501(c) organization (without regard to whether the
payee is a foreign private foundation).
Part XXII Nonprofit Organization
36 I certify that the entity identified in Part I is a nonprofit organization that meets the following requirements.
The entity is established and maintained in its country of residence exclusively for religious, charitable, scientific, artistic, cultural or educational purposes;
The entity is exempt from income tax in its country of residence;
The entity has no shareholders or members who have a proprietary or beneficial interest in its income or assets;
Neither the applicable laws of the entity’s country of residence nor the entity’s formation documents permit any income or assets of the entity
to be distributed to, or applied for the benefit of, a private person or noncharitable entity other than pursuant to the conduct of the entity’s charitable activities or as payment of reasonable compensation for services rendered or payment representing the fair market value of property which the entity has purchased; and
- The applicable laws of the entity’s country of residence or the entity’s formation documents require that, upon the entity’s liquidation or
dissolution, all of its assets be distributed to an entity that is a foreign government, an integral part of a foreign government, a controlled entity of a foreign government, or another organization that is described in this part or escheats to the government of the entity’s country of residence or any political subdivision thereof.
Part XXIII Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation
Check box 37a or 37b, whichever applies.
37a I certify that:
The entity identified in Part I is a foreign corporation that is not a financial institution; and
The stock of such corporation is regularly traded on one or more established securities markets, including
(name one securities exchange upon which the stock is regularly traded).
b I certify that:
The entity identified in Part I is a foreign corporation that is not a financial institution;
The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an established securities market;
The name of the entity, the stock of which is regularly traded on an established securities market, is ; and
The name of the securities market on which the stock is regularly traded is .
Part XXIV Excepted Territory NFFE
38 I certify that:
The entity identified in Part I is an entity that is organized in a possession of the United States;
The entity identified in Part I:
(i) Does not accept deposits in the ordinary course of a banking or similar business;
(ii) Does not hold, as a substantial portion of its business, financial assets for the account of others; or
(iii) Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with
respect to a financial account; and
- All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated.
Part XXV Active NFFE
39 I certify that:
The entity identified in Part I is a foreign entity that is not a financial institution;
Less than 50% of such entity’s gross income for the preceding calendar year is passive income; and
Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as a
weighted average of the percentage of passive assets measured quarterly) (see instructions for the definition of passive income).
Part XXVI Passive NFFE
40a I certify that the entity identified in Part I is a foreign entity that is not a financial institution (other than an investment entity organized in a possession of the United States) and is not certifying its status as a publicly traded NFFE (or affiliate), excepted territory NFFE, active NFFE, direct reporting NFFE, or sponsored direct reporting NFFE.
Check box 40b or 40c, whichever applies.
b I further certify that the entity identified in Part I has no substantial U.S. owners (or, if applicable, no controlling U.S. persons); or c I further certify that the entity identified in Part I has provided the name, address, and TIN of each substantial U.S. owner (or, if applicable, controlling U.S. person) of the NFFE in Part XXIX.
Form W-8BEN-E (Rev. 10-2021)
Form W-8BEN-E (Rev. 10-2021) Page 8 Part XXVII Excepted Inter-Affiliate FFI
41 I certify that the entity identified in Part I:
Is a member of an expanded affiliated group;
Does not maintain financial accounts (other than accounts maintained for members of its expanded affiliated group);
Does not make withholdable payments to any person other than to members of its expanded affiliated group;
Does not hold an account (other than depository accounts in the country in which the entity is operating to pay for expenses) with or receive payments from any withholding agent other than a member of its expanded affiliated group; and
- Has not agreed to report under Regulations section 1.1471-4(d)(2)(ii)(C) or otherwise act as an agent for chapter 4 purposes on behalf of any financial institution, including a member of its expanded affiliated group.
Part XXVIII Sponsored Direct Reporting NFFE (see instructions for when this is permitted)
42 Name of sponsoring entity:
43 I certify that the entity identified in Part I is a direct reporting NFFE that is sponsored by the entity identified on line 42. Part XXIX Substantial U.S. Owners of Passive NFFE
As required by Part XXVI, provide the name, address, and TIN of each substantial U.S. owner of the NFFE. Please see the instructions for a definition of substantial U.S. owner. If providing the form to an FFI treated as a reporting Model 1 FFI or reporting Model 2 FFI, an NFFE may also use this part for reporting its controlling U.S. persons under an applicable IGA.
Name Address TIN
Part XXX Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
- The entity identified on line 1 of this form is the beneficial owner of all the income or proceeds to which this form relates, is using this form to certify its status for
chapter 4 purposes, or is submitting this form for purposes of section 6050W or 6050Y;
The entity identified on line 1 of this form is not a U.S. person;
This form relates to: (a) income not effectively connected with the conduct of a trade or business in the United States, (b) income effectively connected with the
conduct of a trade or business in the United States but is not subject to tax under an income tax treaty, (c) the partner’s share of a partnership’s effectively connected taxable income, or (d) the partner’s amount realized from the transfer of a partnership interest subject to withholding under section 1446(f); and
- For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which the entity on line 1 is the beneficial owner or any withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner.
I agree that I will submit a new form within 30 days if any certification on this form becomes incorrect.
I certify that I have the capacity to sign for the entity identified on line 1 of this form.
Sign Here
Signature of individual authorized to sign for beneficial owner Print Name Date (MM-DD-YYYY)
Form W-8BEN-E (Rev. 10-2021)
This page is blank (do not print)
Form W-8EXP
(Rev. October 2023)
Department of the Treasury Internal Revenue Service
Go to www.irs.gov/FormW8EXP for instructions and the latest information.
Section references are to the Internal Revenue Code. Give this form to the withholding agent or payer. Do not send to the IRS.
Certificate of Foreign Government or Other Foreign
Organization for United States Tax
Withholding and Reporting (For use by foreign governments, international organizations, foreign central banks of issue, foreign
OMB No. 1545-1621
tax-exempt organizations, foreign private foundations, and governments of U.S. territories.)
Do not use this form for: Instead, use Form:
A foreign government or other foreign organization that is not claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E or W-8ECI
A beneficial owner solely claiming foreign status or treaty benefits . . . . . . . . . . . . . . . . . W-8BEN or W-8BEN-E
A foreign partnership (except for a withholding qualified holder under section 1445) or a foreign trust . . . . . . . W-8BEN-E or W-8IMY
A person claiming that income is effectively connected with the conduct of a trade or business in the United States . . . . . . W-8ECI
• A person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
4 Chapter 4 Status (FATCA status): Participating FFI. Foreign government (including a political subdivision), Reporting Model 1 FFI. Reporting Model 2 FFI. Complete Part III. Registered deemed-compliant FFI (other than a Reporting Model 1 FFI). 501(c) organization. Complete Part III.
Foreign government (including a political subdivision), government of a U.S. territory, or foreign central bank of issue. Complete Part III.
Nonreporting IGA FFI. Complete Part III. Territory financial institution. Complete Part III. International organization.
Exempt retirement plan of foreign government. Complete Part III. 501(c) organization. Complete Part III. Passive NFFE. Complete Part III. Direct reporting NFFE. Sponsored direct reporting NFFE. Complete Part III.
5 Permanent address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).
City or town, state or province. Include postal code where appropriate. Country
6 Mailing address (if different from above).
City or town, state or province. Include postal or ZIP code where appropriate. Country
7 U.S. TIN, if required (see instructions) 8a GIIN b Foreign TIN (see instructions)
9 Reference number(s) (see instructions)
Part II Qualification Statement for Chapter 3 Status 10 For a foreign government: a I certify that the entity identified in Part I is a foreign government within the meaning of section 892 and the payments are within the scope of the exemption granted by section 892. Check box 10b or box 10c, whichever applies. b The entity identified in Part I is an integral part of the government of . c The entity identified in Part I is a controlled entity of the government of . If box 10c is checked, check box 10d or box 10e, whichever applies. d I certify that for a beneficial owner that is a controlled entity of a foreign sovereign (other than a foreign central bank of issue wholly owned by a foreign sovereign), the beneficial owner is not engaged in commercial activities within or outside the United States.
e I certify that for a beneficial owner that is a foreign central bank of issue and a controlled entity of a foreign sovereign, the beneficial owner is not engaged in commercial activities within the United States. 11 For an international organization:
I certify that:
- The entity identified in Part I is an international organization within the meaning of section 7701(a)(18), and
• The payments are within the scope of the exemption granted by section 892.
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25401F Form W-8EXP (Rev. 10-2023)
Form W-8EXP (Rev. 10-2023) Page 2 Part II Qualification Statement for Chapter 3 Status (continued) 12 For a foreign central bank of issue (not wholly owned by the foreign sovereign):
I certify that:
The entity identified in Part I is a foreign central bank of issue,
The entity identified in Part I does not hold obligations or bank deposits to which this form relates for use in connection
with the conduct of a commercial banking function or other commercial activity, and
- The payments are within the scope of the exemption granted by section 895.
13 For a foreign tax-exempt organization, including foreign private foundations:
If any of the income to which this certification relates constitutes income includible under section 512 in computing the entity’s unrelated business taxable income, attach a statement identifying the amounts. Check either box 13a or box 13b. a I certify that the entity identified in Part I has been issued a determination letter by the IRS dated that is currently in effect and that concludes that it is an exempt organization described in section 501(c). b I have attached to this form an opinion from U.S. counsel concluding that the entity identified in Part I is described in section 501(c). For section 501(c)(3) organizations only, check either box 13c or box 13d. c If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that the organization is not a private foundation described in section 509. I have attached an affidavit of the organization setting forth sufficient facts for the IRS to determine that the organization is not a private foundation because it meets one of the exceptions described in section 509(a)(1), (2), (3), or (4).
d If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that the organization is a private foundation described in section 509. 14 For a government of a U.S. territory:
I certify that the entity identified in Part I is a government of a territory of the United States, or is a political subdivision thereof, and is claiming the exemption granted by section 115(2). 15 For a withholding qualified holder: Check either box 15a or 15b. a I certify that the entity identified in Part I is treated as a non-foreign person for purposes of sections 897 and 1445 because it is a qualified holder under Regulations section 1.897(I)-1(d). b I certify that the entity identified in Part I is treated as a non-foreign person for purposes of sections 897 and 1445 because it is a foreign partnership, all of the interests of which are held by qualified holders (under Regulations section 1.897(I)-1(d)), including through one or more partnerships. Part III Qualification Statement for Chapter 4 Status (if required) 16 For a nonreporting IGA FFI:
I certify that the entity identified in Part I:
- Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States
and ;
Is treated as a under the provisions of the applicable IGA (see instructions); and
If you are an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 IGA, provide your
GIIN: . 17 For a territory financial institution:
I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under the laws of a territory of the United States. 18 For a foreign government (including a political subdivision), government of a U.S. territory, or foreign central bank of issue:
I certify that the entity identified in Part I is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)).
19 For an exempt retirement plan of a foreign government: Check box 19a or box 19b, whichever applies. a I certify that the entity identified in Part I is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. territory (each as defined in Regulations section 1.1471-6 or an applicable Model 1 or Model 2 IGA) to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons designated by such employees); or
b I certify that the entity identified in Part I is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. territory (each as defined in Regulations section 1.1471-6 or an applicable Model 1 or Model 2 IGA) to provide retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in consideration of personal services performed for the sponsor.
Form W-8EXP (Rev. 10-2023)
Form W-8EXP (Rev. 10-2023) Page 3 Part III Qualification Statement for Chapter 4 Status (if required) (continued) 20 For a 501(c) organization:
I certify that the entity identified in Part I is an entity described in section 501(c) but is not an insurance company described in section 501(c)(15). 21 For a passive NFFE: a I certify that the entity identified in Part I is a foreign entity that is not a financial institution (other than an investment entity organized in a territory of the United States). Check box 21b or 21c, whichever applies. b I further certify that the entity identified in Part I has no substantial U.S. owners, or c I further certify that the entity identified in Part I has provided a statement including the name, address, and TIN of each substantial U.S. owner of the NFFE (see instructions). 22 Name of sponsoring entity:
I certify that the entity identified in Part I is a direct reporting NFFE that is sponsored by the entity identified in line 22.
Part IV Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
- The organization for which I am signing is the beneficial owner of the income and other payments to which this form relates, and
the beneficial owner is not a U.S. person; and/or
- The organization for which I am signing is a withholding qualified holder because it is a qualified holder under Regulations section 1.897(I)-1(d) or it is a partnership and all of its interests are held, directly or indirectly, by qualified holders under Regulations section 1.1445-1(g)(11). Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the payments of which I am the beneficial owner or any withholding agent that can disburse or make payments of the amounts of which I am the beneficial owner.
I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
I certify that I have the capacity to sign for the entity identified on line 1 of this form.
Sign Here
Signature of authorized official Print name Date (MM-DD-YYYY)
Form W-8EXP (Rev. 10-2023)
This page is blank (do not print)
Form W-8IMY
(Rev. October 2021)
Department of the Treasury Internal Revenue Service
Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain
U.S. Branches for United States Tax Withholding and Reporting
- Section references are to the Internal Revenue Code.
▶ Go to www.irs.gov/FormW8IMY for instructions and the latest information.
- Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Do not use this form for: Instead, use Form:
A beneficial owner solely claiming foreign status or treaty benefits (other than a qualified intermediary (QI) acting as a qualified derivatives dealer (QDD)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN or W-8BEN-E
A hybrid entity claiming treaty benefits on its own behalf (other than a QI acting as a QDD) . . . . . . . . . . . . . . W-8BEN-E
A foreign person claiming that income is effectively connected with the conduct of a trade or business in the United States . . . . . W-8ECI
A disregarded entity with a single foreign owner that is the beneficial owner (other than a QI acting as a QDD) of the income to which this form relates. Instead, the single foreign owner should use . . . . . . . . . . . . . . . . . . W-8BEN, W-8ECI, or W-8BEN-E
A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) . . . . . . . . . . W-8EXP
U.S. entity or U.S. citizen or resident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-9
A foreign person documenting itself for purposes of section 6050W . . . . . . . . . . . . . . W-8BEN, W-8BEN-E, or W-8ECI
Part I Identification of Entity 1 Name of organization that is acting as intermediary 2 Country of incorporation or organization
3 Name of disregarded entity (if applicable), see instructions
4 Chapter 3 Status (entity type) (Must check one box only.):
QI (including a QDD). Complete Part III.
Nonqualified intermediary. Complete Part IV. Territory financial institution. Complete Part V. U.S. branch. Complete Part VI.
Withholding foreign partnership. Complete Part VII.
Withholding foreign trust. Complete Part VII.
Nonwithholding foreign partnership. Complete Part VIII. Nonwithholding foreign simple trust. Complete Part VIII. Nonwithholding foreign grantor trust. Complete Part VIII.
5 Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity’s applicable status.) (Must check one box only.):
Nonparticipating foreign financial institution (FFI) (including an FFI related to a Reporting IGA FFI other than a deemed-compliant FFI, participating FFI, or exempt beneficial owner). Complete Part IX (if applicable). Participating FFI.
Reporting Model 1 FFI. Reporting Model 2 FFI.
Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XIX).
Territory financial institution. Complete Part V.
Sponsored FFI (other than a certified deemed-compliant sponsored, closely held investment vehicle). Complete Part X.
Certified deemed-compliant nonregistering local bank. Complete Part XII.
Certified deemed-compliant FFI with only low-value accounts. Complete Part XIII.
Certified deemed-compliant sponsored, closely held investment vehicle. Complete Part XIV.
Certified deemed-compliant limited life debt investment entity. Complete Part XV.
Certain investment entities that do not maintain financial accounts. Complete Part XVI.
Owner-documented FFI. Complete Part XI. Restricted distributor. Complete Part XVII. Foreign central bank of issue. Complete Part XVIII.
Nonreporting IGA FFI. Complete Part XIX. Exempt retirement plans. Complete Part XX. Excepted nonfinancial group entity. Complete Part XXI.
Excepted nonfinancial start-up company. Complete Part XXII. Excepted nonfinancial entity in liquidation or bankruptcy. Complete Part XXIII.
Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIV.
Excepted territory NFFE. Complete Part XXV.
Active NFFE. Complete Part XXVI. Passive NFFE. Complete Part XXVII. Direct reporting NFFE.
Sponsored direct reporting NFFE. Complete Part XXVIII.
6 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).
City or town, state or province. Include postal code where appropriate. Country
7 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country
8 U.S. taxpayer identification number, if required ▶
QI-EIN WP-EIN WT-EIN EIN
9a GIIN (if applicable) ▶
b Foreign taxpayer identification number, if required ▶
10 Reference number(s) (see instructions)
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25402Q Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 2 Part II Disregarded Entity or Branch Receiving Payment. (Complete only if a disregarded entity with a GIIN or a branch of an FFI in a country other than the FFI’s country of residence. Do not complete Part II for QDD branches. See instructions.)
11 Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment.
Branch treated as nonparticipating FFI. Participating FFI.
Reporting Model 1 FFI. Reporting Model 2 FFI.
U.S. Branch.
12 Address of branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).
City or town, state or province. Include postal code where appropriate. Country
13 GIIN (if any) ▶
Chapter 3 Status Certifications
Part III Qualified Intermediary All Qualified Intermediaries
14 I certify that the entity identified in Part I (or branch, if relevant):
- Is a QI with respect to the accounts identified on line 10 or in a withholding statement associated with this form (as required) that is one
or more of the following:
(i) Not acting for its own account; (ii) A QDD receiving payments on underlying securities and/or potential section 871(m) transactions;
(iii) A QI assuming primary withholding responsibility for payments of substitute interest, as permitted by the QI Agreement.
- Has provided or will provide a withholding statement (as required) for purposes of chapters 3 and 4, and section 1446(a), or section
1446(f), subject to the certifications made on this form.
- To the extent it acts as a disclosing QI for purposes of section 1446(a) or (f) for payments associated with this form, the QI is to provide
the required payee documentation to associate with an amount realized or an amount subject to withholding on a PTP distribution.
Qualified Intermediaries When Not Acting As Qualified Derivatives Dealers (check all that apply)
15a I certify that the entity identified in Part I of this form assumes primary withholding responsibility for purposes of chapters 3 and 4 for each account identified on a withholding statement attached to this form (or, if no withholding statement is attached to this form, for all accounts).
b I certify that the entity identified in Part I of this form assumes primary withholding and reporting responsibility for each payment of an amount realized from the sale of an interest in a publicly traded partnership under section 1446(f) associated with each account identified on a withholding statement attached to this form for receiving such amounts (or, if no withholding statement is attached to this form, for all accounts).
c I certify that the entity identified in Part I of this form assumes primary withholding as a nominee under Regulations section 1.1446-4(b)(3) for each distribution by a publicly traded partnership associated with each account identified on a withholding statement attached to this form for receiving such distributions (or, if no withholding statement is attached to this form, for all accounts).
d I certify that the entity identified in Part I of this form is a QI acting as a qualified securities lender assuming primary withholding and reporting responsibilities with respect to payments that are U.S. source substitute dividends received from the withholding agent associated with each account identified on a withholding statement attached to this form (or, if no withholding statement is attached to this form, for all accounts).
e I certify that the entity identified in Part I of this form assumes primary withholding responsibility for purposes of chapters 3 and 4 and primary Form 1099 reporting and backup withholding responsibility for all payments of U.S. source interest and substitute interest associated with this form, as permitted by the QI Agreement.
f I certify that the entity identified in Part I of this form assumes primary Form 1099 reporting and backup withholding responsibility or reporting responsibility as a participating FFI or registered deemed-compliant FFI with respect to accounts that it maintains that are held by specified U.S. persons as permitted under Regulations sections 1.6049-4(c)(4)(i) or (c)(4)(ii) in lieu of Form 1099 reporting for each account identified on a withholding statement attached to this form (or, if no withholding statement is attached to this form, for all accounts).
g I certify that the entity identified in Part I of this form does not assume primary Form 1099 reporting and backup withholding responsibility for each account identified on a withholding statement attached to this form (or, if no withholding statement is attached to this form, for all accounts).
h (Complete only to the extent the entity identified in Part I of this form does not assume primary Form 1099 reporting and backup withholding responsibility.) If the entity identified in Part I of this form has allocated or will allocate a portion of a payment to a chapter 4 withholding rate pool of U.S. payees on a withholding statement associated with this form, I certify that the entity meets the requirements of Regulations section 1.6049-4(c)(4)(iii) with respect to any account holder of an account it maintains that is included in such a withholding rate pool.
i (Complete only to the extent the entity identified in Part I of this form does not assume primary Form 1099 reporting and backup withholding responsibility.) If the entity identified in Part I of this form has allocated or will allocate a portion of a payment to a chapter 4 withholding rate pool of U.S. payees on a withholding statement associated with this form, to the extent the U.S. payees are account holders of an intermediary or flowthrough entity receiving a payment from the entity, I certify that the entity has obtained, or will obtain, documentation sufficient to establish each such intermediary or flow-through entity status as a participating FFI, registered deemed-compliant FFI, or FFI that is a QI.
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 3 Qualified Derivatives Dealers
16a I certify that each QDD identified in Part I of this form or on a withholding statement associated with this form meets the requirements to act as a QDD (including approval by the IRS to so act) and assumes primary withholding and reporting responsibilities under chapters 3, 4, and 61 and section 3406 with respect to any payments it makes with respect to potential section 871(m) transactions.
b Entity classification of QDD: Corporation Partnership Disregarded Entity Part IV Nonqualified Intermediary Check all that apply.
17a (All nonqualified intermediaries and QIs that are not acting in their capacity as such check here.) I certify that the entity identified in Part I of this form is not acting as a QI with respect to each account(s) for which this form is provided and is not acting for its own account.
b I certify that the entity identified in Part I of this form is using this form to transmit withholding certificates and/or other documentation and has provided, or will provide, a withholding statement, as required. Note: If this form is provided for purposes of the entity’s interest in a publicly traded partnership, see the instructions for Part IV before checking this box .
c I certify that the entity identified in Part I of this form meets the requirements of Regulations section 1.6049-4(c)(4)(iii) with respect to any account holder of an account it maintains that is included in a withholding rate pool of U.S. payees provided on a withholding statement associated with this form (excluding a distribution from a publicly traded partnership).
d I certify that the entity identified in Part I of this form is acting as a qualified securities lender (other than a QI) assuming primary withholding and reporting responsibilities with respect to payments associated with this form that are U.S. source substitute dividends received from the withholding agent.
e To the extent that the entity identified in Part I of this form is providing an alternative withholding statement described in Regulations section 1.1441-1(e)(3)(iv)(C)(3) for any payments associated with the form, the entity represents that the information on all of the withholding statements associated with this withholding certificate have been (or will be) verified for inconsistency with any other account information the entity has for the beneficial owners for determining the rate of withholding with respect to each payee (applying the standards of knowledge under section 1441 or section 1471, as applicable). Part V Territory Financial Institution
18a I certify that the entity identified in Part I is a financial institution (other than an investment entity that is not also a depository institution, custodial institution, or specified insurance company) that is incorporated or organized under the laws of a territory of the United States. Check the box on line 18b or 18c, whichever applies.
b I further certify that the entity identified in Part I is using this form as evidence of its agreement with the withholding agent to be treated as a U.S. person for purposes of chapters 3 and 4 with respect to any reportable amounts and withholdable payments associated with this withholding certificate.
c I further certify that the entity identified in Part I:
- Is using this form to transmit withholding certificates and/or other documentation for the persons for whom it receives a payment of a
reportable amount or a withholdable payment; and
- Has provided or will provide a withholding statement, as required.
Check the boxes on lines 18d, and 18e or 18f, as applicable.
d I certify that the entity identified in Part I agrees to be treated as a U.S. person under Regulations section 1.1446(f)-4(a)(2)(i)(B) with respect to amounts realized on sales of interests in publicly traded partnerships.
e I certify that the entity identified in Part I agrees to be treated as a U.S. person (as described in Regulations section 1.1441-1(b)(2)(iv)(A)) and as a nominee under Regulations section 1.1446-4(b)(3) with respect to distributions by publicly traded partnerships, or
f Is not acting as a nominee for distributions from publicly traded partnerships and is providing withholding statements for the distributions. Note: If this form is provided for an amount realized, see the instructions for Part V before providing a withholding statement for an amount realized when the entity does not check the box on line 18d.
Part VI Certain U.S. Branches
19a I certify that the entity identified in Part I is a U.S. branch receiving reportable amounts or withholdable payments that are not income effectively connected with the conduct of a trade or business in the United States, distributions from publicly traded partnerships, or amounts realized on sales of interests in publicly traded partnerships.
Check the box on line 19b or 19c, whichever applies.
b I certify that the entity identified in Part I is a U.S. branch of a foreign bank or insurance company described in Regulations section 1.1441-1(b)(2)(iv)(A) that is using this form as evidence of its agreement with the withholding agent to be treated as a U.S. person with respect to any reportable amounts or withholdable payments associated with this withholding certificate.
c I certify that the entity identified in Part I:
Is using this form to transmit withholding certificates and/or other documentation for the persons for whom the branch receives a payment of a reportable amount;
Has provided or will provide a withholding statement, as required; and
In the case of a withholdable payment, is applying the rules described in Regulations section 1.1471-4(d)(2)(iii)(C).
Check the boxes on lines 19d, and 19e or 19f, as applicable.
d I certify that the entity identified in Part I is a U.S. branch (as described in Regulations section 1.1446(f)-4(a)(2)(i)(B)) that is acting as a U.S. person with respect to amounts realized on the sales of interests in publicly traded partnerships,
e I certify that the entity identified in Part I is a U.S. branch (as described in Regulations section 1.1441-1(b)(2)(iv)(A)) that is treated as a U.S. person and as a nominee with respect to distributions by publicly traded partnerships under Regulations section 1.1446-4(b)(3), or
f Is not acting as a nominee for distributions from publicly traded partnerships and is providing withholding statements for the distributions. Note: If this form is provided for an amount realized, see the instructions for Part VI before providing a withholding statement for an amount realized when the U.S. branch does not check the box on line 19d.
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 4 Part VII Withholding Foreign Partnership (WP) or Withholding Foreign Trust (WT)
20 I certify that the entity identified in Part I is a withholding foreign partnership or a withholding foreign trust that is compliant with the terms of its WP or WT agreement. Part VIII Nonwithholding Foreign Partnership, Simple Trust, or Grantor Trust Check all that apply.
21a I certify that the entity identified in Part I:
- Is a nonwithholding foreign partnership, a nonwithholding foreign simple trust, or a nonwithholding foreign grantor trust and is providing
this form for payments that are not effectively connected, or are not treated as effectively connected, with the conduct of a trade or business in the United States; and
- Is using this form to transmit withholding certificates and/or other documentation and has provided or will provide a withholding statement, as required for purposes of chapters 3 and 4, that is subject to the certifications made on this form.
b I certify that the entity identified in Part I is a foreign partnership or foreign grantor trust that is a partner in a lower-tier partnership and is providing this Form W-8IMY for purposes of section 1446(a).
c I certify that the entity identified in Part I is a foreign partnership receiving an amount realized on the transfer of an interest in a partnership for purposes of section 1446(f).
d I certify that the entity identified in Part I is a foreign partnership providing a withholding statement for a modified amount realized from the transfer (check, when applicable, only if box 21c is checked).
e I certify that the entity identified in Part I is a foreign grantor trust providing the form on behalf of each grantor or other owner of the trust under Regulations section 1.1446(f)-1(c)(2)(vii) that is transmitting withholding certificates and providing a withholding statement to allocate the amount realized to each grantor or other owner.
f To the extent the entity identified in Part I of this form is providing an alternative withholding statement described in Regulations section 1.1441-1(e)(3)(iv)(C)(3) for any payments associated with the form, the entity represents that the information on all of the withholding certificates associated with the withholding statement may be relied on based on the standards of knowledge under section 1441 or section 1471 applicable to the entity.
Chapter 4 Status Certifications
Part IX Nonparticipating FFI with Exempt Beneficial Owners
22 I certify that the entity identified in Part I is using this form to transmit withholding certificates and/or other documentation and has provided or will provide a withholding statement that indicates the portion of the payment allocated to one or more exempt beneficial owners.
Part X Sponsored FFI
23a Name of sponsoring entity: ▶ Check the box on line 23b or 23c, whichever applies.
b I certify that the entity identified in Part I:
Is an investment entity;
Is not a QI, WP (except to the extent permitted in the withholding foreign partnership agreement), or WT; and
Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity.
c I certify that the entity identified in Part I:
Is a controlled foreign corporation as defined in section 957(a);
Is not a QI, WP, or WT;
Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this
entity; and
- Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not limited to, customer identification information, customer documentation, account balance, and all payments made to account holders or payees.
Part XI Owner-Documented FFI
Note: This status only applies if the U.S. financial institution, participating FFI, reporting Model 1 FFI, or reporting Model 2 FFI to which this form is given has agreed that it will treat the FFI as an owner-documented FFI. The owner-documented FFI must make the certifications below.
24a I certify that the FFI identified in Part I:
Does not act as an intermediary;
Does not accept deposits in the ordinary course of a banking or similar business;
Does not hold, as a substantial portion of its business, financial assets for the account of others;
Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with
respect to a financial account;
- Is not affiliated with an entity (other than an FFI that is also treated as an owner-documented FFI) that accepts deposits in the ordinary
course of a banking or similar business, holds, as a substantial portion of its business, financial assets for the account of others, or is an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to a financial account; and
- Does not maintain a financial account for any nonparticipating FFI .
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 5 Part XI Owner-Documented FFI (continued) Check the box on line 24b or 24c, whichever applies.
b I certify that the FFI identified in Part I:
- Has provided, or will provide, an FFI owner reporting statement (including any applicable owner documentation) that contains:
(i) The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified U.S. person that owns a direct or indirect equity interest in the owner-documented FFI (looking through all entities other than specified U.S. persons);
(ii) The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified
U.S. person that owns a debt interest in the owner-documented FFI (including any indirect debt interest, which includes debt interests in any entity that directly or indirectly owns the payee or any direct or indirect equity interest in a debt holder of the payee) that constitutes a financial account in excess of $50,000 (disregarding all such debt interests owned by participating FFIs, registered deemed-compliant FFIs, certified deemed-compliant FFIs, excepted NFFEs, exempt beneficial owners, or U.S. persons other than specified U.S. persons); and
(iii) Any additional information the withholding agent requests in order to fulfill its obligations with respect to the entity. c I certify that the FFI identified in Part I:
- Has provided, or will provide, an auditor’s letter, signed no more than 4 years prior to the date of payment, from an independent
accounting firm or legal representative with a location in the United States stating that the firm or representative has reviewed the FFI’s documentation with respect to all of its owners and debt holders identified in Regulations section 1.1471-3(d)(6)(iv)(A)(2) and that the FFI meets all the requirements to be an owner-documented FFI. The FFI identified in Part I has also provided, or will provide, an FFI owner reporting statement and Form W-9, with applicable waivers, as described in Regulations section 1.1471-3(d)(6)(iv). Part XII Certified Deemed-Compliant Nonregistering Local Bank
25 I certify that the FFI identified in Part I:
- Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country
of incorporation or organization;
- Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to
such bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than 5% interest in such credit union or cooperative credit organization;
Does not solicit account holders outside its country of organization;
Has no fixed place of business outside such country (for this purpose, a fixed place of business does not include a location that is not
advertised to the public and from which the FFI performs solely administrative support functions);
- Has no more than $175 million in assets on its balance sheet and, if it is a member of an expanded affiliated group, the group has no
more than $500 million in total assets on its consolidated or combined balance sheets; and
- Does not have any member of its expanded affiliated group that is an FFI, other than an FFI that is incorporated or organized in the same
country as the FFI identified in Part I and that meets the requirements set forth in this Part XII.
Part XIII Certified Deemed-Compliant FFI With Only Low-Value Accounts
26 I certify that the FFI identified in Part I:
Is not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security, partnership interest, commodity, notional principal contract, insurance contract, or annuity contract;
- No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of
$50,000 (as determined after applying applicable account aggregation rules); and
- Neither the FFI nor the FFI’s entire expanded affiliated group, if any, has more than $50 million in assets on its consolidated or combined
balance sheet as of the end of its most recent accounting year. Part XIV Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle
27a Name of sponsoring entity: ▶
b I certify that the FFI identified in Part I:
Is an FFI solely because it is an investment entity described in Regulations section 1.1471-5(e)(4);
Is not a QI, WP, or WT;
Will have all of its due diligence, withholding, and reporting responsibilities (determined as if the FFI were a participating FFI) fulfilled by
the sponsoring entity identified on line 27a; and
- 20 or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial
institutions, participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an entity that owns 100% of the equity interests in the FFI identified in Part I and is itself a sponsored FFI). Part XV Certified Deemed-Compliant Limited Life Debt Investment Entity
28 I certify that the FFI identified in Part I:
Was in existence as of January 17, 2013;
Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar
agreement; and
- Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the
restrictions with respect to its assets and other requirements under Regulations section 1.1471-5(f)(2)(iv)).
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 6 Part XVI Certain Investment Entities That Do Not Maintain Financial Accounts
29 I certify that the entity identified in Part I:
Is a financial institution solely because it is an investment entity described in Regulations section 1.1471-5(e)(4)(i)(A); and
Does not maintain financial accounts.
Part XVII Restricted Distributor
30a (All restricted distributors check here.) I certify that the entity identified in Part I:
- Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;
Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to each other;
- Is required to perform AML due diligence procedures under the anti-money laundering laws of its country of organization (which is a
FATF-compliant jurisdiction);
- Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same
country of incorporation or organization as all members of its affiliated group, if any;
Does not solicit customers outside its country of incorporation or organization;
Has no more than $175 million in total assets under management and no more than $7 million in gross revenue on its income statement
for the most recent accounting year;
- Is not a member of an expanded affiliated group that has more than $500 million in total assets under management or more than $20
million in gross revenue for its most recent accounting year on a combined or consolidated income statement; and
- Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantial
U.S. owners, or nonparticipating FFIs.
Check the box on line 30b or 30c, whichever applies.
I further certify that with respect to all sales of debt or equity interests in the restricted fund with respect to which this form is furnished that are made after December 31, 2011, the entity identified in Part I:
b Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S. resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.
c Is currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI and, for all sales made prior to the time that such a restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures identified in Regulations section 1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any securities which were sold to specified U.S. persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs, or will transfer the securities to a distributor that is a participating FFI, reporting Model 1 FFI, or reporting Model 2 FFI.
Part XVIII Foreign Central Bank of Issue
31 I certify that the entity identified in Part I is treated as the beneficial owner of the payment solely for purposes of chapter 4 under Regulations section 1.1471-6(d)(4).
Part XIX Nonreporting IGA FFI
32 I certify that the entity identified in Part I:
Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States and . The applicable IGA is a Model 1 IGA or a Model 2 IGA; and is treated as a under the provisions of the applicable IGA or Treasury regulations (if applicable, see instructions); and
- If you are a trustee documented trust or a sponsored entity, provide the name of the trustee or sponsor .
The trustee is: U.S. Foreign
Part XX Exempt Retirement Plans Check the box on line 33a, b, c, d, e, or f, whichever applies.
33a I certify that the entity identified in Part I:
Is established in a country with which the United States has an income tax treaty in force;
Is operated principally to administer or provide pension or retirement benefits; and
Is entitled to treaty benefits on income that the fund derives from U.S. sources (or would be entitled to benefits if it derived any such
income) as a resident of the other country which satisfies any applicable limitation on benefits requirement.
b I certify that the entity identified in Part I:
- Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former
employees of one or more employers in consideration for services rendered;
No single beneficiary has a right to more than 5% of the FFI’s assets;
Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operated; and
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 7 Part XX Exempt Retirement Plans (continued)
(i) Is generally exempt from tax on investment income under the laws of the country in which it is established or operates due to its status as a retirement or pension plan; (ii) Receives at least 50% of its total contributions from sponsoring employers (disregarding transfers of assets from other plans
described in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, other retirement funds described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A));
(iii) Either does not permit or penalizes distributions or withdrawals made before the occurrence of specified events related to
retirement, disability, or death (except rollover distributions to accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), to retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or to other retirement funds described in this part or in an applicable Model 1 or Model 2 IGA); or
(iv) Limits contributions by employees to the fund by reference to earned income of the employee or may not exceed $50,000 annually.
c I certify that the entity identified in Part I:
Is organized for the provision of retirement, disability, or death benefits (or any combination thereof) to beneficiaries that are former employees of one or more employers in consideration for services rendered;
Has fewer than 50 participants;
Is sponsored by one or more employers, each of which is not an investment entity or passive NFFE;
Employee and employer contributions to the fund (disregarding transfers of assets from other plans described in this part, retirement and
pension accounts described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A)) are limited by reference to earned income and compensation of the employee, respectively;
Participants that are not residents of the country in which the fund is established or operated are not entitled to more than 20% of the fund’s assets; and
Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operates.
d I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other than the requirement that the plan be funded by a trust created or organized in the United States.
e I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds described in this part or in an applicable Model 1 or Model 2 IGA, accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
f I certify that the entity identified in Part I:
- Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S.
possession (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons designated by such employees); or
- Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S.
possession (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in consideration of personal services performed for the sponsor. Part XXI Excepted Nonfinancial Group Entity
34 I certify that the entity identified in Part I:
- Is a holding company, treasury center, or captive finance company and substantially all of the entity’s activities are functions described in
Regulations section 1.1471-5(e)(5)(i)(C) through (E);
Is a member of a nonfinancial group described in Regulations section 1.1471-5(e)(5)(i)(B);
Is not a depository or custodial institution (other than for members of the entity’s expanded affiliated group); and
Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or
any investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
Part XXII Excepted Nonfinancial Start-Up Company
35 I certify that the entity identified in Part I:
- Was formed on (or in the case of a new line of business, the date of board resolution approving the new line of business)
(date must be less than 24 months prior to date of payment);
- Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of
business other than that of a financial institution or passive NFFE; and
- Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or
any investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.
Part XXIII Excepted Nonfinancial Entity in Liquidation or Bankruptcy
36 I certify that the entity identified in Part I:
Filed a plan of liquidation, filed a plan for reorganization, or filed for bankruptcy on the following date: ;
Has not been engaged during the past 5 years in business as a financial institution or acted as a passive NFFE;
Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a
nonfinancial entity; and
- Has provided, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if
it remains in bankruptcy or liquidation for more than 3 years.
Form W-8IMY (Rev. 10-2021)
Form W-8IMY (Rev. 10-2021) Page 8 Part XXIV Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation Check the box on line 37a or 37b, whichever applies.
37a I certify that:
The entity identified in Part I is a foreign corporation that is not a financial institution; and
The stock of such corporation is regularly traded on one or more established securities markets, including .
b I certify that:
The entity identified in Part I is a foreign corporation that is not a financial institution;
The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an
established securities market;
- The name of the entity, the stock of which is regularly traded on an established securities market, is ; and
• The name of the securities market on which the stock is regularly traded is ▶ . Part XXV Excepted Territory NFFE
38 I certify that:
The entity identified in Part I is an entity that is organized in a possession of the United States;
All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated;
and
- The entity identified in Part I:
(i) Does not accept deposits in the ordinary course of a banking or similar business; (ii) Does not hold, as a substantial portion of its business, financial assets for the account of others; and (iii) Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with
respect to a financial account.
Part XXVI Active NFFE
39 I certify that:
The entity identified in Part I is a foreign entity that is not a financial institution;
Less than 50% of such entity’s gross income for the preceding calendar year is passive income; and
Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as a
weighted average of the percentage of passive assets measured quarterly). See the instructions for the definition of passive income. Part XXVII Passive NFFE
40 I certify that the entity identified in Part I:
- Is a foreign entity that is not a financial institution (this category includes an entity organized in a possession of the United States that
engages (or holds itself out as being engaged) primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional principal contracts, insurance or annuity contracts, or any interest in such security, partnership interest, commodity, notional principal contract, insurance contract, or annuity contract); and
- Is using this form to transmit withholding certificates and/or other documentation and has provided or will provide a withholding
statement, as required.
Part XXVIII Sponsored Direct Reporting NFFE
41 Name of sponsoring entity: ▶
42 I certify that the entity identified in Part I is a direct reporting NFFE that is sponsored by the entity identified on line 41.
Part XXIX Certification
Under penalties of perjury, I declare that I have examined the information on this form, and to the best of my knowledge and belief, it is true, correct, and complete. Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income or proceeds for which I am providing this form or any withholding agent that can disburse or make payments of the amounts for which I am providing this form.
I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
Sign Here
Signature of authorized official Print Name Date (MM-DD-YYYY)
Form W-8IMY (Rev. 10-2021)
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