搜索
FormW-8BEN-E(Rev.July2017)DepartmentoftheTreasuryInternalRevenueServiceCertificateofStatusofBeneficialOwnerforUnitedStatesTaxWithholdingandReporting(Entities)▶Forusebyentities.IndividualsmustuseFormW-8BEN.▶SectionreferencesaretotheInternalRevenueCode.▶Goto▶Givethisformtothewithholdingagentorpayer.DonotsendtotheIRS.OMBNo.1545-1621DoNOTusethisformfor:InsteaduseForm:•U.S.entityorU.S.citizenorresident................................W-9•Aforeignindividual............................W-8BEN(Individual)orForm8233•AforeignindividualorentityclaimingthatincomeiseffectivelyconnectedwiththeconductoftradeorbusinesswithintheU.S.(unlessclaimingtreatybenefits).................................W-8ECI•Aforeignpartnership,aforeignsimpletrust,oraforeigngrantortrust(unlessclaimingtreatybenefits)(seeinstructionsforexceptions)..W-8IMY•Aforeigngovernment,internationalorganization,foreigncentralbankofissue,foreigntax-exemptorganization,foreignprivatefoundation,orgovernmentofaU.S.possessionclaimingthatincomeiseffectivelyconnectedU.S.incomeorthatisclaimingtheapplicabilityofsection(s)115(2),501(c),892,895,or1443(b)(unlessclaimingtreatybenefits)(seeinstructionsforotherexceptions).........W-8ECIorW-8EXP•Anypersonactingasanintermediary(includingaqualifiedintermediaryactingasaqualifiedderivativesdealer).........W-8IMYPartIIdentificationofBeneficialOwner1Nameoforganizationthatisthebeneficialowner2Countryofincorporationororganization3Nameofdisregardedentityreceivingthepayment(ifapplicable,seeinstructions)4Chapter3Status(entitytype)(Mustcheckoneboxonly):CorporationDisregardedentityPartnershipSimpletrustGrantortrustComplextrustEstateGovernmentCentralBankofIssueTax-exemptorganizationPrivatefoundationInternationalorganizationIfyouentereddisregardedentity,partnership,simpletrust,orgrantortrustabove,istheentityahybridmakingatreatyclaim?IfYescompletePartIII.YesNo5Chapter4Status(FATCAstatus)(Seeinstructionsfordetailsandcompletethecertificationbelowfortheentity'sapplicablestatus.)NonparticipatingFFI(includinganFFIrelatedtoaReportingIGAFFIotherthanadeemed-compliantFFI,participatingFFI,orexemptbeneficialowner).ParticipatingFFI.ReportingModel1FFI.ReportingModel2FFI.Registereddeemed-compliantFFI(otherthanareportingModel1FFI,sponsoredFFI,ornonreportingIGAFFIcoveredinPartXII).Seeinstructions.SponsoredFFI.CompletePartIV.Certifieddeemed-compliantnonregisteringlocalbank.CompletePartV.Certifieddeemed-compliantFFIwithonlylow-valueaccounts.CompletePartVI.Certifieddeemed-compliantsponsored,closelyheldinvestmentvehicle.CompletePartVII.Certifieddeemed-compliantlimitedlifedebtinvestmententity.CompletePartVIII.Certaininvestmententitiesthatdonotmaintainfinancialaccounts.CompletePartIX.Owner-documentedFFI.CompletePartX.Restricteddistributor.CompletePartXI.NonreportingIGAFFI.CompletePartXII.Foreigngovernment,governmentofaU.S.possession,orforeigncentralbankofissue.CompletePartXIII.Internationalorganization.CompletePartXIV.Exemptretirementplans.CompletePartXV.Entitywhollyownedbyexemptbeneficialowners.CompletePartXVI.Territoryfinancialinstitution.CompletePartXVII.Exceptednonfinancialgroupentity.CompletePartXVIII.Exceptednonfinancialstart-upcompany.CompletePartXIX.Exceptednonfinancialentityinliquidationorbankruptcy.CompletePartXX.501(c)organization.CompletePartXXI.Nonprofitorganization.CompletePartXXII.PubliclytradedNFFEorNFFEaffiliateofapubliclytradedcorporation.CompletePartXXIII.ExceptedterritoryNFFE.CompletePartXXIV.ActiveNFFE.CompletePartXXV.PassiveNFFE.CompletePartXXVI.Exceptedinter-affiliateFFI.CompletePartXXVII.DirectreportingNFFE.SponsoreddirectreportingNFFE.CompletePartXXVIII.Accountthatisnotafinancialaccount.6Permanentresidenceaddress(street,apt.orsuiteno.,orruralroute).DonotuseaP.O.boxorin-care-ofaddress(otherthanaregisteredaddress).Cityortown,stateorprovince.Includepostalcodewhereappropriate.Country7Mailingaddress(ifdifferentfromabove)Cityortown,stateorprovince.Includepostalcodewhereappropriate.Country8U.S.taxpayeridentificationnumber(TIN),ifrequired9aGIINbForeignTIN10Referencenumber(s)(seeinstructions)Note:PleasecompleteremainderoftheformincludingsigningtheforminPartXXX.ForPaperworkReductionActNotice,seeseparateinstructions.Cat.No.59689NFormW-8BEN-E(Rev.7-2017)FormW-8BEN-E(Rev.7-2017)Page2PartIIDisregardedEntityorBranchReceivingPayment.(CompleteonlyifadisregardedentitywithaGIINorabranchofanFFIinacountryotherthantheFFI'scountryofresidence.Seeinstructions.)11Chapter4Status(FATCAstatus)ofdisregardedentityorbranchreceivingpaymentBranchtreatedasnonparticipatingFFI.ParticipatingFFI.ReportingModel1FFI.ReportingModel2FFI.U.S.Branch.12Addressofdisregardedentityorbranch(street,apt.orsuiteno.,orruralroute).DonotuseaP.O.boxorin-care-ofaddress(otherthanaregisteredaddress).Cityortown,stateorprovince.Includepostalcodewhereappropriate.Country13GIIN(ifany)PartIIIClaimofTaxTreatyBenefits(ifapplicable).(Forchapter3purposesonly.)14Icertifythat(checkallthatapply):aThebeneficialownerisaresidentofwithinthemeaningoftheincomet