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February 2006) Department of the Treasury Internal Revenue Service  \nCertificate of Foreign Status of Beneficial Owner for United States Tax Withholding  \n􀀂 Section references are to the Internal Revenue Code. 􀀂 See separate instructions.  \n􀀂 Give this form to the withholding agent or payer. Do not send to the IRS.  \nOMB No. 1545-1621  \nDo not use this form for: Instead, use Form:  \n● A U.S. citizen or other U.S. person, including a resident alien individual W-9  \n● A person claiming that income is effectively connected with the conduct  \nof a trade or business in the United States W-8ECI  \n● A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions) W-8ECI or W-8IMY  \n● A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession that received effectively connected income or that is  \nclaiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions) W-8ECI or W-8EXP  \nNote: These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only to claim they are a foreign person exempt from backup withholding.  \n● A person acting as an intermediary W-8IMY  \nNote: See instructions for additional exceptions.  \n\n|  Part I  Identification of Beneficial Owner (See instructions.) |  |\n| --- | --- |\n| 1 Name of individual or organization that is the beneficial owner | 2 Country of incorporation or organization |\n\n3 Type of beneficial owner:  \n Grantor trust  \n Individual  \n Complex trust  \n Corporation  \n Estate  \n Disregarded entity  \n Government  \n Partnership  Simple trust  \n International organization  \n Central bank of issue  \n Tax-exempt organization  \n Private foundation  \n\n| 4 Permanent residence address (street, apt. or suite no. , or rural route) . Do not use a P.O. box or in-care-of address. |  |\n| --- | --- |\n| City or town, state or province. Include postal code where appropriate. | Country (do not abbreviate) |\n\n5 Mailing address (if different from above)  \n\n| City or town, state or province. Include postal code where appropriate. |  |  | Country (do not abbreviate) |\n| --- | --- | --- | --- |\n| 6 | U.S. taxpayer identification number, if required (see instructions)\u003Cbr> SSN or ITIN  EIN | 7 Foreign tax identifying number, if any (optional) |  |\n\n8 Reference number(s) (see instructions)  \n\n| Part II | Claim of Tax Treaty Benefits (if applicable) |\n| --- | --- |\n\n9 I certify that (check all that apply):  \na  The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. b  If required, the U.S. taxpayer identification number is stated on line 6 (see instructions) .  \nc  The beneficial owner is not an individual, 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 (see instructions) .  \nd  The beneficial owner is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest from a  \n[U.S. trade](U.S. trade) or business of a foreign corporation, and meets qualified resident status (see instructions).  \ne  The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file Form 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000 .  \n10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article of the  \ntreaty identified on line 9a above to claim a  % rate of withholding on (specify type of income):  . Explain the reasons the beneficial owner meets the terms of the treaty article:   \n|  Part III  Notional Principal Contracts |  |\n| --- | --- |\n| 11 |  I hav","cbCaisSvJL82moc9","https://ap.wps.com/l/cbCaisSvJL82moc9","pdf",93210,"English","# Part I - Identification of Beneficial Owner\n## Tax treaty status and identifying information\n# Part II - Claim of Tax Treaty Benefits (if applicable)\n## Certification and treaty benefit claim\n# Part III - Notional Principal Contracts\n## Statement and update agreement\n# Part IV - Certification\n## Under penalties of perjury declaration","[{\"question\":\"What information must be provided on the form?\",\"answer\":\"It requests identification details, country of incorporation or organization (if applicable), permanent residence and mailing addresses, and relevant taxpayer or foreign tax identification numbers, plus required certifications.\"}]","Form W-8BEN - Rev. February 2006 - Certificate of Foreign Status of Beneficial Owner | PDF",1789782997]