Form W-8BEN-E (Rev. October 2021), Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities) Completed Form Examples and Samples

Access filled examples and samples of IRS Form W-8BEN-E (Rev. October 2021). Learn how to complete the Certificate of Status of Beneficial Owner for foreign entities to manage U.S. tax withholding and claim treaty benefits.
Form W-8BEN-E (Rev. October 2021), Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities) has a complex Form Complexity Index of 75/100 — Instafill’s AI completes it in under a minute.
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Completed sample Form W-8BEN-E (Rev. October 2021) for a foreign corporation claiming tax treaty benefits.

Form W-8BEN-E Example – Foreign Corporation Claiming Treaty Benefits

How this form was filled:

This is an example of a completed Form W-8BEN-E for a Canadian corporation providing services to a U.S. client. The form identifies the entity as a corporation and an 'Active Non-Financial Foreign Entity' (Active NFFE) for FATCA purposes. It correctly completes Part III to claim a 0% withholding rate on service income under Article VII of the U.S.-Canada tax treaty, asserting it does not have a permanent establishment in the U.S. The form is certified by an authorized director.

Information used to fill out the document:

  • Legal Name of Entity: Innovate Solutions Inc.
  • Country of Incorporation: Canada
  • Entity Type: Corporation
  • FATCA Status (Chapter 4): Active NFFE (Non-Financial Foreign Entity)
  • Permanent Residence Address: 555 Bay Street, Toronto, ON M5G 2C2
  • Country: Canada
  • Mailing Address: Same as permanent residence address
  • Foreign TIN: 987654321RC0001
  • Reference Number: CLI-12345
  • Tax Treaty Claim: Yes, under the U.S.-Canada tax treaty
  • Treaty Article and Paragraph: Article VII
  • Withholding Rate Claimed: 0%
  • Type of Income: Services (Software Development)
  • Treaty Benefit Explanation: Beneficial owner is a resident of Canada and derives business profits from services performed. The income is not attributable to a permanent establishment in the United States.
  • Signatory Name: Jane Smith
  • Signatory Title: Director
  • Date of Signature: October 26, 2026

What this filled form sample shows:

  • Identifies the entity as a Corporation in Part I, line 4.
  • Specifies the Chapter 4 Status as an Active NFFE in Part I, line 5, and completes the corresponding certification in Part XXV.
  • Completes Part III (Claim of Tax Treaty Benefits) to claim a reduced withholding rate under a specific U.S. tax treaty.
  • Provides a clear and sufficient explanation for meeting the terms of the treaty article.
  • The form is properly signed and dated by an individual with the capacity to sign for the entity.

Form specifications and details:

Use Case: Foreign corporation in a treaty country providing services to a U.S. payer.
Form Version: Form W-8BEN-E (Rev. October 2021)
Categories: NJ state forms, PA state forms, reporting forms, state ID forms, state tax forms, tax withholding forms, withholding forms
Created: February 03, 2026 07:53 PM
Completed sample Form W-8BEN-E (Rev. October 2021) for a foreign corporation claiming tax treaty benefits.