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 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) |
Created: February 03, 2026 07:53 PM
