Form W-8IMY (Rev. October 2021), Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding and Reporting Instructions

Enter the branch's street address, including apartment or suite number or rural route; do not enter a P.O. box or an in-care-of address. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Enter the branch's city or town followed by the state or province and include the postal (ZIP) code where appropriate. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Enter the country where the branch is located (use the full country name). Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Enter the branch's Global Intermediary Identification Number (GIIN) if it has one; leave blank if not applicable. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Check this box if the entity is a qualified intermediary (QI), including a qualified derivative dealer (QDD); then complete Part III.

Check this box if the entity is a nonqualified intermediary; then complete Part IV.

Check this box if the entity is a territory financial institution; then complete Part V.

Check this box if the entity is a U.S. branch; then complete Part VI.

Check this box if the entity is a withholding foreign partnership; then complete Part VII.

Check this box if the entity is a withholding foreign trust; then complete Part VII.

Check this box if the entity is a nonwithholding foreign partnership; then complete Part VIII.

Check this box if the entity is a nonwithholding foreign simple trust; then complete Part VIII.

Check this box if the entity is a nonwithholding foreign grantor trust; then complete Part VIII.

Check this box if the entity is a nonparticipating FFI under FATCA (including the described related FFIs); if so, complete Part IX if applicable.

Check this box if the entity is a participating FFI that has agreed to comply with FATCA requirements.

Check this box if the entity is a Model 1 FFI that reports to its tax authority under a Model 1 IGA.

Check this box if the entity is a Model 2 FFI that reports directly to the IRS under a Model 2 IGA.

Check this box if the entity is a registered deemed-compliant FFI (excluding the listed exceptions).

Check this box if the entity is a U.S. territory financial institution; if checked, complete Part V.

Check this box if the entity is a sponsored FFI (excluding certified deemed-compliant sponsored closely held investment vehicles); if checked, complete Part X.

Check this box if the entity qualifies as a certified deemed-compliant nonregistering local bank; if checked, complete Part XII.

Check this box if the entity is a certified deemed-compliant FFI that only maintains low-value accounts; if checked, complete Part XIII.

Check this box if the entity is a certified deemed-compliant sponsored closely held investment vehicle; if checked, complete Part XIV.

Check this box if the entity is a certified deemed-compliant limited life debt investment entity; if checked, complete Part XV.

Check this box if the entity is an investment entity that does not maintain financial accounts; if checked, complete Part XVI.

Check this box if the entity is an owner-documented FFI; if checked, complete Part XI.

Check this box if the entity qualifies as a restricted distributor under FATCA; if checked, complete Part XVII.

Check this box if the entity is a foreign central bank of issue; if checked, complete Part XVIII.

Check this box if the entity is a nonreporting IGA FFI covered by an intergovernmental agreement; if checked, complete Part XIX.

Check this box if the entity is an exempt retirement plan under FATCA; if checked, complete Part XX.

Check this box if the entity is an excepted nonfinancial group entity; if checked, complete Part XXI.

Check this box if the entity is an excepted nonfinancial start-up company; if checked, complete Part XXII.

Check this box if the entity is an excepted nonfinancial entity currently in liquidation or bankruptcy; if checked, complete Part XXIII.

Check this box if the entity is a publicly traded NFFE or an affiliate of a publicly traded corporation; if checked, complete Part XXIV.

Check this box if the entity is an excepted territory NFFE; if checked, complete Part XXV.

Check this box if the entity is an active NFFE (meets the active NFFE criteria); if checked, complete Part XXVI.

Check this box if the entity is a passive NFFE (does not meet active NFFE criteria); if checked, complete Part XXVII.

Check this box if the entity is a direct-reporting NFFE that will report directly to the IRS.

Check this box if the entity is a sponsored direct-reporting NFFE; if checked, complete Part XXVIII.

Check this box if the disregarded entity or branch receiving payment is treated as a nonparticipating FFI for Chapter 4 (FATCA) purposes. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Check this box if the disregarded entity or branch receiving payment is a participating FFI that has agreed to FATCA requirements. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Check this box if the disregarded entity or branch receiving payment is a Reporting Model 1 FFI under a Model 1 intergovernmental agreement. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Check this box if the disregarded entity or branch receiving payment is a Reporting Model 2 FFI under a Model 2 intergovernmental agreement. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Check this box if the branch receiving payment is a U.S. branch. Fill only if 'Name of disregarded entity (if applicable)' is not blank.

Enter the full legal name of the organization that is acting as the intermediary for this form.

Enter the name of the country where the organization is legally incorporated or organized.

If the entity is a disregarded entity, enter its legal name exactly as it appears in official records; otherwise leave this field blank.

Enter the taxpayer identification number issued to the foreign owner by their country (the foreign TIN), exactly as it appears on official documents — include any letters, spaces, or punctuation used in the official number.

Enter the entity's Global Intermediary Identification Number (GIIN) assigned under FATCA; leave this field blank if the entity does not have a GIIN.

Enter the full mailing street address where correspondence should be sent, including apartment, suite, unit number, or P.O. box alternative if appropriate. Fill only if 'Permanent residence address (street, apt., or rural route)', 'City or town, state or province, postal code', 'Country of permanent residence' is different from above (any).

Provide the city, state or province, and postal (ZIP) code for the mailing address, separated as needed for your country’s format. Fill only if 'Permanent residence address (street, apt., or rural route)', 'City or town, state or province, postal code', 'Country of permanent residence' is different from above (any).

Enter the name of the country for the mailing address. Fill only if 'Permanent residence address (street, apt., or rural route)', 'City or town, state or province, postal code', 'Country of permanent residence' is different from above (any).

Check this box if the Qualified Derivatives Dealer (QDD) identified in Part I is classified as a corporation. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the Qualified Derivatives Dealer (QDD) identified in Part I is classified as a partnership. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the Qualified Derivatives Dealer (QDD) identified in Part I is classified as a disregarded entity. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if you certify that each Qualified Derivatives Dealer (QDD) identified in Part I or on an associated withholding statement meets the requirements to act as a QDD and assumes the primary withholding and reporting responsibilities described in line 16a. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity identified in Part I is not acting as a Qualified Intermediary (QI) with respect to each account for which this form is provided and is not acting for its own account. Fill only if 'Chapter 3 Status (entity type)' is 'Nonqualified intermediary'.

Check this box if the entity identified in Part I is using this form to transmit withholding certificates and/or other documentation and has provided, or will provide, the required withholding statement. Fill only if 'Chapter 3 Status (entity type)' is 'Nonqualified intermediary'.

Check this box if the entity identified in Part I meets the requirements of Regulations section 1.6049-4(c)(4)(iii) for any account holder of an account it maintains that is included in a withholding rate pool of U.S. payees on a withholding statement associated with this form. Fill only if 'Chapter 3 Status (entity type)' is 'Nonqualified intermediary'.

Check this box if the entity identified in Part I is acting as a qualified securities lender (other than a QI) and is assuming primary withholding and reporting responsibilities for U.S.-source substitute dividends associated with this form. Fill only if 'Chapter 3 Status (entity type)' is 'Nonqualified intermediary'.

Check this box if the entity identified in Part I is providing an alternative withholding statement (per Regulations section 1.1441-1(e)(3)(iv)(C)(3)) and represents that all associated withholding statements have been or will be verified for inconsistencies with other account information used to determine each payee's withholding rate. Fill only if 'Chapter 3 Status (entity type)' is 'Nonqualified intermediary'.

Check this box if the entity listed in Part I is using Form W-8IMY to transmit withholding certificates and/or other documentation and has provided or will provide a withholding statement showing the portion of the payment allocated to one or more exempt beneficial owners. Fill only if 'Chapter 4 Status (FATCA status): Nonparticipating foreign financial institution (FFI)' is 'Yes'.

Check this box if the entity in Part I agrees to be treated as a U.S. person under the referenced regulations with respect to amounts realized on sales of interests in publicly traded partnerships. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box if the entity in Part I agrees to be treated as a U.S. person (and as a nominee under the cited regulations) for distributions by publicly traded partnerships. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box if the entity in Part I is not acting as a nominee for distributions from publicly traded partnerships and is providing withholding statements for those distributions. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box if the entity identified in Part I is a financial institution (excluding 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. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box when the entity 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 for any reportable amounts and withholdable payments associated with this certificate. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box when the entity in Part I is using this form to transmit withholding certificates or other documentation for payees for whom it receives reportable or withholdable payments and has provided (or will provide) the required withholding statement. Fill only if 'Chapter 3 Status (entity type)' is 'Territory financial institution'.

Check this box if the entity in Part I is a U.S. branch (under Regulations section 1.1446(f)-4(a)(2)(i)(B)) and is to be treated as a U.S. person with respect to amounts realized on sales of interests in publicly traded partnerships. Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity in Part I is a U.S. branch (under Regulations section 1.1441-1(b)(2)(iv)(A)) that is to be treated as a U.S. person and as a nominee with respect to distributions by publicly traded partnerships. Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity in Part I is not acting as a nominee for distributions from publicly traded partnerships and is providing withholding statements for those distributions. Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity in Part I is a U.S. branch receiving reportable amounts or withholdable payments that are not effectively connected with the conduct of a U.S. trade or business (for example, distributions from publicly traded partnerships or amounts realized on sales of interests in publicly traded partnerships). Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity in Part I is a U.S. branch of a foreign bank or insurance company that is using this form as evidence of its agreement with the withholding agent to be treated as a U.S. person for any reportable amounts or withholdable payments associated with this withholding certificate. Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity in Part I is using this form to transmit withholding certificates and/or other documentation for persons for whom the branch receives reportable payments, has provided or will provide any required withholding statements, and (for withholdable payments) is applying the rules cited in the regulations. Fill only if 'Chapter 3 Status (entity type)' is 'U.S. branch'.

Check this box if the entity identified in Part I is a withholding foreign partnership (WP) or a withholding foreign trust (WT) that is compliant with the terms of its WP or WT agreement. Fill only if 'Chapter 3 Status (entity type): Withholding foreign partnership' or 'Chapter 3 Status (entity type): Withholding foreign trust' is 'Yes'.

Check this box if the entity identified in Part I is a nonwithholding foreign partnership, nonwithholding foreign simple trust, or nonwithholding foreign grantor trust that is providing this form for payments not effectively connected with a U.S. trade or business and is using this form to transmit withholding certificates and will provide the required withholding statement under chapters 3 and 4. Fill only if 'Chapter 3 Status (entity type): Nonwithholding foreign partnership' or 'Chapter 3 Status (entity type): Nonwithholding foreign simple trust' or 'Chapter 3 Status (entity type): Nonwithholding foreign grantor trust' is 'Yes'.

Check this box if 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 Form W-8IMY for purposes of section 1446(a). Fill only if 'Chapter 3 Status (entity type): Nonwithholding foreign partnership' or 'Chapter 3 Status (entity type): Nonwithholding foreign grantor trust' is 'Yes'.

Check this box if 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). Fill only if 'Chapter 3 Status (entity type): Nonwithholding foreign partnership' is 'Yes'.

Check this box if the entity identified in Part I is a foreign partnership providing a withholding statement for a modified amount realized from the transfer; only check this box when applicable and only if box 21c is also checked. Fill only if 'Part VIII — 21c: Foreign partnership receiving amount realized on transfer (section 1446(f))' is 'Yes'.

Check this box if the entity identified in Part I is a foreign grantor trust providing the form on behalf of each grantor or other owner and is transmitting withholding certificates and a withholding statement to allocate the amount realized to each grantor or owner as described in Reg. section 1.1446(f)-1(c)(2)(vii). Fill only if 'Chapter 3 Status (entity type): Nonwithholding foreign grantor trust' is 'Yes'.

Check this box if the entity identified in Part I is providing an alternative withholding statement described in Reg. section 1.1441-1(e)(3)(iv)(C)(3) and represents that the information on all withholding certificates associated with that statement may be relied on under the standards of knowledge in sections 1441 or 1471 applicable to the entity. Fill only if 'Chapter 3 Status (entity type): Nonwithholding foreign partnership' or 'Chapter 3 Status (entity type): Nonwithholding foreign simple trust' or 'Chapter 3 Status (entity type): Nonwithholding foreign grantor trust' is 'Yes'.

Check this box when the entity listed in Part I is an investment entity, is not a QI, WP (except as permitted), or WT, and has agreed with the named sponsoring entity to have that entity act as its sponsoring FFI for the purposes of this form. Fill only if 'Chapter 4 Status (FATCA status): Sponsored FFI (other than a certified deemed-compliant sponsored, closely held investment vehicle)' is 'Yes'.

Check this box when the entity listed in Part I is a controlled foreign corporation under section 957(a), is not a QI, WP, or WT, is wholly owned (directly or indirectly) by the U.S. financial institution identified as sponsor which agrees to act as sponsoring entity, and shares a common electronic account system with that sponsoring entity enabling identification of owners. Fill only if 'Chapter 4 Status (FATCA status): Sponsored FFI (other than a certified deemed-compliant sponsored, closely held investment vehicle)' is 'Yes'.

Enter the full legal name of the sponsoring entity for Part X (line 23a) as it should appear on tax or legal documents. Fill only if '23b: Sponsored FFI — Investment entity and sponsor agreement', '23c: Sponsored FFI — Controlled foreign corporation and sponsor agreement' is 'Yes' (any).

Check this box if the FFI identified in Part I meets all of the listed owner-documented FFI conditions (for example, it does not act as an intermediary, does not accept deposits in the ordinary course of a banking business, does not hold substantial financial assets for others, is not an insurance company that issues/obligates payments with respect to a financial account, etc.). Fill only if 'Chapter 4 Status (FATCA status): Owner-documented FFI' is 'Yes'.

Check this box when you are certifying that the FFI identified in Part I has provided, or will provide, an owner reporting statement (including any required owner documentation) containing the required name, address, TIN/chapter 4 status and documentation for the specified U.S. owners as described in the form instructions. Fill only if 'Chapter 4 Status (FATCA status)' is 'Owner-documented FFI'.

Check this box if the FFI identified in Part I has provided (or will provide) an independent auditor’s letter, signed within the last 4 years, and has provided (or will provide) the required owner reporting statement and Form W-9 as described for an owner‑documented FFI. Fill only if 'Chapter 4 Status (FATCA status)' is 'Owner-documented FFI'.

Check this box if the FFI identified in Part I is a certified deemed-compliant nonregistering local bank (i.e., operates and is licensed solely as a bank or credit union in its country of incorporation and engages primarily in receiving deposits and making loans to local retail customers, and meets the other conditions described on line 25). Fill only if 'Chapter 4 Status (FATCA status)' is 'Certified deemed-compliant nonregistering local bank'.

Check this box to certify that the FFI identified in Part I meets the Part XIII criteria (not primarily engaged in investing/reinvesting/trading in certain financial instruments and that no financial account maintained by the FFI or its expanded affiliated group has a balance or value in excess of $50,000, and other conditions listed under line 26). Fill only if 'Chapter 4 Status (FATCA status)' is 'Certified deemed-compliant FFI with only low-value accounts'.

Enter the full legal name of the sponsoring entity for the closely held investment vehicle as it should appear on official documents. Fill only if 'Part XIV b: I certify that the FFI identified in Part I' is 'Yes'.

Check this box only if the sponsoring entity (the FFI identified in Part I) meets all of the listed conditions in Part XIV b (for example, it is an FFI solely because it is an investment entity described in Regulations section 1.1471‑5(e)(4), is not a QI/WP/WT, and will perform the due diligence, withholding, and reporting responsibilities described in the bullets). Fill only if 'Chapter 4 Status (FATCA status)' is 'Certified deemed-compliant sponsored, closely held investment vehicle'.

Enter the full name of the applicable intergovernmental agreement (IGA) under which this entity is treated (e.g., the exact title of the IGA between the United States and the relevant jurisdiction). Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box if the applicable intergovernmental agreement (IGA) between the United States and the entity's jurisdiction is a Model 1 IGA. Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box if the applicable intergovernmental agreement (IGA) between the United States and the entity's jurisdiction is a Model 2 IGA. Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box if you certify that the entity identified in Part I meets the requirements to be treated as a nonreporting financial institution under an applicable IGA between the United States and the entity's jurisdiction (i.e., the entity is a nonreporting IGA FFI as described on line 32). Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Enter the entity's treated-as status under the applicable IGA/Treasury regulations (the classification or designation that describes how the entity is treated for chapter 4 purposes). Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Enter the full name of the trustee or sponsor of the trust or sponsored entity as required for Part XIX. Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box if the trustee named in Part I is a U.S. person (the trustee is U.S.). Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box if the trustee named in Part I is a foreign person (the trustee is not a U.S. person). Fill only if 'Chapter 4 Status (FATCA status)' is 'Nonreporting IGA FFI'.

Check this box only if the FFI qualifies as a Certified Deemed‑Compliant Limited Life Debt Investment Entity — i.e., it was in existence as of January 17, 2013, issued all classes of its debt or equity interests to investors on or before that date (pursuant to a trust indenture or similar agreement), and otherwise meets the specific requirements and restrictions listed in Part XV. Fill only if 'Chapter 4 Status (FATCA status)' is 'Certified deemed-compliant limited life debt investment entity'.

Check this box if the entity listed 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 the entity does not maintain financial accounts. Fill only if 'Chapter 4 Status (FATCA status)' is 'Certain investment entities that do not maintain financial accounts'.

Check this box if the entity identified in Part I is a restricted distributor and you certify that it operates as a distributor for the restricted fund, provides investment services to at least 30 unrelated customers (with less than half related), and is required to perform AML due diligence under the anti‑money‑laundering laws of its country of organization (FATF‑compliant). Fill only if 'Chapter 4 Status (FATCA status)' is 'Restricted distributor'.

Check this box if the entity identified in Part I was 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 prohibits 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. Fill only if 'Chapter 4 Status (FATCA status)' is 'Restricted distributor'.

Check this box if the entity identified in Part I 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 such a restriction was included) has reviewed related accounts per the cited regulations and has redeemed/retired or transferred such securities as described. Fill only if 'Chapter 4 Status (FATCA status)' is 'Restricted distributor'.

Check this box if 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). Fill only if 'Chapter 4 Status (FATCA status)' is 'Foreign central bank of issue'.

Check this box if the entity is an exempt retirement plan that is established in a country with a U.S. income tax treaty, is operated principally to administer or provide pension or retirement benefits, and is entitled to treaty benefits on income it derives from U.S. sources. Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box if the entity is organized to provide retirement, disability, or death benefits to beneficiaries (typically former employees), no single beneficiary has a right to more than 5% of the fund's assets, and the fund is subject to government regulation and provides required annual information reporting about its beneficiaries. Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box only if the entity meets all of the listed c) criteria — it is organized to provide retirement, disability, or death benefits to former employees; has fewer than 50 participants; is sponsored by one or more employers that are not investment entities or passive NFFEs; has the contribution and participant residency limits described; and is subject to government regulation and required beneficiary reporting. Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box only if the entity was formed pursuant to a pension plan that would meet the requirements of section 401(a), except for the requirement that the plan be funded by a trust created or organized in the United States. Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box only if the entity 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 related retirement/pension accounts). Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box only if the entity is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession (or is an exempt beneficial owner described in an applicable IGA) to provide retirement, disability, or death benefits to current or former employees or designated persons. Fill only if 'Chapter 4 Status (FATCA status)' is 'Exempt retirement plans'.

Check this box when the entity identified in Part I meets the Excepted Nonfinancial Group Entity criteria shown (for example, it is a holding/treasury/captive finance company or other nonfinancial group as described, is not a depository/custodial institution, and does not function as an investment fund) and you are certifying those statements. Fill only if 'Chapter 4 Status (FATCA status)' is 'Excepted nonfinancial group entity'.

Check this box if the entity in Part I is an excepted nonfinancial start‑up company that was formed (or, for a new line of business, formed on the board resolution date) within the required timeframe (date must be less than 24 months prior to date of payment), is not yet operating or has no prior operating history (or is investing capital with intent to operate a new line of business), and otherwise meets the start‑up conditions described in Part XXII. Fill only if 'Chapter 4 Status (FATCA status)' is 'Excepted nonfinancial start-up company'.

Enter the date the entity was formed or, for a new line of business, the date of the board resolution approving the new line of business (this date must be less than 24 months prior to the date of payment). Fill only if 'Part XXII - I certify that the entity identified in Part I (Start‑Up Company formation/date)' is 'Yes'.

Enter the date the entity filed a plan of liquidation, filed a plan for reorganization, or filed for bankruptcy. Fill only if 'topmostSubform[0].Page7[0].c7_7[0]_2' is 'Yes'.

Check this box if the entity identified in Part I is a foreign corporation that is not a financial institution and the stock of that corporation is regularly traded on one or more established securities markets (enter the market(s) on the blank provided). Fill only if 'Chapter 4 Status (FATCA status)' is 'Publicly traded NFFE or NFFE affiliate of a publicly traded corporation'.

Enter the name or names of the established securities market(s) where the corporation’s stock is regularly traded (for example, NASDAQ or NYSE). Fill only if 'Part XXIV Line 37a — I certify that (Publicly Traded NFFE)' is 'Yes'.

Check this box when the entity in Part I is a foreign corporation that is not a financial institution and is a member of the same expanded affiliated group as an entity whose stock is regularly traded on an established securities market (and you will provide the name of that entity and the securities market as requested). Fill only if 'Chapter 4 Status (FATCA status)' is 'Publicly traded NFFE or NFFE affiliate of a publicly traded corporation'.

Enter the full legal name of the affiliated entity whose stock is regularly traded on an established securities market. Fill only if 'Part XXIV Line 37b — I certify that (NFFE Affiliate of Publicly Traded Corporation)' is 'Yes'.

Enter the name of the securities market on which the affiliated entity's stock is regularly traded (for example, NYSE, NASDAQ, London Stock Exchange). Fill only if 'Part XXIV Line 37b — I certify that (NFFE Affiliate of Publicly Traded Corporation)' is 'Yes'.

Enter the full printed name of the authorized official who is certifying and signing the form.

Enter the date when the authorized official signs the certification.

Check this box if the entity in Part I meets all Excepted Territory NFFE requirements listed on line 38 (organized in a U.S. possession, all owners are bona fide residents of that possession, and the entity satisfies the further conditions described such as not accepting deposits in the ordinary course of a banking or similar business). Fill only if 'Chapter 4 Status (FATCA status)' is 'Excepted territory NFFE'.

Check this box if the entity identified in Part I certifies it is a foreign entity that is not a financial institution, and that less than 50% of the entity’s gross income for the preceding calendar year is passive income and less than 50% of its assets are assets that produce or are held for the production of passive income (i.e., the entity meets the Active NFFE criteria). Fill only if 'Chapter 4 Status (FATCA status)' is 'Active NFFE'.

Check this box only if you are certifying that the entity named in Part I meets the IRS definition of a Passive NFFE (as described on line 40) and you are attesting to the specific statements and conditions listed under line 40. Fill only if 'Chapter 4 Status (FATCA status)' is 'Passive NFFE'.

Enter the full legal name of the sponsoring entity that sponsors the direct-reporting NFFE identified elsewhere on this form. Fill only if 'Part XXVIII - Line 42: Certification that entity in Part I is a direct reporting NFFE sponsored by entity on line 41' is 'Yes'.

Check this box only if the entity identified in Part I is a direct reporting NFFE and is sponsored by the sponsoring entity named on line 41. Fill only if 'Chapter 4 Status (FATCA status)' is 'Sponsored direct reporting NFFE'.

Enter the street address of your permanent residence (no P.O. boxes or in-care-of addresses), including apartment or suite number or rural route as applicable.

Enter the city or town and state or province of your permanent residence and include the postal (ZIP) code where appropriate.

Enter the name of the country where your permanent residence is located.

Check this box if the entity assumes primary withholding responsibility under Chapters 3 and 4 for each account identified on a withholding statement attached to this form (or for all accounts if no withholding statement is attached). Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity assumes primary withholding and reporting responsibility for amounts realized from the sale of an interest in a publicly traded partnership under section 1446(f) for each account identified on an attached withholding statement (or for all accounts if none is attached). Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity assumes primary withholding as a nominee under Regulations section 1.1446‑4(b)(3) for distributions by a publicly traded partnership for each account identified on an attached withholding statement (or for all accounts if none is attached). Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity is a QI acting as a qualified securities lender and assumes primary withholding and reporting responsibilities for U.S. source substitute dividends received from the withholding agent associated with each account on an attached withholding statement (or for all accounts if none is attached). Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity assumes primary withholding responsibility for 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. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity assumes primary Form 1099 reporting and backup withholding responsibility or reporting responsibility as a participating FFI or registered deemed‑compliant FFI for accounts it maintains that are held by specified U.S. persons, as permitted under the referenced regulations. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity does not assume primary Form 1099 reporting and backup withholding responsibility for each account identified on a withholding statement attached to this form (or for all accounts if no withholding statement is attached). Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box only if the entity does not assume primary Form 1099 reporting and backup withholding responsibility and the entity 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 and meets the requirements of Regulations section 1.6049‑4(c)(4)(iii) with respect to any account it maintains that is included in such a withholding rate pool. Fill only if '15g — Does not assume primary Form 1099 reporting and backup withholding responsibility' is 'Yes'. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box only to the extent the entity does not assume primary Form 1099 reporting and backup withholding responsibility and the entity has allocated or will allocate payments to a chapter 4 withholding rate pool for U.S. payees who are account holders of an intermediary or flow‑through entity, and the entity will obtain documentation sufficient to establish each intermediary or flow‑through entity's status as a participating FFI, registered deemed‑compliant FFI, or FFI that is a QI. Fill only if '15g — Does not assume primary Form 1099 reporting and backup withholding responsibility' is 'Yes'. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Check this box if the entity identified in Part I (or its branch, if applicable) is certifying that it is a Qualified Intermediary (QI) for the accounts identified on line 10 or on a required withholding statement and meets the QI conditions described in the certification. Fill only if 'Chapter 3 Status (entity type)' is 'QI (including a QDD)'.

Enter any identifying reference number(s) for this entity (for example account numbers, internal reference IDs, or other identifying codes) as a text string.

Enter the entity's U.S. taxpayer identification number (TIN) as assigned by the IRS; include all digits and any necessary leading zeros.

Check this box if the U.S. taxpayer identification number you entered is the QI-EIN.

Check this box if the U.S. taxpayer identification number you entered is the WP-EIN.

Check this box if the U.S. taxpayer identification number you entered is the WT-EIN.

Check this box if the U.S. taxpayer identification number you entered is the entity's EIN (Employer Identification Number).