Form W-8BEN-E, Certificate of Status of Beneficial Owner Instructions

List any account numbers, invoice numbers, or other references that will help the withholding agent match this form to the correct payment or account. Separate multiple numbers with commas. Do not put EIN, GIIN, or country information here. If did not requested anything specific - leave it blank.

Enter the name of the foreign country or jurisdiction that has an applicable IGA with the United States.

Check this box if the applicable intergovernmental agreement (IGA) between the United States and the relevant jurisdiction is a Model 1 IGA.

Check this box if the applicable intergovernmental agreement (IGA) between the United States and the relevant jurisdiction is a Model 2 IGA.

Enter the entity’s classification or category under the applicable IGA or Treasury regulations (for example, the specific type of nonreporting financial institution).

Enter the legal name of the organization that is the beneficial owner.

Enter the country where the beneficial owner organization is incorporated or otherwise organized.

Provide the signature of the authorized representative of the beneficial owner. This is required to certify the information provided in the form.

Check this box if the entity identified in Part I qualifies as a certified deemed-compliant limited life debt investment entity and meets the listed requirements for this status.

Check this box if the entity identified in Part I is an investment entity described in the regulations and does not maintain financial accounts.

Check this box if the FFI in Part I qualifies as a certified deemed-compliant nonregistering local bank and meets all the listed conditions in Part V.

Check this box if the FFI in Part I qualifies as a certified deemed-compliant FFI with only low-value accounts and meets the listed conditions in Part VI.

Enter the full legal name of the sponsoring entity for this certified deemed-compliant sponsored, closely held investment vehicle.

Check this box to certify that the entity named in Part I meets the requirements listed under Part VII for a certified deemed-compliant sponsored, closely held investment vehicle.

Check this box if the beneficial owner is a corporation for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a partnership for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a simple trust for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a tax-exempt organization for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a complex trust for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a foreign government controlled entity for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a central bank of issue for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a private foundation for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is an estate for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is an integral part of a foreign government for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a grantor trust for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is a disregarded entity for Chapter 3 status (select only one entity type).

Check this box if the beneficial owner is an international organization for Chapter 3 status (select only one entity type).

Check this box if you selected disregarded entity, partnership, simple trust, or grantor trust above and the entity is a hybrid making a treaty claim. Fill only if 'Chapter 3 Entity Type - Partnership', 'Chapter 3 Entity Type - Simple trust', 'Chapter 3 Entity Type - Grantor trust', 'Chapter 3 Entity Type - Disregarded entity' is selected (any).

Check this box if you selected disregarded entity, partnership, simple trust, or grantor trust above and the entity is not a hybrid making a treaty claim. Fill only if 'Chapter 3 Entity Type - Partnership', 'Chapter 3 Entity Type - Simple trust', 'Chapter 3 Entity Type - Grantor trust', 'Chapter 3 Entity Type - Disregarded entity' is selected (any).

Check this box if the entity’s FATCA status is a Nonparticipating FFI (including an FFI related to a Reporting IGA FFI other than a deemed-compliant FFI, participating FFI, or exempt beneficial owner).

Check this box if the entity is a Participating Foreign Financial Institution (FFI) under FATCA.

Check this box if the entity is a Reporting Model 1 FFI under an applicable IGA.

Check this box if the entity is a Reporting Model 2 FFI under an applicable IGA.

Check this box if the entity is a Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII).

Check this box if the entity is a Sponsored FFI (and will complete Part IV as indicated on the form).

Check this box if the entity qualifies as a certified deemed-compliant nonregistering local bank (and will complete Part V as indicated).

Check this box if the entity is a certified deemed-compliant FFI with only low-value accounts (and will complete Part VI as indicated).

Check this box if the entity is a certified deemed-compliant sponsored, closely held investment vehicle (and will complete Part VII as indicated).

Check this box if the entity is a certified deemed-compliant limited life debt investment entity (and will complete Part VIII as indicated).

Check this box if the entity is one of the investment entities that does not maintain financial accounts (and will complete Part IX as indicated).

Check this box if the entity is an Owner-documented FFI (and will complete Part X as indicated).

Check this box if the entity qualifies as a Restricted distributor (and will complete Part XI as indicated).

Check this box if the entity is a Nonreporting IGA FFI (and will complete Part XII as indicated).

Check this box if the entity is a foreign government, a government of a U.S. possession, or a foreign central bank of issue (and will complete Part XIII as indicated).

Check this box if the entity is an International organization (and will complete Part XIV as indicated).

Check this box if the entity qualifies as an Exempt retirement plan (and will complete Part XV as indicated).

Check this box if the entity is wholly owned by exempt beneficial owners (and will complete Part XVI as indicated).

Check this box if the entity is a Territory financial institution (and will complete Part XVII as indicated).

Check this box if the entity is an Excepted nonfinancial group entity (and will complete Part XVIII as indicated).

Check this box if the entity is an Excepted nonfinancial start-up company (and will complete Part XIX as indicated).

Check this box if the entity is an Excepted nonfinancial entity in liquidation or bankruptcy (and will complete Part XX as indicated).

Check this box if the entity is a 501(c) organization (and will complete Part XXI as indicated).

Check this box if the entity qualifies as a Nonprofit organization (and will complete Part XXII as indicated).

Check this box if the entity is a publicly traded NFFE or an NFFE affiliate of a publicly traded corporation (and will complete Part XXIII as indicated).

Check this box if the entity is an Excepted territory NFFE (and will complete Part XXIV as indicated).

Check this box if the entity is an Active NFFE (and will complete Part XXV as indicated).

Check this box if the entity is a Passive NFFE (and will complete Part XXVI as indicated).

Check this box if the entity is an Excepted inter-affiliate FFI (and will complete Part XXVII as indicated).

Check this box if the entity is a Direct reporting NFFE (and will complete Part XXVIII as indicated).

Check this box if the entity is a Sponsored direct reporting NFFE (and will complete Part XXVIII as indicated).

Check this box if the payment is made to an account that is not a financial account for FATCA purposes.

Check this box if the disregarded entity or branch receiving the payment is treated as a nonparticipating foreign financial institution (FFI).

Check this box if the disregarded entity or branch receiving the payment is a participating FFI.

Check this box if the disregarded entity or branch receiving the payment is treated as a reporting Model 1 FFI.

Check this box if the disregarded entity or branch receiving the payment is treated as a reporting Model 2 FFI.

Check this box if the disregarded entity or branch receiving the payment is a U.S. branch.

Enter the name of the disregarded entity receiving the payment, if applicable. Fill only if 'Chapter 3 Entity Type - Disregarded entity' is selected.

Enter the disregarded entity or branch street address, including apartment, suite number, or rural route (do not use a P.O. box or in-care-of address other than a registered address).

Enter the city or town and the state or province for the disregarded entity or branch address, including the postal code where applicable.

Enter the country for the disregarded entity or branch address.

Enter the Global Intermediary Identification Number (GIIN) for the disregarded entity or branch receiving the payment, if applicable.

Check this box if the beneficial owner is claiming treaty benefits for U.S.-source dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign corporation and meets qualified resident status.

Enter the full legal name of the eighth substantial U.S. owner of the passive NFFE.

Enter the complete mailing address (street, city, state/province, postal code, and country if applicable) of the eighth substantial U.S. owner.

Enter the U.S. taxpayer identification number (TIN) for the eighth substantial U.S. owner.

Check this box if the entity in Part I is a pension/retirement fund established in a country with a U.S. income tax treaty and is entitled to treaty benefits on U.S.-source income as described in 29a.

Check this box if the entity in Part I meets the requirements in 29b for an exempt retirement plan (organized to provide retirement/disability/death benefits, subject to government regulation and reporting, generally tax-exempt, and meeting the contribution/distribution limits listed).

Check this box if the entity in Part I meets the requirements in 29c for an exempt retirement plan, including being organized to provide retirement/disability/death benefits and having fewer than 50 participants (and the other conditions stated in 29c).

Enter the full legal name of the fifth substantial U.S. owner of the passive NFFE.

Enter the complete mailing address of the fifth substantial U.S. owner of the passive NFFE.

Enter the U.S. taxpayer identification number (TIN) for the fifth substantial U.S. owner.

Enter the full legal name of the first substantial U.S. owner of the passive NFFE.

Enter the complete mailing address of the first substantial U.S. owner of the passive NFFE.

Enter the U.S. taxpayer identification number (TIN) for the first substantial U.S. owner of the passive NFFE.

Check this box if the entity identified in Part I is a foreign government, government of a U.S. possession, or foreign central bank of issue that is the beneficial owner of the payment and is not engaged in prohibited commercial financial activities for the relevant payments/accounts/obligations.

Enter the full legal name of the fourth substantial U.S. owner of the entity.

Enter the complete mailing address (street, city, state/province, and postal code, as applicable) for the fourth substantial U.S. owner.

Enter the U.S. taxpayer identification number (TIN) for the fourth substantial U.S. owner.

Check this box if the entity identified in Part I is an international organization described in section 7701(a)(18).

Check this box if the entity identified in Part I meets the listed criteria for an international organization (primarily foreign governments, recognized under foreign law, and income does not inure to private persons).

Enter the mailing street address (street name and number, apartment or suite number, or rural route), if different from the permanent residence address above. Fill only if 'Permanent Residence Address - Street Address', 'Permanent Residence Address - City/State/Postal Code', 'Permanent Residence Address - Country' is different (any).

Enter the mailing city or town, state or province, and postal code (if applicable), if different from the permanent residence address above. Fill only if 'Permanent Residence Address - Street Address', 'Permanent Residence Address - City/State/Postal Code', 'Permanent Residence Address - Country' is different (any).

Enter the country for the mailing address, if different from the permanent residence address above. Fill only if 'Permanent Residence Address - Street Address', 'Permanent Residence Address - City/State/Postal Code', 'Permanent Residence Address - Country' is different (any).

Enter the full legal name of the ninth substantial U.S. owner of the passive NFFE.

Enter the complete mailing address of the ninth substantial U.S. owner, including street, city, state/province, and postal code.

Enter the U.S. taxpayer identification number (TIN) for the ninth substantial U.S. owner.

Check this box to certify that the entity identified in Part I meets the requirements to be considered a nonreporting financial institution under an applicable IGA.

Check this box if the entity is claiming Owner-Documented FFI status and can certify it meets all the listed conditions in Part X line 24a.

Check this box if the FFI has provided, or will provide, an FFI owner reporting statement (and required valid documentation) as described in Part X line 24b.

Check this box if the FFI has provided, or will provide, an auditor’s letter meeting the requirements described in Part X line 24c.

Check this box if the entity on line 1 is a trust that has no contingent beneficiaries or designated classes with unidentified beneficiaries, as stated in Part X line 24d.

Check this box if you are certifying that the entity in Part I meets the criteria to be treated as an Excepted Nonfinancial Start-Up Company under Part XIX.

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. Fill only if 'Part XIX: I certify the entity identified in Part I is an Excepted Nonfinancial Start-Up Company' is 'Yes'.

Check this box if the entity in Part I is formed pursuant to a pension plan that would meet section 401(a) requirements (other than the requirement that the plan be funded by a U.S. trust).

Check this box if the entity in Part I is established exclusively to earn income for the benefit of one or more retirement funds or retirement/pension accounts described in Part XV (continued) e (including applicable Model 1/Model 2 IGA accounts or certain accounts described in Regulations section 1.1471-5(b)(2)(i)(A)).

Check this box if the entity in Part I is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession (or an exempt beneficial owner under an applicable Model 1 or Model 2 IGA) to provide retirement, disability, or death benefits to eligible beneficiaries or participants.

Check this box if the entity identified in Part I qualifies as an entity wholly owned by exempt beneficial owners and you are certifying the statements listed under Part XVI.

Check this box if the entity identified in Part I is a financial institution (other than an investment entity) incorporated or organized under the laws of a U.S. possession.

Check this box if the entity identified in Part I qualifies as an excepted nonfinancial group entity and you are certifying the statements listed under Part XVIII.

Check this box if you certify that the entity identified in Part I meets the conditions listed under Part XX (Excepted Nonfinancial Entity in Liquidation or Bankruptcy).

Enter the date on which the entity filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy. Fill only if 'Part XX - I certify that the entity identified in Part I' is 'Yes'.

Check this box to certify that the entity identified in Part I is a section 501(c) organization as described in Part XXI (including having an IRS determination letter in effect or a U.S. counsel opinion).

Enter the date shown on the IRS determination letter concluding the payee is a section 501(c) organization.

Check this box if you certify that the entity named in Part I is a nonprofit organization that meets the listed requirements in Part XXII.

Check this box if the entity is a foreign corporation that is not a financial institution and its stock is regularly traded on one or more established securities markets.

Enter the name of one securities exchange on which the entity’s stock is regularly traded. Fill only if 'Part XXIII 37a - I certify (publicly traded NFFE)' is 'Yes'.

Check this box if the entity in Part I is a foreign corporation that is not a financial institution and is an NFFE affiliate (a member of the same expanded affiliated group) of an entity whose stock is regularly traded on an established securities market.

Enter the name of the entity whose stock is regularly traded on an established securities market. Fill only if 'Part XXIII 37b - I certify that (NFFE affiliate of a publicly traded corporation)' is 'Yes'.

Enter the name of the securities market on which the entity’s stock is regularly traded. Fill only if 'Part XXIII 37b - I certify that (NFFE affiliate of a publicly traded corporation)' is 'Yes'.

Check this box if the entity in Part I qualifies as an Excepted Territory NFFE and you certify all listed statements in Part XXIV are true.

Check this box if the entity in Part I qualifies as an Active NFFE and you certify all listed statements in Part XXV are true.

Check this box to certify the entity identified in Part I is a foreign entity that is not a financial institution (other than a U.S.-organized investment entity) and is not certifying as any other NFFE/FFI status listed in the statement.

Check this box if the entity identified in Part I has no substantial U.S. owners (or, if applicable, no controlling U.S. persons).

Check this box if the entity identified in Part I has provided the name, address, and TIN of each substantial U.S. owner (or, if applicable, controlling U.S. person) in Part XXIX.

Check this box if the entity identified in Part I meets the listed conditions to certify its status as an excepted inter-affiliate FFI.

Enter the full legal name of the sponsoring entity for the sponsored direct reporting NFFE.

Check this box to certify that the entity identified in Part I is a direct reporting NFFE sponsored by the sponsoring entity named on line 42.

Check this box to certify that you have the capacity/authority to sign for the entity identified on line 1 of the form.

Enter the printed name of the individual authorized to sign for the beneficial owner. Fill only if 'Part XXX Certification: Authorized to sign' is 'Yes'.

Enter the date on which the authorized individual signs the certification. Fill only if 'Part XXX Certification: Authorized to sign' is 'Yes'.

Enter the permanent residence street address, including street name and number and any apartment or suite number (or rural route).

Enter the city or town and the state or province, including the postal code where applicable.

Enter the country of the permanent residence address.

Check this box if the entity in Part I qualifies as a restricted distributor and certifies it meets all the listed conditions in Part XI, line 25a.

Check this box if the entity is (and has been) bound by a distribution agreement that generally prohibits sales of the restricted fund’s debt or securities to U.S. entities and U.S. resident individuals (as described in line 25b). Fill only if 'Restricted Distributor - All restricted distributors check here' is 'Yes' and all fields selection if 25c is 'No'.

Check this box if the entity is currently bound by a distribution agreement prohibiting sales to specified U.S. persons, certain passive NFFEs, or nonparticipating FFIs, and (if applicable) has reviewed and remediated any prior sales as described in line 25c. Fill only if 'Restricted Distributor - All restricted distributors check here' is 'Yes' and all fields selection if 25b is 'No'.

Enter the full legal name of the second substantial U.S. owner of the passive NFFE.

Enter the complete mailing address of the second substantial U.S. owner, including street, city, state/province, and postal code.

Enter the taxpayer identification number (TIN) for the second substantial U.S. owner.

Enter the full legal name of the seventh substantial U.S. owner.

Enter the complete mailing address of the seventh substantial U.S. owner.

Enter the taxpayer identification number (TIN) of the seventh substantial U.S. owner.

Enter the full legal name of the sixth substantial U.S. owner of the passive NFFE.

Enter the complete mailing address (street, city, state/province, and postal code, plus country if applicable) for the sixth substantial U.S. owner.

Enter the tax identification number (TIN) for the sixth substantial U.S. owner.

Enter the treaty article and paragraph under which the beneficial owner is claiming special rates and conditions.

Enter the withholding rate the beneficial owner is claiming under the identified treaty provision.

Specify the type of income for which the treaty withholding rate is being claimed.

Explain the additional conditions in the treaty article that the beneficial owner meets to be eligible for the claimed withholding rate.

Enter the full legal name of the sponsoring entity for this Sponsored FFI.

Check this box if you certify that the entity identified in Part I is an investment entity, is not a QI/WP/WT, and has agreed with the sponsoring entity named above to act as its sponsoring entity.

Check this box if you certify that the entity identified in Part I is a controlled foreign corporation (as defined in section 957(a)), is not a QI/WP/WT, and is wholly owned (directly or indirectly) by the U.S. financial institution named above that agrees to act as its sponsoring entity.

Enter the beneficial owner’s U.S. taxpayer identification number (TIN), if required.

Enter the entity’s Global Intermediary Identification Number (GIIN), if applicable.

Enter the beneficial owner’s foreign tax identification number (FTIN). Fill only if 'Check if FTIN not legally required' is 'No'.

Check this box if a foreign taxpayer identification number (FTIN) is not legally required for the beneficial owner.

Begin explaining any additional treaty conditions the entity satisfies to qualify for the reduced rate (for example, ownership or activity tests). Continue on lines 90–91 if needed.

Continue the narrative from line 89 if more space is required to fully describe how the entity meets the treaty conditions.

Use this line for any remaining text needed to complete the explanation begun on lines 89–90.

Enter the full legal name of the third substantial U.S. owner of the passive NFFE.

Enter the complete mailing address of the third substantial U.S. owner of the passive NFFE.

Enter the U.S. taxpayer identification number (TIN) for the third substantial U.S. owner of the passive NFFE.

Check this box if you certify that the beneficial owner derives the income for which treaty benefits are claimed and, if applicable, meets the treaty’s limitation on benefits (LOB) requirements.

Check this box if the beneficial owner qualifies for treaty benefits under the LOB category for a government (or governmental entity) under the applicable treaty.

Check this box if the beneficial owner qualifies for treaty benefits as a tax-exempt pension trust or pension fund under the applicable treaty’s LOB provisions.

Check this box if the beneficial owner qualifies for treaty benefits as another type of tax-exempt organization under the applicable treaty’s LOB provisions.

Check this box if the beneficial owner qualifies for treaty benefits as a publicly traded corporation under the applicable treaty’s LOB provisions.

Check this box if the beneficial owner qualifies for treaty benefits as a subsidiary of a publicly traded corporation under the applicable treaty’s LOB provisions.

Check this box if the beneficial owner qualifies for treaty benefits under the LOB ownership and base erosion test in the applicable treaty.

Check this box if the beneficial owner qualifies for treaty benefits under the LOB derivative benefits test in the applicable treaty.

Check this box if the beneficial owner qualifies for treaty benefits under the LOB active trade or business test in the applicable treaty.

Check this box if the beneficial owner has received a favorable discretionary LOB determination from the U.S. competent authority for purposes of the applicable treaty.

Check this box if the applicable income tax treaty does not contain a limitation on benefits (LOB) article.

Check this box if the beneficial owner qualifies for treaty benefits under another LOB provision and you will specify the applicable treaty Article and paragraph.

Enter the applicable tax treaty limitation on benefits (LOB) article and paragraph when selecting the “Other” LOB provision type. Fill only if 'Line 14b - Other (specify Article and paragraph)' is 'Yes'.

Check this box if the beneficial owner is a resident of the country named on line 14a for purposes of the income tax treaty between that country and the United States.

Enter the country where the beneficial owner is a resident for purposes of the income tax treaty with the United States. Fill only if 'Line 14a – Resident of treaty country (beneficial owner)' is 'Yes'.

Enter the name of the trustee or sponsor for the trustee documented trust or sponsored entity.

Check this box if the trustee (or sponsor) you listed is a U.S. person/entity.

Check this box if the trustee (or sponsor) you listed is a foreign (non-U.S.) person/entity.