EXHIBIT (a)(1)(iii)
Form W-9 Give form to the
requester. Do not
(Rev. December 2000) send to the IRS.
Department of the Treasury
Internal Revenue Service
Request For Taxpayer
Identification Number amd Certification
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Please print or type
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Name (See Specfic Instructions on page 2.)
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Business name, if different from above. (See Specfic Instructions on page 2.)
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Check appropriate box: [ ] Individual/Sole proprietor [ ] Corporation
[ ] Partnership [ ] Other
|> _______
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Address (number, street, and apt. or suite no.)
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City, state, and ZIP code
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Requester's name and address (optional)
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List account number(s) here (optional)
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Part I Taxpayer Identification Number (TIN)
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Enter your TIN in the appropriate box. For individuals, this is your social
security number (SSN). However, for a resident alien, sole proprietor, or
disregarded entity, see the Part I instructions on page 2. For other entities,
it is your employer identification number (EIN). IF you do not have a number,
see How to get a TIN on page 2.
NOTE: If the account is in more than one name, see the chart on page 2 for
guidelines on whose number to enter.
Social security number
[ - - ]
or
Employer identification number
[ - ]
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Part II FOR U.S. PAYEES EXEMPT FROM BACKUP WITHHOLDING (See the
instructions on page 2.)
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|>
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Part III Certification
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Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number
(or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup
withholding, or (b) I have not been notified by the Internal Revenue Service
(IRS) that I am subject to backup withholding as a result of a failure to
report all interest or dividends, or (c) the IRS has notified me that I am no
longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been
notifed by the IRS that you are surrently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For
real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt,
contribtions to an individual retirement arrangement (IRA), and generally,
payments other than interest and dividends, you are not required to sign the
Certification, but you must provide your correct TIN. (See the instructions on
page 2.)
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Sign
Here Signature of U.S person|> DATE |>
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Purpose of Form
A person who is required to file an information return with the IRS must get
your correct tax payer identification number (TIN) to report,for example, income
paid to you, real estate transactions, mortgage interest you paid, acquisition
or abandonment of secured property, cancellation of debt, or contributions you
made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident alien), to
give your correct TIN to the person requesting it (the requester) and, when
applicable, to:
1. Certify the TIN you are giving is correct (or you are waiting
for a number to be issued),
2. Certify you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee.
If you are a foreign person, use the appropriate Form W-8. See PUB. 515,
Withholding of Tax on Nonresident Aliens and Foreign Corporations.
NOTE: If a requester gives you a form other than Form W-9 to request your TIN,
you must use the requester's form if it is substantially similar to this
Form W-9.
What is backup withholding? Persons making certain payments to you must withhold
and pay to the IRS 31% of such payments under certain conditions. This is called
"backup withholding." Payments that may be subject to backup withholding include
interest, dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, and certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
If you give the requestor your correct TIN, make the proper certifications,
and report all your taxable interest and dividends on your tax return, payements
you receive will not be subject to backup withholding. Payments you receive will
be subject to backup withholding if:
1. You do not furnish your TIN to the requester, or
2. You do not certify your TIN when required (see the Part III instructions on
page 2 for details),or
3. The IRS tells the requester that you furnished an incorrect TIN, or
4. The IRS tells you that you are subject to backup withholding because you
did not report all your interest and dividends on your tax return
(for reportable interest and dividends only).
5. You do not certify to the requester that you are not subject to backup
withholding under 3 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding. See the Part
II instructions and the separate INSTRUCTIONS FOR THE REQUESTER OF FORM W-9.
Penalties
Failure to fusnish TIN. If you fail to furnish your correct TIN to a requester,
you are subject to a penalty of $50 for each such failure unless your failure is
due to reasonable cause and not to willful neglect.
Civil penalty for false inforamtion with respect to withholding. If you make a
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications
or affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of Federal
law, the requester may be subject to civil and criminal penalties.
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Form W-9 (Rev. 12-2000)
Cat. No. 10231X
Form W-9(Rev 12-2000) Page 2
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SPECIFIC INSTRUCTIONS
NAME. If you are an individual, you must generally enter the name shown on your
social security card. However, if you have changed your last name, for instance,
due to marriage, without informing the Social Security Administration of the
name change, enter your first name, the last name shown on your social security
card, and your new last name.
If the account is in joint names, list first and then circle the name of the
person or entity whose number you enter in Part I of the form.
SOLE PROPRIETOR. Enter your INDIVIDUAL name as shown on your Social Security
card on the "Name" line. You may also enter your business, trade, or "doing
business as (DBA)" name on the "Business name" line.
LIMITED LIABILITY COMPANY (LLC). If you are a single member LLC (including a
foreign LLC with a domestic owner) that is disregarded as an entity separate
from its owner under Treasury regulations section 301.7701-03, ENTER THE OWNER'S
NAME ON THE "NAME" LINE. Enter the LLC's name on the "Business name" line.
CAUTION: A disregarded domestic entity that has a foreign owner must use the
appropriate Form W-8.
OTHER ENTITIES. Enter your business name as shown on required Federal tax
documents on the "Name" line. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any business,
trade, or DBA name on the "Business name" line.
PART I--TAXPAYER IDENTIFICATION NUMBER (TIN)
ENTER YOUR TIN IN THE APPROPRIATE BOX.
If you are a RESIDENT ALIEN and you do not have and are not eligible to get an
SSN, your TIN is your IRS individual taxpayer identification number (ITIN).
Enter it in the social security number box. If you do not have an ITIN, see HOW
TO GET A TIN below.
If you are a SOLE PROPRIETOR and you have an EIN, you may enter either you SSN
or EIN. However, the IRS prefers that you use your SSN.
If you are an LLC that is DISREGARDED AS AN ENTITY separate from its owner
(see LIMITED LIABILITY COMPANY (LLC) above), and are owned by an individual,
enter your SSN (or "pre-LLC" EIN, if desired). If the owner of a disregarded LLC
is a corporation, partnership, etc., enter the owner's EIN.
NOTE: See the chart on this page for further clarification of name and TIN
combinations.
HOW TO GET A TIN. If you do not have a TIN, apply for one immediately. To apply,
for an SSN, get FORM SS-5, Application for a Social Security Card from your
local Social Security Administration office. Get FORM W-7, Application for IRS
Individual Taxpayer Identification Number, to apply for an ITIN or Form SS-4,
Application for Employer Identification Number, to apply for an EIN. You can get
Forms W-7 and SS-4 from the IRS by calling 1-800-TAX-Form (1-800-829-3676) or
from the IRSs Internet Web Site at www.irs.gov.
If you do not have a TIN, write "Applied For" in the space for the TIN,
sign and date the form, and give it to the requester. For interest and
dividend payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to the
requester before you are subject to backup withholding on payments. The 60-day
rule does not apply to other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to the requester.
NOTE: Writing "Applied For" on the form means that you have already applied for
a TIN OR that you intend to apply for one soon.
PART II--FOR PAYEES EXEMPT FROM BACKUP WITHHOLDING
Individuals (including sole proprietors) are NOT exempt from backup withholding.
Corporations are exempt from backup withholding for certain payments, such as
interest and dividends. For more information on exempt payees, see the separate
instructions for the Requestor of Form W-9.
If you are exempt from backup withholding, you should still complete this form
to avoid possible erroneous backup withholding. Enter your correct TIN in Part
I, write "Exempt" in Part II, and sign and date the form.
If you are a nonresident alien or foreign entity not subject to backup
withholding, give the requester the appropriate completed FORM W-8.
PART III--CERTIFICATION
To establish to the withholding agent that you are a U.S. person, or resident
alien, sign Form W-9. You may be requested to sign by the withholding agent even
if items 1, 3, and 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part 1 should sign
(when required).
1. INTEREST, DIVIDEND, AND BARTER EXCHANGE ACCOUNTS OPENED BEFORE 1984 AND
BROKER ACCOUNTS CONSIDERED ACTIVE DURING 1983. You must give your correct TIN,
but you do not have to sign the certification.
2. INTEREST, DIVIDEND, BROKER, AND BARTER EXCHANGE ACCOUNTS OPENED AFTER 1983
AND BROKER ACCOUNTS CONSIDERED INACTIVE DURING 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
3. REAL ESTATE TRANSACTIONS. You must sign the certification. You may cross
out item 2 of the certification.
4. OTHER PAYMENTS. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given
an incorrect TIN. "Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments to certain
fishing boat crew members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. MORTGAGE INTEREST PAID BY YOU, ACQUISITION OR ABANDONMENT OF SECURED
PROPERTY, CANCELLATION OF DEBT, QUALIFIED STATE TUITION PROGRAM PAYMENTS, IRA OR
MSA CONTRIBUTIONS OR DISTRIBUTIONS, AND PENSION DISTRIBUTIONS. You must give
your correct TIN, but you do not have to sign the certification.
PRIVACY ACT NOTICE
Section 6109 of the Internal Revenue Code requires you to give your correct TIN
to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the
acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA or MSA. The IRS uses the numbers for
identification purposes and to help verify the accuracy of your tax return. The
IRS may also provide this information to the Department of Justice for civil and
criminal litigation, and to cities, states, and the District of Columbia to
carry out their tax laws.
You must provide your TIN whether or not you are required to file a tax
return. Payers must generally withhold 31% of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to a payer. Certain
penalties may also apply.
WHAT NAME AND NUMBER TO GIVE THE REQUESTER
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FOR THIS TYPE OF ACCOUNT: GIVE NAME AND SSN OF:
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1. Individual The individual
2. Two or more individuals The actual owner of the
(joint account) account or, if combined
funds, the first individual
on the account/1/
3. Custodian account of The minor/2/
a minor (Uniform Gift
to Minors Act)
4. a. The usual The grantor-trustee/1/
revocable savings
trust (grantor is
also trustee)
b. So-called trust The actual owner/1/
account that is not
a legal or valid trust
under state law
5. Sole proprietorship The owner/3/
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FOR THIS TYPE OF ACCOUNT: GIVE NAME AND EIN OF:
- ------------------------------ -------------------------------------
6. Sole proprietorship The owner/3/
7. A valid trust, estate or Legal entity/4/
pension trust
8. Corporate The corporation
9. Association, club, The organization
religious, charitable,
educational, or other
tax-exempt
organization
10. Partnership The partnership
11. A broker or registered The broker or nominee
nominee
12. Account with the The public entity
Department of
Agriculture in the name
of a public entity (such
as a state or local
government, school
district, or prison) that
receives agricultural
program payments
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/1/List first and circle the name of the person whose number you furnish. If
only one person on a joint account has an SSN, that person's number must be
furnished.
/2/Circle the minor's name and furnish the minor's SSN.
/3/You must show your individual name, but you may also enter your business or
"DBA" name. You may use either your SSN or EIN (if you have one).
/4/List first and circle the name of the legal trust, estate, or pension
trust. (Do not furnish the TIN of the personal representative or trustee
unless the legal entity itself is not designated in the account title.)
Note: If no name is circled when more than one name is listed, the number will
be considered to be that of the first name listed.
Form W-8BEN OMB No. 1545-1621
(Rev. December 2000)
Department of the Treasury
Internal Revenue Service
Certificate of Foreign Status of Beneficial Owner
for United States Tax Withholding
|> Section references are to the Internal Revenue Code.
|> See separate instructions.
|> Give this form to the withholding agent or payer. Do not send to the IRS.
Do not use this form for: Instead, use Form:
. A U.S. citizen or other U.S. person, including a resident alien individual. . . . . . . . . . . . . . . . . . . . . . . . . . .W-9
. A person claiming an exemption from U.S. withholding on income effectively connected with the conduct
of a trade or business in the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W-8ECI
. A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions). . . .W-8ECI or W-8IMY
. 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 claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions). . . . . . . .W-8ECI or W-8EXP
Note: 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.
. A person acting as an intermediary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
Note: See instructions for additional exceptions.
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Part I Identification of Beneficial Owner (See instructions.)
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1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization
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3 Type of beneficial owner: [ ] Individual [ ] Corporation [ ] Disregarded entity [ ] Partnership [ ] Simple trust
[ ] Grantor trust [ ] Complex trust [ ] Estate [ ] Government [ ] International organization
[ ] Central bank of issue [ ] Tax-exempt organization [ ] Private foundation
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4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)
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5 Mailing address (if different from above)
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City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)
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6 U.S. taxpayer identification number, if required (see instructions) 7 Foreign tax identifying number, if any (optional)
[ ] SSN or ITIN [ ]EIN
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8 Reference number(s) (see instructions)
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Part II Claim of Tax Treaty Benefits (if applicable)
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9 I certify that (check all that apply):
a [ ] 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).
c [ ] 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).
d [ ] The beneficial owner is not an individual, is claiming treaty benefits
for dividends received from a foreign corporation or interest from a
U.S. trade or business of a foreign corporation, and meets qualified
resident status (see instructions).
e [ ] 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.
10 Special rates and conditions (if applicable--see instructions): The
beneficial owner is claiming the provisions of Article of the treaty
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:_____________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Part III Notional Principal Contracts
_____________________________________________________________________________
11 [ ] I have provided or will provide a statement that identifies those
notional principal contracts from which the income is not effectively
connected with the conduct of a trade or business in the United
States. I agree to update this statement as required.
_____________________________________________________________________________
Part IV Certification
_____________________________________________________________________________
Under penalties of perjury, I declare that I have examined the information on
this form and to the best of my knowledge and belief it is true, correct, and
complete. I further certify under penalties of perjury that:
. I am the beneficial owner (or am authorized to sign for the beneficial
owner) of all the income to which this form relates,
. The beneficial owner is not a U.S. person,
. The income to which this form relates is not effectively connected with
the conduct of a trade or business in the United States or is effectively
connected but is not subject to tax under an income tax treaty, and
. For broker transactions or barter exchanges, the beneficial owner is an
exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent
that has control, receipt, or custody of the income of which I am the
beneficial owner or any withholding agent that can disburse or make payments
of the income of which I am the beneficial owner.
Sign Here |>____________________________________________________________________
Signature of beneficial owner (or individual authorized to sign for
beneficial owner)
_________________ ________________________
Date (MM-DD-YYYY) Capacity in which acting
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For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25047Z Form W-8BEN (Rev. 12-2000)
Instructions for Form [LOGO] Department of the Treasury
W-8BEN Internal Revenue Service
(Rev. December 2000)
Certificate of Foreign Status of Beneficial Owner for United States Tax
Withholding
Section references are to the Internal Revenue Code unless otherwise
noted.
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General Instructions
Note: For definitions of terms used throughout these instructions, see
Definitions on pages 2 and 3.
Purpose of Form. Foreign persons are subject to U.S. tax at a 30% rate on income
they receive from U.S. sources that consists of:
. Interest (including certain original issue discount (OID));
. Dividends;
. Rents;
. Royalties;
. Premiums;
. Annuities;
. Compensation for, or in expectation of, services performed;
. Substitute payments in a securities lending transaction; or
. Other fixed or determinable annual or periodical gains, profits, or income.
This tax is imposed on the gross amount paid and is generally collected by
withholding on that amount. A payment is considered to have been made whether it
is made directly to the beneficial owner or to another person, such as an
intermediary, agent, or partnership, for the benefit of the beneficial owner.
If you receive certain types of income, you must provide Form W-8BEN to:
. Establish that you are a foreign person;
. Claim that you are the beneficial owner of the income for which Form W-8BEN is
being provided; and
. If applicable, claim a reduced rate of, or exemption from, withholding as a
resident of a foreign country with which the United States has an income tax
treaty.
You may also be required to submit Form W-8BEN to claim an exception from
domestic information reporting and backup withholding at a 31% rate, including
for certain types of income that are not subject to foreign-person withholding.
Such income includes:
. Broker proceeds.
. Short-term (183 days or less) original issue discount (OID).
. Bank deposit interest.
. Foreign source interest, dividends, rents, or royalties.
. Proceeds from a wager placed by a nonresident alien individual in the games of
blackjack, baccarat, craps, roulette, or "big 6" wheel.
You may also use Form W-8BEN to certify that income from a notional principal
contract is not effectively connected with the conduct of a trade or business in
the United States.
A withholding agent or payer of the income may rely on a properly completed
Form W-8BEN to treat a payment associated with the Form W-8BEN as a payment to a
foreign person who beneficially owns the amounts paid. If applicable, the
withholding agent may rely on the Form W-8BEN to apply a reduced rate of
withholding at source.
Provide Form W-8BEN to the withholding agent or payer before income is paid
or credited to you. Failure to provide a Form W-8BEN when requested may lead to
withholding of a 30% or 31% amount from the payment.
Note: For additional information and instructions for the withholding agent, see
the Instructions for the Requester of Forms W-8BEN, W-8ECI, W-8EXP, and W-8IMY.
Who must file. You must give Form W-8BEN to the withholding agent or payer if
you are a foreign person and you are the beneficial owner of an amount subject
to withholding. Submit Form W-8BEN when requested by the withholding agent or
payer whether or not you are claiming a reduced rate of, or exemption from,
withholding.
Do not use Form W-8BEN if:
. You are a U.S. citizen (even if you reside outside the United States) or other
U.S. person (including a resident alien individual). Instead, use Form W-9,
Request for Taxpayer Identification Number and Certification.
. You are a disregarded entity with a single owner that is a U.S. person and you
are not a hybrid entity claiming treaty benefits. Instead, provide Form W-9.
. You are a nonresident alien individual who claims exemption from withholding
on compensation for independent or dependent personal services performed in the
United States. Instead, provide Form 8233, Exemption from Withholding on
Compensation for Independent (and Certain Dependent) Personal Services of a
Nonresident Alien Individual, or Form W-4, Employee's Withholding Allowance
Certificate.
. You are receiving income that is effectively connected with the conduct of a
trade or business in the United States. Instead, provide Form W-8ECI,
Certificate of Foreign Person's Claim for Exemption From Withholding on Income
Effectively Connected With the Conduct of a Trade or Business in the United
States. If any of the income for which you have provided a Form W-8BEN becomes
effectively connected, this is a change in
Cat. No. 25576H
circumstances and Form W-8BEN is no longer valid. You must file Form W-8ECI. See
Change in circumstances below.
. You are filing for a foreign government, international organization, foreign
central bank of issue, foreign tax-exempt organization, foreign private
foundation, or government of a U.S. possession claiming the applicability of
section 115(2), 501(c), 892, 895, or 1443(b). Instead, provide Form W-8EXP,
Certificate of Foreign Government or Other Foreign Organization for United
States Tax Withholding. However, you should use Form W-8BEN if you are claiming
treaty benefits or are providing the form only to claim you are a foreign person
exempt from backup withholding. You should use Form W-8ECI if you received
effectively connected income (e.g., income from commercial activities).
. You are a foreign flow-through entity, other than a hybrid entity, claiming
treaty benefits. Instead, provide Form W-8IMY, Certificate of Foreign
Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United
States Tax Withholding. However, if you are a partner, beneficiary, or owner of
a flow-through entity and you are not yourself a flow-through entity, you may be
required to furnish a Form W-8BEN to the flow-through entity.
. You are a reverse hybrid entity transmitting beneficial owner documentation
provided by your interest holders to claim treaty benefits on their behalf.
Instead, provide Form W-8IMY.
. You are a withholding foreign partnership or a withholding foreign trust. A
withholding foreign partnership or a withholding foreign trust is a foreign
partnership or trust that has entered into a withholding agreement with the IRS
under which it agrees to assume primary withholding responsibility for each
partner's, beneficary's, or owner's distributive share of income subject to
withholding that is paid to the partnership or trust. Instead, provide Form
W-8IMY.
. You are acting as an intermediary (i.e., acting not for your own account,
but for the account of others as an agent, nominee, or custodian). Instead,
provide Form W-8IMY.
Giving Form W-8BEN to the withholding agent. Do not send Form W-8BEN to the IRS.
Instead, give it to the person who is requesting it from you. Generally, this
will be the person from whom you receive the payment or who credits your
account. Give Form W-8BEN to the person requesting it before the payment is made
to you or credited to your account. If you do not provide this form, the
withholding agent may have to withhold at a 30% (foreign-person withholding) or
31% (backup withholding) rate. If you receive more than one type of income from
a single withholding agent for which you claim different benefits, the
withholding agent may, at its option, require you to submit a Form W-8BEN for
each different type of income. Generally, a separate Form W-8BEN must be given
to each withholding agent.
Note: If you own the income or account jointly with one or more other persons,
the income or account will be treated by the withholding agent as owned by a
foreign person if Forms W-8BEN are provided by all of the owners. If the
withholding agent receives a Form W-9 from any of the joint owners, the payment
must be treated as made to a U.S. person.
Change in circumstances. If a change in circumstances makes any information on
the Form W-8BEN you have submitted incorrect, you must notify the withholding
agent or payer within 30 days of the change in circumstances and you must file a
new Form W-8BEN or other appropriate form.
If you use Form W-8BEN to certify that you are a foreign person, a change of
address to an address in the United States is a change in circumstances.
Generally, a change of address within the same foreign country or to another
foreign country is not a change in circumstances.
However, if you use Form W-8BEN to claim treaty benefits, a move to the United
States or outside the country where you have been claiming treaty benefits is a
change in circumstances. In that case, you must notify the withholding agent or
payer within 30 days of the move.
If you become a U.S. citizen or resident after you submit Form W-8BEN, you
are no longer subject to the 30% foreign-person withholding rate. You must
notify the withholding agent or payer within 30 days of becoming a U.S. citizen
or resident. You may be required to provide a Form W-9. For more information,
see Form W-9 and instructions.
Expiration of Form W-8BEN. Generally, a Form W-8BEN provided without a U.S.
taxpayer identification number (TIN) will remain in effect for a period starting
on the date the form is signed and ending on the last day of the third
succeeding calendar year, unless a change in circumstances makes any information
on the form incorrect. For example, a Form W-8BEN signed on September 30, 2001,
remains valid through December 31, 2004. A Form W-8BEN furnished with a U.S. TIN
will remain in effect until a change in circumstances makes any information on
the form incorrect, provided that the withholding agent reports on Form 1042-S
at least one payment annually to the beneficial owner who provided the Form
W-8BEN. See Line 6 on page 4 for circumstances under which you must provide a
U.S. TIN.
Definitions
Beneficial owner. For payments other than those for which a reduced rate of
withholding is claimed under an income tax treaty, the beneficial owner of
income is generally the person who is required under U.S. tax principles to
include the income in gross income on a tax return. A person is not a beneficial
owner of income, however, to the extent that person is receiving the income as a
nominee, agent, or custodian, or to the extent the person is a conduit whose
participation in a transaction is disregarded. In the case of amounts paid that
do not constitute income, beneficial ownership is determined as if the payment
were income.
Foreign partnerships, foreign simple trusts, and foreign grantor trusts are
not the beneficial owners of income paid to the partnership or trust. The
beneficial owners of income paid to a foreign partnership are generally the
partners in the partnership, provided that the partner is not itself a
partnership, foreign simple or grantor trust, nominee or other agent. The
beneficial owners of income paid to a foreign simple trust (i.e., a foreign
trust that is described in section 651(a)) are generally the
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beneficiaries of the trust, if the beneficiary is not a foreign partnership,
foreign simple or grantor trust, nominee or other agent. The beneficiaries of a
foreign grantor trust (i.e., a foreign trust to the extent that all or a portion
of the income of the trust is treated as owned by the grantor or another person
under sections 671 through 679) are the persons treated as the owners of the
trust. The beneficial owners of income paid to a foreign complex trust (i.e., a
foreign trust that is not a foreign simple trust or foreign grantor trust) is
the trust itself.
The beneficial owner of income paid to a foreign estate is the estate itself.
Note: A payment to a U.S. partnership, U.S. trust, or U.S. estate is treated as
a payment to a U.S. payee that is not subject to 30% foreign-person withholding.
A U.S. partnership, trust, or estate should provide the withholding agent with a
Form W-9.
Foreign person. A foreign person includes a nonresident alien individual, a
foreign corporation, a foreign partnership, a foreign trust, a foreign estate,
and any other person that is not a U.S. person. It also includes a foreign
branch or office of a U.S. financial institution or U.S. clearing organization
if the foreign branch is a qualified intermediary. Generally, a payment to a
U.S. branch of a foreign person is a payment to a foreign person.
Nonresident alien individual. Any individual who is not a citizen or resident of
the United States is a nonresident alien individual. An alien individual meeting
either the "green card test" or the "substantial presence test" for the calendar
year is a resident alien. Any person not meeting either test is a nonresident
alien individual. Additionally, an alien individual who is a resident of a
foreign country under the residence article of an income tax treaty, or an alien
individual who is a resident of Puerto Rico, Guam, the Commonwealth of the
Northern Mariana Islands, the U.S. Virgin Islands, or American Samoa is a
nonresident alien individual. See Pub. 519, U.S. Tax Guide for Aliens, for more
information on resident and nonresident alien status.
Note: Even though a nonresident alien individual married to a U.S. citizen or
resident alien may choose to be treated as a resident alien for certain purposes
(e.g., filing a joint income tax return), such individual is still treated as a
nonresident alien for withholding tax purposes on all income except wages.
Flow-through entity. A flow-through entity is a foreign partnership (other than
a withholding foreign partnership), a foreign simple or foreign grantor trust
(other than a withholding foreign trust), or, for payments for which a reduced
rate of withholding is claimed under an income tax treaty, any entity to the
extent the entity is considered to be fiscally transparent (see below) with
respect to the payment by an interest holder's jurisdiction.
Hybrid entity. A hybrid entity is any person (other than an individual) that is
treated as fiscally transparent (see below) in the United States but is not
treated as fiscally transparent by a country with which the United States has an
income tax treaty. Hybrid entity status is relevant for claiming treaty
benefits. See Line 9c on page 4.
Reverse hybrid entity. A reverse hybrid entity is any person (other than an
individual) that is not fiscally transparent under U.S. tax law principles but
that is fiscally transparent under the laws of a jurisdiction with which the
United States has an income tax treaty. See Line 9c on page 4.
Fiscally transparent entity. An entity is treated as fiscally transparent with
respect to an item of income for which treaty benefits are claimed to the extent
that the interest holders in the entity must, on a current basis, take into
account separately their shares of an item of income paid to the entity, whether
or not distributed, and must determine the character of the items of income as
if they were realized directly from the sources from which realized by the
entity. For example, partnerships, common trust funds, and simple trusts or
grantor trusts are generally considered to be fiscally transparent with respect
to items of income received by them.
Disregarded entity. A business entity that has a single owner and is not a
corporation under Regulations section 301.7701-2(b) is disregarded as an entity
separate from its owner.
Amounts subject to withholding. Generally, an amount subject to withholding is
an amount from sources within the United States that is fixed or determinable
annual or periodical (FDAP) income. FDAP income is all income included in gross
income, including interest (as well as OID), dividends, rents, royalties, and
compensation. FDAP income does not include most gains from the sale of property
(including market discount and option premiums).
Withholding agent. Any person, U.S. or foreign, that has control, receipt, or
custody of an amount subject to withholding or who can disburse or make payments
of an amount subject to withholding is a withholding agent. The withholding
agent may be an individual, corporation, partnership, trust, association, or any
other entity, including (but not limited to) any foreign intermediary, foreign
partnership, and U.S. branches of certain foreign banks and insurance companies.
Generally, the person who pays (or causes to be paid) the amount subject to
withholding to the foreign person (or to its agent) must withhold.
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Specific Instructions
Note: A hybrid entity should give Form W-8BEN to a withholding agent only for
income for which it is claiming a reduced rate of withholding under an income
tax treaty. A reverse hybrid entity should give Form W-8BEN to a withholding
agent only for income for which no treaty benefit is being claimed.
Part I
Line 1. Enter your name. If you are a disregarded entity with a single owner who
is a foreign person and you are not claiming treaty benefits as a hybrid entity,
this form should be completed and signed by your foreign single owner. If the
account to which a payment is made or credited is in the name of the disregarded
entity, the foreign single owner should inform the withholding agent of this
fact. This may be done by including the name and account number of the
disregarded entity on line 8 (reference number) of Part I of the form. However,
if you are a disregarded entity that is claiming treaty benefits as
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a hybrid entity, this form should be completed and signed by you.
Line 2. If you are a corporation, enter the country of incorporation. If you are
another type of entity, enter the country under whose laws you are created,
organized, or governed. If you are an individual, enter N/A (for "not
applicable").
Line 3. Check the one box that applies. By checking a box, you are representing
that you qualify for this classification. You must check the box that represents
your classification (e.g., corporation, partnership, trust, estate, etc.) under
U.S. tax principles. Do not check the box that describes your status under the
law of the treaty country. If you are a partnership or disregarded entity
receiving a payment for which treaty benefits are being claimed, you must check
the "Partnership" or "Disregarded entity" box. If you are a sole proprietor,
check the "Individual" box, not the "Disregarded entity" box.
Caution: Only entities that are tax-exempt under section 501 should check the
"Tax-exempt organizations" box. Such organizations should use Form W-8BEN only
if they are claiming a reduced rate of withholding under an income tax treaty or
some code exception other than section 501. Use Form W-8EXP if you are claiming
an exemption from withholding under section 501.
Line 4. Your permanent residence address is the address in the country where you
claim to be a resident for purposes of that country's income tax. If you are
giving Form W-8BEN to claim a reduced rate of withholding under an income tax
treaty, you must determine your residency in the manner required by the treaty.
Do not show the address of a financial institution, a post office box, or an
address used solely for mailing purposes. If you are an individual who does not
have a tax residence in any country, your permanent residence is where you
normally reside. If you are not an individual and you do not have a tax
residence in any country, the permanent residence address is where you maintain
your principal office.
Line 5. Enter your mailing address only if it is different from the address you
show on line 4.
Line 6. If you are an individual, you are generally required to enter your
social security number (SSN). To apply for an SSN, get Form SS-5 from a Social
Security Administration (SSA) office. Fill in Form SS-5 and return it to the
SSA.
If you do not have an SSN and are not eligible to get one, you must get an
individual taxpayer identification number (ITIN). To apply for an ITIN, file
Form W-7 with the IRS. It usually takes about 30 days to get an ITIN.
If you are not an individual (e.g., a foreign estate or trust), or you are an
individual who is an employer or who is engaged in a U.S. trade or business as a
sole proprietor, use Form SS-4, Application for Employer Identification Number,
to obtain an EIN. If you are a disregarded entity claiming treaty benefits as a
hybrid entity, enter your EIN.
You must provide a U.S. taxpayer identification number (TIN) if you are:
1. Claiming an exemption from withholding under section 871(f) for certain
annuities received under qualified plans, or
2. A foreign grantor trust with 5 or fewer grantors, or
3. Claiming benefits under an income tax treaty.
However, a U.S. TIN is not required to be shown in order to claim treaty
benefits on the following items of income:
. Dividends and interest from stocks and debt obligations that are actively
traded;
. Dividends from any redeemable security issued by an investment company
registered under the Investment Company Act of 1940 (mutual fund);
. Dividends, interest, or royalties from units of beneficial interest in a unit
investment trust that are (or were upon issuance) publicly offered and are
registered with the SEC under the Securities Act of 1933; and
. Income related to loans of any of the above securities.
Note: You may want to obtain and provide a U.S. TIN on Form W-8BEN even though
it is not required. A Form W-8BEN containing a U.S. TIN remains valid for as
long as your status and the information relevant to the certifications you make
on the form remain unchanged provided at least one payment is reported to you
annually on Form 1042-S.
Line 7. If your country of residence for tax purposes has issued you a tax
identifying number, enter it here. For example, if you are a resident of Canada,
enter your Social Insurance Number.
Line 8. This line may be used by the filer of Form W-8BEN or by the withholding
agent to whom it is provided to include any referencing information that is
useful to the withholding agent in carrying out its obligations. For example,
withholding agents who are required to associate the Form W-8BEN with a
particular Form W-8IMY may want to use line 8 for a referencing number or code
that will make the association clear. A beneficial owner may use line 8 to
include the number of the account for which he or she is providing the form.
Part II
Line 9a. Enter the country where you claim to be a resident for income tax
treaty purposes. For treaty purposes, a person is a resident of a treaty country
if the person is a resident of that country under the terms of the treaty.
Line 9b. If you are claiming benefits under an income tax treaty, you must have
a U.S. TIN unless one of the exceptions listed under Line 6 above applies.
Line 9c. An entity (but not an individual) that is claiming a reduced rate of
withholding under an income tax treaty must represent that it (1) derives the
item of income for which the treaty benefit is claimed and (2) meets the
limitation on benefits provisions contained in the treaty, if any.
An item of income may be derived by either the entity receiving the item of
income or by the interest holders in the entity or, in certain circumstances,
both. An item of income paid to an entity is considered to be derived by the
entity only if the entity is not fiscally transparent under the laws of the
entity's jurisdiction with respect to the item of
income. An item of income paid to an entity shall be considered to be derived by
the interest holder in the entity only if (1) the interest holder is not
fiscally transparent in its jurisdiction with respect to the item of income and
(2) the entity is considered to be fiscally transparent under the laws of the
interest holder's jurisdiction with respect to the item of income. An item of
income paid directly to a type of entity specifically identified in a treaty as
a resident of a treaty jurisdiction is treated as derived by a resident of that
treaty jurisdiction.
If an entity is claiming treaty benefits on its own behalf, it should
complete Form W-8BEN. If an interest holder in an entity that is considered
fiscally transparent in the interest holder's jurisdiction is claiming a treaty
benefit, the interest holder should complete Form W-8BEN on its own behalf and
the fiscally transparent entity should associate the interest holder's Form
W-8BEN with a Form W-8IMY completed by the entity.
Note: An income tax treaty may not apply to reduce the amount of any tax on an
item of income received by an entity that is treated as a domestic corporation
for U.S. tax purposes. Therefore, neither the domestic corporation nor its
shareholders are entitled to the benefits of a reduction of U.S. income tax on
an item of income received from U.S. sources by the corporation.
To determine whether an entity meets the limitation on benefits provisions of
a treaty, you must consult the specific provisions or articles under the
treaties. Income tax treaties are available on the IRS Web Site at
www.irs.gov/ind_info/treaties.html.
Note: If you are an entity that derives the income as a resident of a treaty
country, you may check this box if the applicable income tax treaty does not
contain a "limitation on benefits" provision.
Line 9d. Caution: If you are claiming treaty benefits under an income tax treaty
entered into force after December 31, 1986, do not check box 9d. Instead, check
box 9c.
If you are a foreign corporation claiming treaty benefits under an income tax
treaty that entered into force before January 1, 1987 (and has not been
renegotiated) on (a) U.S. source dividends paid to you by another foreign
corporation, or (b) U.S. source interest paid to you by a U.S. trade or business
of another foreign corporation, you must generally be a "qualified resident" of
a treaty country. See section 884 for the definition of interest paid by a U.S.
trade or business of a foreign corporation ("branch interest") and other
applicable rules.
In general, a foreign corporation is a qualified resident of a country if one
or more of the following applies:
. It meets a 50% ownership and base erosion test.
. It is primarily and regularly traded on an established securities market in
its country of residence or the United States.
. It carries on an active trade or business in its country of residence.
. It gets a ruling from the IRS that it is a qualified resident.
See Regulations section 1.884-5 for the requirements that must be met to
satisfy each of these tests.
Line 9e. Check this box if you are related to the withholding agent within the
meaning of section 267(b) or 707(b) and the aggregate amount subject to
withholding received during the calendar year exceeds $500,000. Additionally,
you must file Form 8833, Treaty-Based Return Position Disclosure Under Section
6114 or 7701(b).
Line 10. Line 10 must be used only if you are claiming treaty benefits that
require that you meet conditions not covered by the representations you make in
lines 9a through 9e. However, this line should always be completed by foreign
students and researchers claiming treaty benefits. See Scholarship and
Fellowship Grants below for more information.
Additional examples of persons who should complete this line are:
1. Exempt organizations claiming treaty benefits under the exempt
organization articles of the treaties with Canada, Mexico, Germany, and the
Netherlands.
2. Persons claiming an exemption under a personal services article that
contains a monetary threshold.
3. Foreign corporations that are claiming a preferential rate applicable to
dividends based on ownership of a specific percentage of stock.
4. Persons claiming treaty benefits on royalties if the treaty contains
different withholding rates for different types of royalties.
This line is generally not applicable to claiming treaty benefits under an
interest or dividends (other than dividends subject to a preferential rate based
on ownership) article of a treaty.
Scholarship and Fellowship Grants. A nonresident alien student (including a
trainee or business apprentice) or researcher who receives scholarship or
fellowship grant income may use Form W-8BEN to claim benefits under a tax treaty
that apply to reduce or eliminate U.S. tax on such income. No Form W-8BEN is
required unless a treaty benefit is being claimed. A nonresident alien student
or researcher who receives compensation for personal services should use Form
8233 to claim any benefits of a tax treaty that apply to such compensation if
the compensation is included in, or is in addition to, the individual's
scholarship or fellowship grant income.
Generally, only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on income from a scholarship or
fellowship grant. However, most tax treaties contain a provision known as a
"saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for scholarship or fellowship grant income even
after the recipient has otherwise become a U.S. resident alien for tax purposes.
Thus, a student or researcher may continue to use Form W-8BEN to claim a tax
treaty benefit if the withholding agent has otherwise indicated an intention to
withhold on a scholarship or fellowship grant.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship income received by a Chinese student temporarily
present in the United States. Under U.S. law, this student will become a
resident alien for tax purposes if his or her stay in the United States exceeds
5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China
treaty
Page 5
(dated April 30, 1984) allows the provisions of Article 20 to continue to apply
even after the Chinese student becomes a resident alien of the United States.
Completing lines 4 and 9a. Most tax treaties that contain an article
exempting scholarship or fellowship grant income from taxation require that the
recipient be a resident of the other treaty country at the time of, or
immediately prior to, entry into the United States. Thus, a student or
researcher may claim the exemption even if he or she no longer has a permanent
address in the other treaty country after entry into the United States. If this
is the case, you may provide a U.S. address on line 4 and still be eligible for
the exemption if all other conditions required by the tax treaty are met. You
must also identify on line 9a the tax treaty country of which you were a
resident at the time of, or immediately prior to, your entry into the United
States.
Completing line 10. You must complete line 10 if you are a student or
researcher claiming an exemption from taxation on your scholarship or fellowship
grant income under a tax treaty. You must identify the applicable treaty
article. Additionally, if you are a U.S. resident alien and are relying on an
exception contained in the saving clause of a tax treaty to claim exemption from
taxation on your scholarship or fellowship income, you must specify the article
number (or location) in the tax treaty that contains the saving clause and its
exceptions.
Part III
If you check this box, you must provide the withholding agent with the required
statement for income from a notional principal contract that is to be treated as
income not effectively connected with the conduct of a trade or business in the
United States. You should update this statement as often as necessary. A new
Form W-8BEN is not required for each update provided the form otherwise remains
valid.
Part IV
Form W-8BEN must be signed and dated by the beneficial owner of the income, or,
if the beneficial owner is not an individual, by an authorized representative or
officer of the beneficial owner. If Form W-8BEN is completed by an agent acting
under a duly authorized power of attorney, the form must be accompanied by the
power of attorney in proper form or a copy thereof specifically authorizing the
agent to represent the principal in making, executing, and presenting the form.
Form 2848, Power of Attorney and Declaration of Representative, may be used for
this purpose. The agent, as well as the beneficial owner, may incur liability
for the penalties provided for an erroneous, false, or fraudulent form.
Broker transactions or barter exchanges. Income from transactions with a broker,
or barter exchanges, is subject to reporting rules and backup withholding unless
Form W-8BEN or a substitute form is filed to notify the broker or barter
exchange that you are an exempt foreign person.
You are an exempt foreign person for a calendar year in which: (1) you are a
nonresident alien individual or a foreign corporation, partnership, estate, or
trust; (2) you are an individual who has not been, and does not plan to be,
present in the United States for a total of 183 days or more during the calendar
year; and (3) you are neither engaged, nor plan to be engaged during the year,
in a U.S. trade or business that has effectively connected gains from
transactions with a broker or barter exchange.
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Paperwork Reduction Act Notice. We ask for the information on this form to carry
out the Internal Revenue laws of the United States. You are required to provide
the information. We need it to ensure that you are complying with these laws and
to allow us to figure and collect the right amount of tax.
You are not required to provide the information requested on a form that is
subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and return information are
confidential, as required by section 6103.
The time needed to complete and file this form will vary depending on
individual circumstances. The estimated average time is: Recordkeeping, 5 hr.,
58 min.; Learning about the law or the form, 3 hr., 46 min.; Preparing and
sending the form to IRS, 4 hr., 2 min.
If you have comments concerning the accuracy of these time estimates or
suggestions for making this form simpler, we would be happy to hear from you.
You can write to the Tax Forms Committee, Western Area Distribution Center,
Rancho Cordova, CA 95743-0001. Do not send Form W-8BEN to this office. Instead,
give it to your withholding agent.
Form W-8IMY Certificate of Foreign Intermediary, No. 1545-1621
(Rev. December 2000) Foreign Flow-Through Entity, or Certain U.S.
Branches for United States Tax Withholding
Department of the Section references are to the Internal Revenue Code.
Treasury See separate instructions. Give this form to the withholding
Internal Revenue agent or payer. Do not send to the IRS.
Service
Do not use this form for: Instead, use Form:
. A beneficial owner solely claiming foreign status or
treaty benefits W-8BEN
. A hybrid entity claiming treaty benefits on its own
behalf W-8BEN
. A person claiming an exemption from U.S. withholding on
income effectively connected with the conduct of a
trade or business in the United States W-8ECI
. A disregarded entity. Instead, the single foreign owner
should use W-8BEN or W-8ECI
. A foreign government, international organization,
foreign central bank of issue, foreign tax-exempt
organization, foreign private foundation, or government
of a U.S. possession claiming the applicability of
section(s) 115(2), 501(c), 892, 895, or 1443(b) W-8EXP
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Part I Identification of Entity
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1 Name of individual or organization that is 2 Country of incorporation
acting as intermediary or organization
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3 Type of entity--
check the appropriate box:
[ ] Qualified intermediary. [ ] Withholding foreign trust.
Complete Part II. Complete Part V.
[ ] Nonqualified intermediary. [ ] Nonwithholding foreign partnership.
Complete Part III. Complete Part VI.
[ ] U.S. branch. [ ] Nonwithholding foreign simple trust.
Complete Part IV. Complete Part VI.
[ ] Withholding foreign partnership. [ ] Nonwithholding foreign grantor trust.
Complete Part V. Complete Part VI.
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4 Permanent residence address (street, apt. or suite no., or rural route).
Do not use P.O. box.
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City or town, state or province. Include postal Country (do
code where appropriate. not abbreviate)
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5 Mailing address (if different from above)
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City or town, state or province. Include postal Country (do
code where appropriate. not abbreviate)
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6 U.S. taxpayer identification number (if 7 Foreign tax identifying
required, see instructions) number, if any
(optional)
[_] SSN or ITIN [_] EIN [_] QI-EIN
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8 Reference number(s) (see instructions)
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Part II Qualified Intermediary
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9a [_] (All qualified intermediaries check here) I certify that the entity
identified in Part I:
. Is a qualified intermediary and is not acting for its own account
with respect to the account(s) identified on line 8 or in a
withholding statement associated with this form and
. Has provided or will provide a withholding statement, as
required.
b [_] (If applicable) I certify that the entity identified in Part I has
assumed primary withholding responsibility under Chapter 3 of the Code
with respect to the account(s) identified on this line 9b or in a
withholding statement associated with this form
----------------------------------------------------------------------
c [_] (If applicable) I certify that the entity identified in Part I has
assumed primary Form 1099 reporting and backup withholding
responsibility as authorized in its withholding agreement with the IRS
with respect to the account(s) identified on this line 9c or in a
withholding statement associated with this form
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Part III Nonqualified Intermediary
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10a [_] (All nonqualified intermediaries check here) I certify that the entity
identified in Part I is not a qualified intermediary and is not acting
for its own account.
b [_] (If applicable) I certify that the entity identified in Part I is
using this form to transmit withholding certificates and/or other
documentary evidence and has provided or will provide a withholding
statement, as required.
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For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25402Q Form W-8IMY (Rev. 12-2000)
Form W-8IMY (Rev. 12-2000) Page 2
Part IV Certain United States Branches
Note: You may use this Part if the entity identified in Part I is a U.S. branch
of a foreign bank or insurance company and is subject to certain regulatory
requirements (see instructions).
11 [_] I certify that the entity identified in Part I is a U.S. branch and
that the payments are not effectively connected with the conduct of a
trade or business in the United States.
Check box 12 or box 13, whichever applies:
12 [_] I certify that the entity identified in Part I is using this form as
evidence of its agreement with the withholding agent to be treated as
a U.S. person with respect to any payments associated with this
certificate.
13 [_] I certify that the entity identified in Part I:
. Is using this form to transmit withholding certificates or other
documentary evidence for the persons for whom the branch receives
a payment and
. Has provided or will provide a withholding statement, as
required.
Part V Withholding Foreign Partnership or Withholding Foreign Trust
14 [_] I certify that the entity identified in Part I:
. Is a withholding foreign partnership or a withhholding foreign
trust and
. Has provided or will provide the withholding statement, as
required.
Part VI Nonwithholding Foreign Partnership, Simple Trust, or Grantor Trust
15 [_] I certify that the entity identified in Part I:
. Is a nonwithholding foreign partnership, a nonwithholding foreign
simple trust, or a nonwithholding foreign grantor trust and that
the payments to which this certificate relates are not
effectively connected, or are not treated as effectively
connected, with the conduct of a trade or business in the United
States and
. Has provided or will provide a withholding statement, as
required.
Part VII Certification
Under penalties of perjury, I declare that I have examined the information on
this form and to the best of my knowledge and belief it is true, correct, and
complete. Furthermore, I authorize this form to be provided to any withholding
agent that has control, receipt, or custody of the income for which I am
providing this form or any withholding agent that can disburse or make payments
of the income for which I am providing this form.
Sign Here _______________________________________ _______________________
Signature of authorized official Date (MM-DD-YYYY)
Instructions for Form W-8IMY Department of the Treasury
(Rev. December 2000) Internal Revenue Service
Certificate of Foreign Intermediary, Foreign
Flow-Through Entity, or Certain U.S. Branches for
United States Tax Withholding
Section references are to the Internal Revenue Code unless otherwise noted.
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General Instructions
Note: For definitions of terms used throughout these instructions, see
Definitions on pages 2 and 3.
Foreign persons are subject to U.S. tax at a 30% rate on income they receive
from U.S. sources that consists of interest (including certain original issue
discount (OID)), dividends, rent, premiums, annuities, compensation for, or in
expectation of, services performed, or other fixed or determinable annual or
periodical (FDAP) gains, profits, or income. This tax is imposed on the gross
amount paid and is generally collected by withholding on that amount. A payment
is considered to have been made whether it is made directly to the beneficial
owner or to another person, such as an intermediary, agent, trustee, executor,
or partnership, for the benefit of the beneficial owner.
Note: For additional information and instructions for the withholding agent, see
the Instructions for the Requester of Forms W-8BEN, W-8ECI, W-8EXP, and W-8IMY.
Who must file. Form W-8IMY must be provided by:
. A foreign person, or a foreign branch of a U.S. person, to establish that it
is a qualified intermediary that is not acting for its own account, to represent
that it has provided or will provide a withholding statement, as required, and,
if applicable, to represent that it has assumed primary withholding
responsibility under Chapter 3 of the Code and/or primary Form 1099 reporting
and backup withholding responsibility.
. A foreign person to establish that it is a nonqualified intermediary that is
not acting for its own account, and, if applicable, that it is using the form to
transmit withholding certificates and/or other documentary evidence and has
provided, or will provide, a withholding statement as required. A U.S. person
cannot be a nonqualified intermediary.
. A U.S. branch of certain foreign banks or foreign insurance companies to
represent that the income it receives is not effectively connected with the
conduct of a trade or business within the United States and either (a) that it
is using the form as evidence of its agreement with the withholding agent to be
treated as a U.S. person with respect to any payments associated with the Form
W-8IMY or (b) that it is using the certificate to transmit the documentation of
the persons for whom it receives a payment and has provided, or will provide, a
withholding statement, as required.
. A flow-through entity to represent that it is (a) a withholding foreign
partnership or withholding foreign trust and will provide a withholding
statement, as required or (b) a nonwithholding foreign partnership or
nonwithholding foreign simple or grantor trust, the income which it receives is
not effectively connected with a U.S. trade or business, and it has provided a
withholding statement as required.
Note: Solely for purposes of providing this form, a reverse hybrid entity that
is providing documentation on behalf of its interest holders to claim a reduced
rate of withholding under a treaty is considered to be a nonqualified
intermediary unless it has entered into a qualified intermediary agreement with
the IRS.
Provide Form W-8IMY to the withholding agent or payer before income is paid
or credited to you on behalf of the beneficial owner. Failure to provide a Form
W-8IMY or failure to provide necessary documentation and withholding statements
to be associated with the form may lead to withholding of a 30% or 31% amount
from the payment.
Do not use Form W-8IMY if:
. You are the beneficial owner of U.S. source income (other than income that
is effectively connected with the conduct of a trade or business within the
United States) and you need to establish that you are not a U.S. person.
Instead, submit Form W-8BEN, Certificate of Foreign Status of Beneficial Owner
for United States Tax Withholding.
. You are the beneficial owner of U.S. source income (other than income that is
effectively connected with the conduct of a trade or business within the United
States) and are claiming a reduced rate of, or exemption from, withholding as a
resident of a foreign country with which the United States has an income tax
treaty. Instead, provide Form W-8BEN.
. You are filing for a hybrid entity claiming treaty benefits on its own behalf,
or you are filing for a reverse hybrid entity and are not claiming treaty
benefits on behalf of its interest holders. Instead, provide Form W-8BEN.
. You are the beneficial owner of income that is effectively connected with
the conduct of a trade or business within the United States. Instead, provide
Form W-8ECI, Certificate of Foreign Person's Claim for Exemption From
Withholding on Income Effectively Connected With the Conduct of a Trade or
Business in the United States.
. You are a nonresident alien individual who claims exemption from withholding
on compensation for independent or certain dependent personal services performed
in the United States. Instead, provide Form 8233, Exemption From Withholding on
Compensation for Independent (and Certain Dependent) Personal Services of a
Nonresident Alien Individual, or Form W-4, Employee's Withholding Allowance
Certificate.
Cat. No. 25904R
. You are filing for a disregarded entity (i.e., a business entity that has a
single owner and is not a corporation under Regulations section 301.7701-2(b) is
disregarded as an entity separate from its owner). Instead, provide Form W-8BEN
or W-8ECI.
. You are filing for a foreign government, international organization, foreign
central bank of issue, foreign tax-exempt organization, foreign private
foundation, or government of a U.S. possession claiming the applicability of
section 115(2), 501(c), 892, 895, or 1443(b). Instead, provide Form W-8EXP,
Certificate of Foreign Government or Other Foreign Organization for United
States Tax Withholding. However, these entities should use Form W-8BEN if they
are claiming treaty benefits or are providing the form only to claim exempt
recipient status for backup withholding purposes.
Giving Form W-8IMY to the withholding agent. Do not send Form W-8IMY to the IRS.
Instead, give it to the person who is requesting it. Generally, this person will
be the one from whom you receive the payment or who credits your account. Give
Form W-8IMY to the person requesting it before income is paid to you or credited
to your account. If you do not provide this form, the withholding agent may have
to withhold at a 30% rate (foreign-person withholding) or 31% (backup
withholding) rate. Generally, a separate Form W-8IMY must be submitted to each
withholding agent.
Change in circumstances. If a change in circumstances makes any information on
the Form W-8IMY (or any documentation or a withholding statement associated with
the Form W-8IMY) you have submitted incorrect, you must notify the withholding
agent or payer within 30 days of the changes in circumstances and you must file
a new Form W-8IMY or provide new documentation or a new withholding statement.
You must update the information associated with Form W-8IMY as often as is
necessary to enable the withholding agent to withhold at the appropriate rate on
each payment and to report such income.
Expiration of Form W-8IMY. Generally, a Form W-8IMY remains valid until the
status of the person whose name is on the certificate is changed in a way
relevant to the certificate or circumstances change that make the information on
the certificate no longer correct. The indefinite validity period does not
extend, however, to any withholding certificates, documentary evidence, or
withholding statements associated with the certificate.
Definitions
Foreign person. A foreign person includes a nonresident alien individual, a
foreign corporation, a foreign partnership, a foreign trust, a foreign estate,
and any other person that is not a U.S. person. It also includes a foreign
branch or office of a U.S. financial institution or U.S. clearing organization
if the foreign branch is a qualified intermediary. Generally, a payment to a
U.S. branch of a foreign person is a payment to a foreign person.
Intermediary. An intermediary is any person that acts as a custodian, broker,
nominee, or otherwise as an agent for another person, regardless of whether that
other person is the beneficial owner of the amount paid, a flow-through entity,
or another intermediary.
Qualified intermediary. A qualified intermediary is a person that is a party
to a withholding agreement with the IRS and is:
. A foreign financial institution or a foreign clearing organization (other
than a U.S. branch or U.S. office of the institution or organization),
. A foreign branch or office of a U.S. financial institution or a foreign branch
or office of a U.S. clearing organization,
. A foreign corporation for purposes of presenting claims of benefits under an
income tax treaty on behalf of its shareholders, or
. Any other person the IRS accepts as a qualified intermediary and who enters
into a withholding agreement with the IRS.
See Rev. Proc. 2000-12, 2000-4 I.R.B. 387, for procedures to apply to be a
qualified intermediary.
Nonqualified intermediary. A nonqualified intermediary is any intermediary
that is not a U.S. person and that is not a qualified intermediary.
Beneficial owner. For payments other than those for which a reduced rate of
withholding is claimed under an income tax treaty, the beneficial owner of
income is generally the person who is required under U.S. tax principles to
include the income in gross income on a tax return. A person is not a beneficial
owner of income, however, to the extent that person is receiving the income as a
nominee, agent, or custodian, or to the extent the person is a conduit whose
participation in a transaction is disregarded. In the case of amounts paid that
do not constitute income, beneficial ownership is determined as if the payment
were income.
Foreign partnerships, foreign simple trusts, and foreign grantor trusts are
not the beneficial owners of income paid to the partnership or trust. The
beneficial owners of income paid to a foreign partnership are generally the
partners in the partnership, provided that the partner is not itself a
partnership, foreign simple or grantor trust, nominee or other agent. The
beneficial owners of income paid to a foreign simple trust (i.e., a foreign
trust that is described in section 651(a)) are generally the beneficiaries of
the trust, if the beneficiary is not itself a foreign partnership, foreign
simple or grantor trust, nominee or other agent. The beneficiaries of a foreign
grantor trust (i.e., a foreign trust to the extent that all or a portion of the
income of the trust is treated as owned by the grantor or another person under
sections 671 through 679) are the persons treated as the owners of the trust.
The beneficial owner of income paid to a foreign complex trust (i.e., a foreign
trust that is not a foreign simple trust or foreign grantor trust) is the trust
itself.
The beneficial owner of income paid to a foreign estate is the estate itself.
Flow-through entity. A flow-through entity is a foreign partnership (other than
a withholding foreign partnership), a foreign simple or foreign grantor trust
(other than a withholding foreign trust), or, for payments for which a reduced
rate of withholding is claimed under an income tax treaty, any entity to the
extent the entity is considered to be fiscally transparent (see page 3) with
respect to the payment by an interest holder's jurisdiction.
Withholding foreign partnership or withholding foreign trust. A withholding
foreign partnership or withholding foreign trust is a foreign partnership or a
foreign simple or grantor trust that has entered into a withholding agreement
with the IRS in which it agrees to assume primary withholding responsibility for
all payments that are made to it for its partners, beneficiaries, or owners.
Page 2
Nonwithholding foreign partnership, simple trust, or grantor trust. A
nonwithholding foreign partnership is any foreign partnership other than a
withholding foreign partnership. A nonwithholding foreign simple trust is any
foreign simple trust that is not a withholding foreign trust. A nonwithholding
foreign grantor trust is any foreign grantor trust that is not a withholding
foreign trust.
Hybrid entity. A hybrid entity is any person (other than an individual) that is
treated as fiscally transparent (see below) in the United States but is not
treated as fiscally transparent by a country with which the United States has an
income tax treaty. Hybrid status is relevant for claiming treaty benefits.
Reverse hybrid entity. A reverse hybrid entity is any person (other than an
individual) that is not fiscally transparent under U.S. tax law principles but
that is fiscally transparent under the laws of a jurisdiction with which the
United States has an income tax treaty.
Fiscally transparent entity. An entity is treated as fiscally transparent with
respect to an item of income to the extent that the interest holders in the
entity must, on a current basis, take into account separately their shares of an
item of income paid to the entity, whether or not distributed, and must
determine the character of the items of income as if they were realized directly
from the sources from which realized by the entity.
Amounts subject to withholding. Generally, an amount subject to withholding is
an amount from sources within the United States that is FDAP income. FDAP income
is all income included in gross income, including interest (and original issue
discount), dividends, rents, royalties, and compensation. FDAP income does not
include most gains from the sale of property (including market discount and
option premiums). FDAP income also does not include items of U.S. source income
that are excluded from gross income without regard to the U.S. or foreign status
of the holder, such as interest under section 103(a).
Reportable amount. Solely for purposes of the statements required to be attached
to Form W-8IMY, a reportable amount is an amount subject to withholding, U.S.
source deposit interest (including original issue discount), and U.S. source
interest or original issue discount on the redemption of short-term obligations.
It does not include payments on deposits with banks and other financial
institutions that remain on deposit for 2 weeks or less or amounts received from
the sale or exchange (other than a redemption) of a short-term obligation that
is effected outside the United States. It also does not include amounts of
original issue discount arising from a sale and repurchase transaction completed
within a period of 2 weeks or less, or amounts described in Regulations section
1.6049-5(b)(7), (10), or (11) (relating to certain obligations issued in bearer
form). See the instructions for Forms 1042-S and 1099 to determine whether these
amounts are also subject to information reporting.
Withholding agent. A withholding agent is any person, U.S. or foreign, that has
control, receipt, or custody of an amount subject to withholding or who can
disburse or make payments of an amount subject to withholding. The withholding
agent may be an individual, corporation, partnership, trust, association, or any
other entity, including (but not limited to) any foreign intermediary, foreign
partnership, and U.S. branches of certain foreign banks and insurance companies.
Generally, the person who pays (or causes to be paid) the amount subject to
withholding to the foreign person (or to its agent) must withhold.
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Specific Instructions
Part I
Line 1. Enter your name. By doing so, you are representing to the payer or
withholding agent that you are not the beneficial owner of the amounts that will
be paid to you.
Line 2. If you are a corporation, enter the country of incorporation. If you are
another type of entity, enter the country under whose laws you are created,
organized, or governed. If you are an individual, enter "N/A" (for "not
applicable").
Line 3. Check the one box that applies. If you are a foreign partnership
receiving the payment on behalf of your partners, check the "Withholding foreign
partnership" box or the "Nonwithholding foreign partnership" box, whichever is
appropriate. If you are a foreign simple trust or foreign grantor trust
receiving the payment on behalf of your beneficiaries or owners, check the
"Withholding foreign trust" box, the "Nonwithholding foreign simple trust" box,
or the "Nonwithholding foreign grantor trust" box, whichever is appropriate. If
you are a foreign partnership (or a foreign trust) receiving a payment on behalf
of persons other than your partners (or beneficiaries or owners), check the
"Qualified intermediary" box or the "Nonqualified intermediary" box, whichever
is appropriate. A reverse hybrid entity that is providing documentation from its
interest holders to claim a reduced rate of withholding under a treaty should
check the "Nonqualified intermediary" box unless it has entered into a qualified
intermediary agreement with the IRS. See
Parts II Through VI on page 4 if you are acting in more than one capacity.
Line 4. Your permanent residence address is the address in the country where you
claim to be a resident. Do not show the address of a financial institution, a
post office box, or an address used solely for mailing purposes. If you do not
have a tax residence in any country, the permanent residence address is where
you maintain your principal office or, if you are an individual, where you
normally reside.
Line 5. Enter your mailing address only if it is different from the address you
show on line 4.
Line 6. You must provide an employer identification number (EIN) if you are a
U.S. branch of a foreign bank or insurance company.
If you are acting as a qualified intermediary or a withholding foreign
partnership or a withholding foreign trust, you must use the EIN that was issued
to you in such capacity (your "QI-EIN"). If you also act as a nonqualified
intermediary with respect to other amounts subject to withholding, you must
complete a separate Form W-8IMY for those amounts and use the EIN, if any, that
is not your QI-EIN.
A nonqualified intermediary, a nonwithholding foreign partnership, or a
nonwithholding foreign simple or grantor trust is generally not required to
provide a U.S. TIN. However, a nonwithholding foreign grantor trust with five or
fewer grantors is required to provide an EIN.
Page 3
Line 7. If your country of residence for tax purposes has issued you a tax
identifying number, enter it here.
Line 8. This line may be used by the filer of Form W-8IMY or by the withholding
agent to whom it is provided to include any referencing information that is
useful to the withholding agent in carrying out its obligations. For example, a
withholding agent who is required to associate a particular Form W-8BEN with
this Form W-8IMY may want to use line 8 for a referencing number or code that
will make the association clear.
Parts II Through VI
You should complete only one part. If you are acting in multiple capacities, you
must provide separate Forms W-8IMY for each capacity. For example, if you are
acting as a qualified intermediary for one account, but a nonqualified
intermediary for another account, you must provide one Form W-8IMY in your
capacity as a qualified intermediary, and a separate Form W-8IMY in your
capacity as a nonqualified intermediary.
Part II -- Qualified Intermediary
Check box 9a if you are a qualified intermediary (QI) (whether or not you assume
primary withholding responsibility) for the income for which you are providing
this form. By checking the box, you are certifying to all of the statements
contained on line 9a.
Check box 9b only if you have assumed primary withholding responsibility
under Chapter 3 of the Code (nonresident alien withholding) with respect to the
accounts identified on this line or in a withholding statement associated with
this form.
Check box 9c only if you have assumed primary Form 1099 reporting and backup
withholding responsibility as authorized in a withholding agreement with the IRS
with respect to the accounts identified on this line or in a withholding
statement associated with this form.
Although a QI obtains withholding certificates or appropriate documentation
from beneficial owners, payees, and, if applicable, shareholders, as specified
in your withholding agreement with the IRS, a QI does not need to attach the
certificates or documentation to this form. However, to the extent you have not
assumed primary Form 1099 reporting or backup withholding responsibility, you
must disclose the names of those U.S. persons for whom you receive reportable
amounts and that are not exempt recipients (as defined in Regulations section
1.6049-4(c)(1)(ii) or under section 6041, 6042, 6045, or 6050N). You should make
this disclosure by attaching to Form W-8IMY the Forms W-9 (or substitute forms)
of persons that are not exempt recipients. If you do not have a Form W-9 for a
non-exempt U.S. payee, you must attach to Form W-8IMY any information you do
have regarding that person's name, address, and TIN.
Withholding statement of a QI. As a QI, you must provide a withholding statement
to each withholding agent from which you receive reportable amounts. The
withholding statement becomes an integral part of the Form W-8IMY and,
therefore, the certification statement that you sign in Part VII of the form
applies to the withholding statement as well as to the form. The withholding
statement must:
1. Designate those accounts for which you act as a QI.
2. Designate those accounts for which you assumed primary withholding
responsibility under Chapter 3 of the Code and/or primary Form 1099 reporting
and backup withholding responsibility.
3. Provide information regarding withholding rate pools.
A withholding rate pool is a payment of a single type of income, based on the
categories of income reported on Form 1042-S or Form 1099 (e.g., interest,
dividends), that is subject to a single rate of withholding. The withholding
rate pool may be established by any reasonable method agreed upon by you and the
withholding agent. For example, you may agree to establish a separate account
for a single withholding rate pool or you may agree to divide a payment made to
a single account into portions allocable to each withholding rate pool. You must
provide the withholding rate pool information that is required for the
withholding agent to meet its withholding and reporting obligations. A
withholding agent may request any information reasonably necessary to withhold
and report payments correctly.
If you do not assume primary Form 1099 reporting and backup withholding
responsibility, you must establish a separate withholding rate pool for each
U.S. non-exempt recipient account holder disclosed to the withholding agent
unless the alternative procedure is used (see below). The withholding rate pools
are based on valid documentation that you obtain under your withholding
agreement with the IRS or, if a payment cannot be reliably associated with valid
documentation, under the applicable presumption rules.
Alternative procedure for U.S. non-exempt recipients. If permitted by the QI
withholding agreement with the IRS and if approved by the withholding agent, you
may establish:
. A single withholding rate pool (not subject to backup withholding) for all
U.S. non-exempt recipient account holders for whom you have provided Forms W-9
prior to the withholding agent making any payments. Alternatively, you may
include such U.S. non-exempt recipients in a zero rate withholding pool that
includes U.S. exempt recipients and foreign persons exempt from non-resident
alien withholding provided all the conditions of the alternative procedure are
met and
. A separate withholding rate pool (subject to 31% backup withholding) for all
U.S. non-exempt recipient account holders for whom you have not provided Forms
W-9 prior to the withholding agent making any payments.
If you elect the alternative procedure, you must provide the information
required by your QI withholding agreement to the withholding agent not later
than January 15 of the year following the year in which the payments are paid.
Failure to provide this information may result in penalties under sections 6721
and 6722 and termination of your withholding agreement with the IRS.
Updating the statement. The statement by which you identify the relevant
withholding rate pools must be updated as often as is necessary to allow the
withholding agent to withhold at the appropriate rate on each payment and to
correctly report the income to the IRS. The updated information becomes an
integral part of Form W-8IMY.
Part III -- Nonqualified Intermediary
If you are providing Form W-8IMY as a nonqualified intermediary (NQI), you must
check box 10a. By checking
Page 4
this box, you are certifying to all of the statements on line 10a. Check box 10b
if you are using this form to transmit withholding certificates or other
documentation.
If you are acting on behalf of another NQI or on behalf of a foreign
partnership or foreign trust that is not a withholding foreign partnership or a
withholding foreign trust, you must attach to your Form W-8IMY the Form W-8IMY
of the other NQI or the foreign partnership or the foreign trust together with
the withholding certificates and other documentation attached to that Form
W-8IMY.
Withholding statement of an NQI. An NQI must provide a withholding statement to
obtain reduced rates of withholding for its customers and to avoid certain
reporting responsibilities. The withholding statement must be provided prior to
a payment and becomes an integral part of the Form W-8IMY and, therefore, the
certification statement that you sign in Part VII of the form applies to the
withholding statement as well as to the form. The withholding statement must:
1. Contain the name, address, U.S. TIN (if any), and the type of
documentation (documentary evidence, Form W-9, or type of Form W-8) for every
person for whom documentation has been received and must state whether that
person is a U.S. exempt recipient, a U.S. non-exempt recipient, or a foreign
person. The statement must indicate whether a foreign person is a beneficial
owner or an intermediary, flow-through entity, or U.S. branch and the type of
recipient, based on the recipient codes reported on Form 1042-S.
2. Allocate each payment by income type to every payee for whom
documentation has been provided. The type of income is based on the income codes
reported on Form 1042-S (or, if applicable, the income categories for Form
1099). If a payee receives income through another NQI, flow-through entity, or
U.S. branch, your withholding certificate must also state the name, address, and
U.S. TIN, if known, of the other NQI or U.S. branch from which the payee
directly receives the payment or the flow-through entity in which the payee has
a direct ownership interest. If another NQI, flow-through entity, or U.S. branch
fails to allocate a payment, you must provide, for that payment, the name of the
NQI, flow-through entity, or U.S. branch that failed to allocate the payment.
3. If a payee is identified as a foreign person, you must specify the rate
of withholding to which the payee is subject, the payee's country of residence
and, if a reduced rate of withholding is claimed, the basis for that reduced
rate (e.g., treaty benefit, portfolio interest, exempt under section 501(c)(3),
892, or 895). The statement must also include the U.S. TIN (if required) and, if
the beneficial owner is not an individual and is claiming treaty benefits, state
whether the limitation on benefits and section 894 statements have been provided
by the beneficial owner. You must inform the withholding agent as to which
payments those statements relate.
4. Contain any other information the withholding agent requests in order to
fulfill its withholding and reporting obligations under Chapter 3 of the Code
and/or Form 1099 reporting and backup withholding responsibility.
Alternative procedures for NQIs. Under this procedure, you may provide
information allocating a payment of a reportable amount to each payee (including
U.S.-exempt recipients) after a payment is made. To use the alternative
procedure you must inform the withholding agent on your withholding statement
that you are using the procedure and the withholding agent must agree to the
procedure.
CAUTION This alternative procedure cannot be used for payments that are
allocable to U.S. non-exempt recipients.
Under this procedure, you must provide a withholding agent with all the
information required on the withholding statement (see above) and all payee
documentation, except the specific allocation information for each payee, prior
to the payment of a reportable amount. In addition, you must provide the
withholding agent with withholding rate pool information. The withholding
statement must assign each payee to a withholding rate pool prior to the payment
of a reportable amount. A withholding rate pool is a payment of a single type of
income, based on the income codes reported on Form 1042-S (e.g., interest,
dividends), that is subject to a single rate of withholding. The withholding
rate pool may be established by any reasonable method agreed upon by you and the
withholding agent. For example, you may agree to establish a separate account
for a single withholding rate pool, or you may agree to divide a payment made to
a single account into portions allocable to each withholding rate pool. You must
determine withholding rate pools based on valid documentation or, to the extent
a payment cannot be reliably associated with valid documentation, the applicable
presumption rules.
You must provide the withholding agent with sufficient information to
allocate the income in each withholding rate pool to each payee (including U.S.
exempt recipients) within the pool no later than January 31 of the year
following the year of payment. If you fail to provide allocation information, if
required, by January 31 for any withholding rate pool, you may not use this
procedure for any payment made after that date for all withholding rate pools.
You may remedy your failure to provide allocation information by providing the
information to the withholding agent no later than February 14. See Regulations
section 1.1441-1.
Part IV -- Certain United States Branches
Line 11
Check the box to certify that you are either:
. A U.S. branch of a foreign bank subject to regulatory supervision by the
Federal Reserve Board or
. A U.S. branch of a foreign insurance company required to file an annual
statement on a form approved by the National Association of Insurance
Commissioners with the insurance department of a state, a territory, or the
District of Columbia.
By checking the box you are also certifying that the income you are receiving
is not effectively connected with the conduct of your trade or business in the
United States. You must provide your EIN on line 6 of Part I.
Line 12 or 13
If you are one of the types of U.S. branches specified in the instructions for
line 11 above, then you may choose to be treated in one of two ways:
1. Check box 12 if you have an agreement with the withholding agent to
which you are providing this form to be treated as a U.S. person. In this case,
you will be treated as a U.S. person. Therefore, you will receive the payment
free of Chapter 3 withholding but you will yourself
Page 5
be responsible for Chapter 3 withholding and backup withholding for any payments
you make or credit to the account of persons for whom you are receiving the
payment.
2. Check box 13 if you do not have an agreement with the withholding agent
to be treated as a U.S. person. Withholding statement of a U.S. branch not
treated as a U.S. person. If you checked box 13, you must provide the
withholding agent with a written withholding statement. The withholding
statement becomes an integral part of the Form W-8IMY. The withholding statement
must provide the same information outlined under Withholding statement of an NQI
on page 5.
Part V -- Withholding Foreign
Partnership or Withholding Foreign Trust
Check box 14 if you are a withholding foreign partnership or a withholding
foreign trust for the accounts for which you are providing this form and you are
receiving the income from those accounts on behalf of your partners,
beneficiaries, or owners. If you are not receiving the income on behalf of your
partners, beneficiaries, or owners, do not complete Part V. Instead, complete
Part II or Part III, whichever is appropriate.
If you are acting as a withholding foreign partnership or as a withholding
foreign trust, you must assume primary withholding responsibility for all
payments that are made to you for your partners, beneficiaries, or owners.
Therefore, you are not required to provide information to the withholding agent
regarding each partner's, beneficiary's, or owner's distributive share of the
payment. If you are also receiving payments from the same withholding agent for
persons other than your partners, beneficiaries, or owners, you must provide a
separate Form W-8IMY for those payments.
Part VI -- Nonwithholding Foreign
Partnership, Simple Trust, or Grantor
Trust
Check box 15 if you are a foreign partnership or a foreign simple or grantor
trust that is not a withholding foreign partnership or a withholding foreign
trust. By checking this box, you are certifying to both of the statements on
line 15. If you are receiving income that is effectively connected with the
conduct of a trade or business in the United States, provide Form W-8ECI.
If you are not receiving the income on behalf of your partners,
beneficiaries, or owners, do not complete Part VI. Instead, complete Part II or
Part III, whichever is appropriate.
If you are acting on behalf of an NQI or another foreign partnership or
foreign trust that is not a withholding foreign partnership or a withholding
foreign trust, you must associate with your Form W-8IMY the Form W-8IMY of the
other foreign partnership or foreign trust together with the withholding
certificates and other documentation attached to that other form.
Withholding statement of nonwithholding foreign partnership or nonwithholding
foreign trust. You must provide the withholding agent with a written withholding
statement to obtain reduced rates of withholding and relief from certain
reporting obligations. The withholding statement becomes an integral part of the
Form W-8IMY. The withholding statement must provide the same information
outlined under Withholding statement of an NQI on page 5.
Part VII -- Certification
Form W-8IMY must be signed and dated by a person authorized to sign a
declaration under penalties of perjury on behalf of the person whose name is on
the form.
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Paperwork Reduction Act Notice. We ask for the information on this form to carry
out the Internal Revenue laws of the United States. If you are acting in any
capacity described in these instructions, you are required to give us the
information. We need it to ensure that you are complying with these laws and to
allow us to figure and collect the right amount of tax.
You are not required to provide the information requested on a form that is
subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and return information are
confidential, as required by section 6103.
The time needed to complete and file this form will vary depending on
individual circumstances. The estimated average time is: Recordkeeping, 5 hr.,
58 min.; Learning about the law or the form, 4 hr., 38 min.; Preparing and
sending the form to IRS, 6 hr., 8 min.
If you have comments concerning the accuracy of these time estimates or
suggestions for making this form simpler, we would be happy to hear from you.
You can write to the Tax Forms Committee, Western Area Distribution Center,
Rancho Cordova, CA 95743-0001. Do not send Form W-8IMY to this office. Instead,
give it to your withholding agent.
Page 6