W-8BEN
(Rev. February 2006)
Department of the Treasury
Internal Revenue Service
Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding
OMB No. 1545-1621
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:
● A U.S. citizen or other U.S. person, including a resident alien individual
● A person claiming that income is effectively connected with the conduct of a trade or business in the United States
● A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)
● A foreign government, international organization, …show more content…
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
10
The beneficial owner is a resident of
b
within the meaning of the income tax treaty between the United States and that country.
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.
Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article
% rate of withholding on (specify type of …show more content…
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:
1 I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,
2 The beneficial owner is not a U.S. person,
3 The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject to tax under an income tax treaty, or (c) the partner’s share of a partnership’s effectively connected income, and
4 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