A B C Translated by The Hongkong and Shanghai Banking Corporation Limited D PPL1099 W-8BEN (05/17)

Transcription

1 W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) For Joint Accounts, each account holder must complete a separate form. A form W-8BEN must be completed correctly without any alterations. If you make a mistake, please start over using a new form. Do not use liquid paper or any other correctional tool. All W Forms must be completed in English. HSBC Bank plc All Rights Reserved A B C D A. Please read this section and the associated instructions to ensure you are completing the correct W form. B. PART I (Identification of Beneficial Owner) Line 1 Full Name (First Name and Last Name). Line 2 Country of Citizenship Line 3 Insert full street address on the first line, and the City or town, state or province including post code on the 2nd line. DO NOT USE: PO Box or C/O address Name of a third party Address at a Financial Institution US address Line 4 Insert a mailing address only if it is different from your Permanent residence address. Note: If a US mailing address is entered, a written explanation/reason for the US mailing address will be required. If the country differs to the country in the permanent residence address then a written explanation will be required. Line 5 Insert your US Taxpayer Identification Number (TIN). It will either be a Social Security Number (SSN) or an Individual Taxpayer Identification Number (ITIN). A valid TIN will always be made up of 9 digits. A TIN should not: (1) contain something other than numbers, (2) contain fewer than or more than nine digits, (3) consist of nine of the same number, or (4) consist of nine sequential numbers (whether ascending or descending order). Line 6 Insert your non-us tax identifying number. If you do not have one, go to Line 8 and write down your date of birth (MM/DD/YYYY). Line 7 DO NOT LIST ACCOUNT NUMBERS as this could limit the form to the accounts listed and you may have to provide another form for your other accounts. Note: Please refer to the W-8BEN instructions for further guidance on who is the beneficial owner. C. PART II (Claim of Tax Treaty Benefits) Lines 9 and 10 Only complete this section if you are resident in a treaty country and entitled to claim tax treaty benefits, ie if you are receiving fixed or determinable, annual or periodical (FDAP) income, for example dividend payments, and the payment is from sources within the US. If you have any queries regarding your eligibility to claim tax treaty benefits, we suggest that you seek independent tax advice. D. PART III (Certification) 1. Please sign the form and print your name on the line below your signature. 2. Please date the form using the MM/DD/YYYY format. 3. If you are signing on behalf of the person stated on Line 1, please complete the capacity field. Note: This form cannot be signed under a Power of Attorney (POA) unless the POA document specifically mentions that the agent/attorney is able to sign on tax matters or on tax forms (and a copy is provided, or held), or alternatively if an IRS Form 2848 is provided. * Hang Seng is unable to provide any Tax advice. If you require any advice please refer to an independent tax advisor. PPL1099 W-8BEN (05/17)

2 A B C Translated by The Hongkong and Shanghai Banking Corporation Limited D PPL1099 W-8BEN (05/17)

3 W-8BEN 美国预提税及申报受益所有人之外国人身分证明 ( 个人 ) 如为联名户口, 每位户口持有人必须分别填写一份表格 W-8BEN 表格必须准确填写, 不得涂改 如果填写有误, 请用新表格重新填写 请勿使用涂改液或其他涂改工具 所有 W 表格均必须以英文填写 A B C A. 请详阅本节和相关指引, 确保使用正确的 W 表格 B. 第一部分 ( 受益所有人身分 ) 第 1 栏全名 ( 姓名 ) 第 2 栏国籍第 3 栏在第一行填写完整的街道地址, 在第二行填写城市或城镇 州或省, 包括邮政编码 请勿使用 : 邮政信箱或代收地址第三方姓名金融机构的地址美国地址第 4 栏如果您的邮寄地址与永久居住地址不同, 请填写邮寄地址 注意 : 如果填写美国邮寄地址, 必须书面说明使用美国邮寄地址的原因 如果填写的国家与永久居住地所在国家不同, 也必须书面说明原因 第 5 栏填写您的美国纳税人识别号码 (TIN) 该号码为您的社会保障号码 (SSN) 或个人纳税人识别号码 (ITIN) 有效的纳税人识别号码应由 9 个数字组成 纳税人识别号码不会 : (1) 含有数字以外的内容, (2) 少于或超过 9 个数字, (3) 含有 9 个相同的数字, 或 (4) 含有 9 个顺序排列的数字 ( 无论升序还是降序 ) 第 6 栏填写您在美国以外的税务识别号码 如果没有外国税务识别号码, 请转至第 8 栏并填写您的出生日期 ( 月月 / 日日 / 年年年年 ) 第 7 栏请勿填写户口号码, 否则表格将仅限于所列户口使用, 您可能须为其他户口另外填写表格 注意 : 有关谁是受益所有人的进一步说明, 请参阅 W-8BEN 指引 C. 第二部分 ( 申请税务协定利益 ) 第 9 栏和第 10 栏仅当您是协定国居民并有权申请税务协定利益, 即您收到源自美国的固定或可确定年度或定期 (FDAP) 收入 ( 如股息 ) 时, 才需填写本节内容 如果对您是否有资格申请税务协定利益存有疑问, 我们建议您寻 英国汇丰银行有限公司 年 版权所有 D 求独立税务意见 D. 第三部分 ( 证明 ) 1. 请在表格上签名, 并在签名下方的横线上以正楷工整书写姓名 2. 请以月月 / 日日 / 年年年年的格式填写日期 3. 如果您代表第 1 栏所述的人士签名, 请填写行事代表人一栏 注意除非授权书特别注明代理人 / 律师可以签署税务文件或税务表格 ( 并提供或持有相关副本 ), 或者提供国税局 2848 表格, 否则本表格不得通过授权书授权签署 * 恒生不能提供任何税务建议 如需有关建议, 请咨询独立税务顾问 PPL1099 W-8BEN (05/17)

4 Form W-8BEN (Rev. February 2014) Department of the Treasury Internal Revenue Service W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) For use by individuals. Entities must use Form W-8BEN-E. W-8BEN-E Information about Form W-8BEN and its separate instructions is at W-8BEN Give this form to the withholding agent or payer. Do not send to the IRS. OMB No (OMB) All responses must be written in English. Do NOT use this form if: Instead, use Form: You are NOT an individual......w-8ben-e w......w-8ben-e.... You are a U.S. citizen or other U.S. person, including a resident alien individual...w w-9.. You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business ss within the U.S. (other than personal services)...w-8eci....w-8eci... You are a beneficial owner who is receiving compensation for personal services performed in i the United States or W or W-4 A person acting as an intermediary...w-8imy...w-8imy Part I I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial ial owner 2 Country of citizenship 3 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 4 Mailing address s (if dif different from above) City or town, state or province. Include postal code where appropriate. 5 U.S. taxpayer identifica identification number (SSN or ITIN), if required (see instructions) s Country 6 Foreign tax identifying number (see instructions) 7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions) (--)

5 Part II 䫔 II 悐 9 10 Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 䓛婳䦭 䙲炷 旸㕤䫔 3 䪈炸炷婳 教 炸 I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country. 㛔Ṣ嫱㖶炻 䙲㑩㚱Ṣ䁢伶 冯 䯥会䘬 䦭 㵝佑ℏ䘬娚 㮹ˤ Special rates and conditions (if applicable see instructions): The beneficial owner is claiming the provisions of Article of the treaty identified on line 9 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: 䈡 䦭䌯 㡅ẞ炷 怑䓐 婳 教 炸 烉 䙲㑩㚱Ṣ㬋㟡㒂ᶲ徘䫔 9 㪬 䣢 䫔 㡅炻 炷 栆 㓞ℍ炸䓛婳丛䲵 䘦 㭼 (%) 䘬枸 䦭烉 婒㖶 䙲㑩㚱Ṣ䫎 㡅㫦䘬 烉 Part III 䫔 III 悐 Certification 嫱㖶 x 請 本 使 文 用 件 英 只 文 供 表 參 格 考 填 用 寫 途 並 提 交 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. mp I further certify under penalties of perjury that: ἄ 嫱 优䘬 ᶳ炻㛔Ṣ倚㖶 㩊㞍㛔堐㟤 屯㕁炻 㛔Ṣ䎮妋䭬 ℏ䡢ᾉ屯㕁 䁢䛇 ˣ㬋䡢 㔜ˤ ἄ 嫱 优䘬 ᶳ炻㛔Ṣ忚ᶨ㬍嫱㖶烉 ᶳ炻㛔Ṣ忚 I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial eficial owner) of all the income ome to which this form relates or am using this form to document myself as an individual that is an owner or account holder of a foreign financial nancial institution institution, 㛔Ṣ䁢㬌堐㟤䚠斄䘬 㚱㓞ℍ䘬 䙲㑩㚱Ṣ炷 䌚 㪲ẋ堐 䙲㑩㚱Ṣ䯥会炸炻 䓐㬌堐㟤䓛 㛔Ṣ䁢ᶨ 慹圵㨇㥳 㚱Ṣ 㚱Ṣ䘬ᾳṢ炻 㛔Ṣ䁢ᶨ 慹圵㨇 㚱Ṣ 㚱Ṣ䘬 x The person named on line 1 of this form is not a U.S. person, 㕤㬌堐㟤䫔 1 㪬䘬Ṣ 朆伶 Ṣ 炻 x The income to which this form relates is: 㬌堐㟤䘬䚠斄㓞ℍ䁢烉 (a) not effectively connected with the conduct of a trade or business in the United ted States, 朆冯㕤伶 忚埴屧㖻 㤕 晃䚠斄炻 (b) effectively connected but is not subject to tax under an applicable income ncome tax treaty, or 晃䚠斄炻Ữ㰺㚱怑䓐 䦭 ᶳ䘬ㅱ丛䦭枭炻 (c) the partner s share of a partnership's effectively connected income, ome, Ṣ ẩ㤕䘬 晃䚠斄㓞ℍ Ỽấ柵 x The person named on line 1 of this form is a resident of the treaty country listed liste on line ine 9 of the form (if a any) within the meaning of the income tax treaty between the United States and that country, and 㕤㬌堐㟤䫔 1 㪬䘬Ṣ 炻䁢堐㟤䫔 9 㪬 䘬伶 冯娚 炷 㚱炸䯥会䘬 䦭 㵝佑ℏ䘬 㮹炻 䘬伶 冯娚 炷 䘬 䦭 㵝佑ℏ䘬 x For broker transactions or barter exchanges, the he beneficial owner iis an exempt foreign person as defined in the instructions. 䴻䲨Ṍ㖻 㖻屐Ṍ㖻㕡朊炻 䙲㑩㚱Ṣ䁢 佑䘬䌚審 Ṣˤ 佑䘬䌚審 Furthermore, I authorize this form to be e provided to any withholding agent that has con control, receipt, or custody of the income of which I am the beneficial owner or any withholding agent that can disburse urse or make paym payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes inco incorrect. 㬌 炻㛔Ṣ 㪲㬌堐㟤 ὃḱảỽ ˣ㓞 ᾅ䭉㛔 䙲㑩㚱Ṣ㓞ℍ䘬ảỽ枸 ẋ䎮炻 㚱㪲 㛔 䙲㑩㚱Ṣ 䘤 㓗Ẁ徨䦭 枸 ẋ䎮ˤ ảỽ ˣ㓞 䙲㑩㚱Ṣ㓞ℍ䘬 㬌堐㟤䘬ảỽ嫱 㖶嬲 ᶵ㬋䡢炻㛔Ṣ シ㕤 㕤 30 0 ℏ慵㕘 Ṍ堐㟤ˤ 慵㕘 Ṍ 㟤 Sign Here 㬌䯥会 Signature nature of beneficial bene beneficia owner wner er (or individual autho authorized to sign for beneficial owner) 䙲㑩㚱Ṣ炷 䌚 㪲ẋ堐 䙲㑩㚱Ṣ䘬ᾳṢ炸䯥会 䙲 㚱Ṣ炷 㚱Ṣ 炷 䌚 㪲ẋ堐 㪲ẋ堐 䙲 Printt name of o signer ner 䯥会Ṣ㬋㤟 会Ṣ㬋 䯥会Ṣ㬋㤟 For Paperwork Reduction Act Notice, see separate sepa instructions. 㚱斄 㔯㚠䯉 夷 忂䞍 炻婳 教 㖶䘬 ˤ 炻婳 教 㖶䘬 ĩ㛔㔯ß 㔯嬗㛔 ὃ 侫炻 劙㔯㛔 ℏ 㚱㬏䔘炻㤪ẍ劙㔯㛔䁢㸾ˤĪ ὃ 侫炻 劙㔯㛔 Date MM-DD-YYYY 㖍㛇 (㚰㚰-㖍㖍- ) Capacity in which acting (if form is not signed by beneficial owner) 埴ḳẋ堐Ṣ炷 堐㟤 朆䓙 䙲㑩㚱Ṣ䯥会炸 Cat. No Z 栆. 䶐嘇 Z Form W-8BEN (Rev ) W-8BEN 堐㟤炷㕤 㚰ᾖ妪炸

6 Instructions for Form W-8BEN W-8BEN (Rev. February 2014) Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) Section references are to the Internal Revenue Code unless otherwise noted. Future Developments For the latest information about developments related to Form W-8BEN and its instructions, such as legislation enacted after they were published, go to Department of the Treasury Internal Revenue Service W-8BEN What's New FATCA. In 2010, Congress passed the Hiring Incentives to Restore Employment Act of 2010, P. L (the HIRE Act), which added chapter 4 of Subtitle A (chapter 4) to the Code, consisting of sections 1471 through 1474 of the Code and commonly referred to as FATCA or chapter 4. Under chapter 4, participating foreign financial institutions (FFIs) and certain registered-deemed compliant FFIs are generally required to identify their U.S. account holders, regardless of whether a payment subject to withholding is made to the account. The IRS has published regulations that provide due diligence, withholding, and reporting rules for both U.S. withholding agents and FFIs under chapter 4. This form, along with Form W-8ECI, W-8EXP, and W- 8IMY, has been updated to reflect the documentation requirements of chapter 4. In particular, this Form W-8BEN is now used exclusively by individuals. Entities documenting their foreign status, chapter 4 status, or making a claim of treaty benefits (if applicable) should use Form W-8BEN-E. Individual account holders (both U.S. and foreign) that do not document their status may be deemed recalcitrant and, in some cases, subject to 30% withholding on certain payments. Foreign individuals can avoid being classified as recalcitrant account holders by using Form W-8BEN to document their foreign status. FATCA A FATCA 4 4 (FFI) 4 W-8ECI W-8EXP W-8IMY 4 W-8BEN 4 W-8BEN-E 30% W-8BEN

7 Foreign individuals should use Form W-8BEN to document their foreign status and claim any applicable treaty benefits for chapter 3 purposes (including a foreign individual that is the single member of an entity that is disregarded for U.S. tax purposes). See the instructions to Form W-8BEN-E concerning claims for treaty benefits and chapter 4 certifications in the case of a hybrid entity. Reportable payment card transactions. Section 6050W was added by section 3091 of the Housing Assistance Tax Act of 2008 and requires information returns to be made by certain payers with respect to payments made to participating payees in settlement of payment card transactions and third party payment network transactions. Information returns are not required with respect to payments made to payees that are foreign persons, however. A payer of a reportable payment may treat a payee as foreign if the payer receives an applicable Form W-8 from the payee. Provide this Form W-8BEN to the requestor if you are a foreign individual that is a participating payee receiving payments in settlement of payment card transactions that are not effectively connected with a U.S. trade or business of the payee. More information. For more information on FATCA, go to General Instructions For definitions of terms used throughout these instructions, see Definitions, later. Purpose of Form Establishing status for chapter 3 purposes. 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 under section 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. W-8BEN 3 W- 8BEN-E (Housing Assistance Tax Act) W W-8 W-8BEN FATCA % (OID) 1441

8 In addition, section 1446 requires a partnership conducting a trade or business in the United States to withhold tax on a foreign partner's distributive share of the partnership's effectively connected taxable income. Generally, a foreign person that is a partner in a partnership that submits a Form W-8BEN for purposes of section 1441 or 1442 will satisfy the documentation requirements under section 1446 as well. However, in some cases the documentation requirements of sections 1441 and 1442 do not match the documentation requirements of section See Regulations sections through Note. The owner of a disregarded entity (including an individual), rather than the disregarded entity itself, must submit the appropriate Form W-8BEN for purposes of section If you receive certain types of income, you must provide Form W-8BEN to: Establish that you are not a U.S. person; Claim that you are the beneficial owner of the income for which Form W-8BEN is being provided or a foreign partner in a partnership subject to section 1446; 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 and who is eligible for treaty benefits. You may also be required to submit Form W-8BEN to claim an exception from domestic information reporting and backup withholding (at the backup withholding rate under section 3406) for certain types of income that are not subject to foreign-person withholding at a rate of 30% under section 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; and Proceeds from a wager placed by a nonresident alien individual in the games of blackjack, baccarat, craps, roulette, or big-6 wheel. 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, or exemption from, 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 at the foreign-person withholding rate of 30% or the backup withholding rate under section W-8BEN W-8BEN W-8BEN 1446 W-8BEN % 3406 W-8BEN 183 (OID) W-8BEN W-8BEN W- 8BEN W- 8BEN W- 8BEN 30% 3406

9 Establishing status for chapter 4 purposes. An FFI may rely on a properly completed Form W-8BEN to establish your chapter 4 status as a foreign person. The Form W- 8BEN should be provided to the FFI when requested. Failure to do so could result in 30 percent withholding on income paid or credited to you as a recalcitrant account holder from sources within the United States. See the definition of amounts subject to withholding, later. Additional information. For additional information and instructions for the withholding agent, see the Instructions for the Requester of Forms W-8BEN, W-8BEN-E, W-8ECI, W-8EXP, and W-8IMY. Who Must Provide Form W-8BEN You must give Form W-8BEN to the withholding agent or payer if you are a nonresident alien who is the beneficial owner of an amount subject to withholding, or if you are an account holder of an FFI documenting yourself as a nonresident alien. If you are the single owner of a disregarded entity, you are considered the beneficial owner of income received by the disregarded entity. Submit Form W-8BEN when requested by the withholding agent, payer, or FFI whether or not you are claiming a reduced rate of, or exemption from, withholding. You should also provide Form W-8BEN to a payment settlement entity (PSE) requesting this form if you are a foreign individual receiving payments subject to reporting under section 6050W (payment card transactions and third-party network transactions) as a participating payee. However, if the payments are income which is effectively connected to the conduct of a U.S. trade or business, you should instead provide the PSE with a Form W-8ECI. Do not use Form W-8BEN if you are described below. You are a foreign entity documenting your foreign status, documenting your chapter 4 status, or claiming treaty benefits. Instead, use Form W-8BEN-E, Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities). 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, to document your status as a U.S. person. You are acting as a foreign intermediary (that is, acting not for your own account, but for the account of others as an agent, nominee, or custodian). Instead, provide Form W-8IMY, Certificate of Foreign Intermediary, Foreign Flow- Through Entity, or Certain U.S. Branches for United States Tax Withholding and Reporting. You are a disregarded entity with a single owner that is a U.S. person. Instead, the owner should provide Form W-9. If the disregarded entity is a hybrid entity claiming treaty benefits, the entity should complete Form W-8BEN-E even if the single owner of such entity is a U.S. person that must also provide a Form W-9. See the instructions to Form W-8BEN-E for information on hybrid entities claiming treaty benefits. 4 W-8BEN 4 W-8BEN 30% W- 8BEN W-8BEN-E W-8ECI W-8EXP W-8IMY W-8BEN W- 8BEN W-8BEN 6050W W-8BEN (PSE) W-8ECI W-8BEN 4 W-8BEN-E W-9 W- 8IMY W-9 W-8BEN-E W-9 W-8BEN- E

10 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, unless it is allocable to you through a partnership. Instead, provide Form W-8ECI, Certificate of Foreign Person's Claim That Income Is 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 circumstances and Form W-8BEN is no longer valid with respect to such income. You must file Form W-8ECI. See Change in circumstances, later. 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, who credits your account, or a partnership that allocates income to you. An FFI may also request this form from you to document your account as other than a U.S. account. Give Form W-8BEN to the person requesting it before the payment is made to you, credited to your account, or allocated. If you do not provide this form, the withholding agent may have to withhold at the 30% rate (under chapter 3 and 4), backup withholding rate, or the rate applicable under section 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 that is a beneficial owner of a payment only if Forms W-8BEN or W-8BEN-E are provided by all of the owners. If the withholding agent or financial institution receives a Form W-9 from any of the joint owners, however, the payment must be treated as made to a U.S. person and the account treated as a U.S. account. 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, payer, or FFI with which you hold an account 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 8233 W-4 W- 8ECI W-8BEN W-8BEN W-8ECI W-8BEN W- 8BEN W-8BEN 30% W-8BEN W-8BEN W-8BEN W-8BEN-E W-9 W-8BEN 30 W- 8BEN W-8BEN W-8BEN 30

11 agent, payer, or FFI within 30 days of the move. If you become a U.S. citizen or resident alien after you submit Form W-8BEN, you are no longer subject to the 30% withholding rate under section 1441 or the withholding tax on a foreign partner's share of effectively connected income under section To the extent you have an account with an FFI, your account may be subject to reporting by the FFI under chapter 4. You must notify the withholding agent, payer, or FFI within 30 days of becoming a U.S. citizen or resident alien. You may be required to provide a Form W-9. For more information, see Form W-9 and its instructions. You may be a U.S. resident for tax purposes depending on the number of days you are physically present in the United States over a 3-year period. See Publication 519, available at irs.gov/publications/p519. If you satisfy the substantial presence test, you must notify the withholding agent, payer, or financial institution with which you have an account within 30 days and provide a Form W-9. Expiration of Form W-8BEN. Generally, a Form W-8BEN will remain in effect for purposes of establishing foreign status 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, 2015, remains valid through December 31, However, under certain conditions a Form W-8BEN will remain in effect indefinitely until a change of circumstances occurs. To determine the period of validity for Form W-8BEN for purposes of chapter 4, see Regulations section (c)(6)(ii). To determine the period of validity for Form W-8BEN for purposes of chapter 3, see Regulations section (e)(4)(ii). Definitions Account holder. An account holder is generally the person listed or identified as the holder or owner of a financial account. For example, if a partnership is listed as the holder or owner of a financial account, then the partnership is the account holder, rather than the partners of the partnership (subject to some exceptions). However, an account that is held by a single-member disregarded entity is treated as held by the person owning the entity. Amounts subject to withholding. Generally, an amount subject to chapter 3 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), as well as other specific items of income described in Regulations section (such as interest on bank deposits and short-term OID). For purposes of section 1446, the amount subject to withholding is the foreign partner s share of the W-8BEN % 4 30 W-9 W-9 irs.gov/publications/p W-9 W-8BEN W-8BEN W-8BEN W-8BEN W-8BEN (c)(6)(ii) W-8BEN (c)(4)(ii) (FDAP)

12 partnership s effectively connected taxable income. Generally, an amount subject to chapter 4 withholding is an amount of U.S. source FDAP income that is also a withholdable payment as defined in Regulations section (a). The exemptions from withholding provided for under chapter 3 are not applicable when determining whether withholding applies under chapter 4. For specific exceptions applicable to the definition of a withholdable payment, see Regulations section (a)(4) (exempting, for example, certain nonfinancial payments). Beneficial owner. For payments other than those for which a reduced rate of, or exemption from, 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 payment 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 (that is, a foreign trust that is described in section 651(a)) are generally the beneficiaries of the trust, if the beneficiary is not a foreign partnership, foreign simple or grantor trust, nominee or other agent. The beneficial owners of a foreign grantor trust (that is, 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 (that is, a foreign trust that is not a foreign simple trust or foreign grantor trust) is the trust itself. For purposes of section 1446, the same beneficial owner rules apply, except that under section 1446 a foreign simple trust rather than the beneficiary provides the form to the partnership. 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% withholding under chapter 3 or 4. A U.S. partnership, trust, or estate should provide the withholding agent with a Form W-9. For purposes of section 1446, a U.S. grantor trust or disregarded entity shall not provide the withholding agent a Form W-9 in its own right. Rather, the grantor or other owner shall provide the withholding agent the appropriate form. Chapter 3. Chapter 3 means Chapter 3 of the Internal Revenue Code (Withholding of Tax on Nonresident Aliens and Foreign Corporations). Chapter 3 contains sections (a) (a)(4) 651(a) % W W

13 1441 through Chapter 4. Chapter 4 means Chapter 4 of the Internal Revenue Code (Taxes to Enforce Reporting on Certain Foreign Accounts). Chapter 4 contains sections 1471 through

14 Deemed-compliant FFI. Under section 1471(b)(2), certain FFIs are deemed to comply with the regulations under chapter 4 without the need to enter into an FFI agreement with the IRS. However, certain deemed-compliant FFIs are required to register with the IRS and obtain a GIIN. These FFIs are referred to as registered deemed-compliant FFIs. See Regulations section (f). Disregarded entity. A business entity that has a single owner and is not a corporation under Regulations section (b) is disregarded as an entity separate from its owner. A disregarded entity does not submit this Form W- 8BEN to a partnership for purposes of section 1446 or to an FFI for purposes of chapter 4. Instead, the owner of such entity provides appropriate documentation. See Regulations section and section (a)(3)(v), respectively. Certain entities that are disregarded for U.S. tax purposes may be recognized for purposes of claiming treaty benefits under an applicable tax treaty (see the definition of hybrid entity below). A hybrid entity claiming treaty benefits is required to complete Form W-8BEN-E. See Form W-8BEN-E and its instructions. Financial account. A financial account includes: A depository account maintained by a financial institution; A custodial account maintained by a financial institution; Equity or debt interests (other than interests regularly traded on an established securities market) in investment entities and certain holding companies, treasury centers, or financial institutions as defined in Regulations section (e); Cash value insurance contracts; and Annuity contracts. For purposes of chapter 4, exceptions are provided for accounts such as certain tax-favored savings accounts; term life insurance contracts; accounts held by estates; escrow accounts; and annuity contracts. These exceptions are subject to certain conditions. See Regulations section (b)(2). Accounts may also be excluded from the definition of financial account under an applicable IGA. Financial institution. A financial institution generally means an entity that is a depository institution, custodial institution, investment entity, or an insurance company (or holding company of an insurance company) that issues cash value insurance or annuity contracts. Foreign financial institution (FFI). A foreign financial institution (FFI) generally means a foreign entity that is a financial institution. Foreign person. A foreign person includes a nonresident alien individual and certain foreign entities that are not U.S. persons (entities should complete Form W-8BEN-E rather than this Form W-8BEN). Hybrid entity. A hybrid entity is any person (other than an individual) that is treated as fiscally transparent 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. 1471(b)(2) 4 GIIN (f) (b) W-8BEN (a)(3)(v) W-8BEN-E W-8BEN-E (e) (b)(2) (FFI) W-8BEN-E W-8BEN

15 Intergovernmental agreement (IGA). An IGA means a Model 1 IGA or a Model 2 IGA. For a list of jurisdictions treated as having in effect a Model 1 or Model 2 IGA, see List of Jurisdictions available at A Model 1 IGA means an agreement between the United States or the Treasury Department and a foreign government or one or more agencies to implement FATCA through reporting by FFIs to such foreign government or agency thereof, followed by automatic exchange of the reported information with the IRS. An FFI in a Model 1 IGA jurisdiction that performs account reporting to the jurisdiction s government is referred to as a reporting Model 1 FFI. A Model 2 IGA means an agreement or arrangement between the U.S. or the Treasury Department and a foreign government or one or more agencies to implement FATCA through reporting by FFIs directly to the IRS in accordance with the requirements of an FFI agreement, supplemented by the exchange of information between such foreign government or agency thereof and the IRS. An FFI in a Model 2 IGA jurisdiction that has entered into an FFI agreement is a participating FFI, but may be referred to as a reporting Model 2 FFI. Nonresident alien individual. Any individual who is not a citizen or resident alien 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 bona fide 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. 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 (for example, filing a joint income tax return), such individual is still treated as a nonresident alien for chapter 3 withholding tax purposes on all income except wages. For purposes of chapter 4, a nonresident alien individual who holds a joint account with a U.S. person will be considered a holder of a U.S. account for chapter 4 purposes. Participating FFI. A participating FFI is an FFI (including a Reporting Model 2 FFI) that has agreed to comply with the terms of an FFI agreement. The term participating FFI also includes a qualified intermediary (QI) branch of a U.S. financial institution, unless such branch is a reporting Model 1 FFI. Participating payee. A participating payee means any person that accepts a payment card as payment or accepts payment from a third party settlement organization in settlement of a third party network transaction. Payment settlement entity (PSE). A payment settlement entity is a merchant acquiring entity or third party settlement organization. Under section 6050W, a PSE is generally required to report payments made in settlement of payment card transactions or third party network transactions. However, a PSE is not required to report (IGA) IGA 1 IGA 2 IGA 1 IGA 2 IGA 1 FATCA IGA 1 1 IGA 2 FATCA IGA (QI) 1 (PSE) 6050W W-8

16 payments made to a beneficial owner that is documented as foreign with an applicable Form W-8. Recalcitrant account holder. A recalcitrant account holder for purposes of chapter 4 includes an individual who fails to comply with the requests of an FFI for documentation and information for determining the U.S. or foreign status of the individual s account, including furnishing this Form W-8BEN when requested. U.S. person. A U.S. person is defined in section 7701(a)(30) and includes an individual who is a citizen or resident of the United States. Withholding agent. Any person, U.S. or foreign, that has control, receipt, custody, disposal, or payment of U.S. source FDAP income subject to chapter 3 or 4 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. For purposes of section 1446, the withholding agent is the partnership conducting the trade or business in the United States. For a publicly traded partnership, the withholding agent may be the partnership, a nominee holding an interest on behalf of a foreign person, or both. See Regulations sections through W-8BEN 7701(a)(30) Specific Instructions Part I Line 1. Enter your name. If you are a foreign individual who is the single owner of a disregarded entity that is not claiming treaty benefits as a hybrid entity, with respect to a payment, you should complete this form with your name and information. If the account to which a payment is made or credited is in the name of the disregarded entity, you 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 7 (reference number) of the form. However, if the disregarded entity is claiming treaty benefits as a hybrid entity, it should complete Form W-8BEN-E instead of this Form W-8BEN. Line 2. Enter your country of citizenship. If you are a dual citizen, enter the country where you are both a citizen and a resident at the time you complete this form. If you are not a resident in any country in which you have citizenship, enter the country where you were most recently a resident. However, if you are a United States citizen, you should not complete this form even if you hold citizenship in another jurisdiction. Instead, provide Form W-9. Line 3. 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 completing 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 do not have a tax residence in any I 1 7 W-8BEN-E W-8BEN 2 W-9 3 W-8BEN

17 country, your permanent residence is where you normally reside. If you reside in a country that does not use street addresses, you may enter a descriptive address on line 3. The address must accurately indicate your permanent residence in the manner used in your jurisdiction. Line 4. Enter your mailing address only if it is different from the address you show on line 3. Line 5. If you have a social security number (SSN), enter it here. To apply for an SSN, get Form SS-5 from a Social Security Administration (SSA) office or online at If you are in the United States, you can call the SSA at Complete Form SS-5 and return it to the SSA. If you do not have an SSN and are not eligible to get one, you can get an individual taxpayer identification number (ITIN). To apply for an ITIN, file Form W-7 with the IRS. It usually takes 4-6 weeks to get an ITIN. To claim certain treaty benefits, you must complete line 5 by submitting an SSN or ITIN, or line 6 by providing a foreign tax identification number (foreign TIN). An ITIN is for tax use only. It does not entitle you to social security benefits or change your employment or immigration status under U.S. law. A partner in a partnership conducting a trade or business in the United States will likely be allocated effectively connected taxable income. The partner is required to file a U.S. federal income tax return and must have a U.S. taxpayer identification number (TIN). You must provide an SSN or TIN if you are: Claiming an exemption from withholding under section 871(f) for certain annuities received under qualified plans, or Submitting the form to a partnership that conducts a trade or business in the United States. If you are claiming treaty benefits, you are generally required to provide an ITIN if you do not provide a tax identifying number issued to you by your jurisdiction of tax residence on line 6. However, an ITIN is not required to claim treaty benefits relating to: 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. Line 6. If you are providing this Form W-8BEN to document yourself with respect to a financial account that you hold at a U.S. office of a financial institution, provide the tax identifying number (TIN) issued to you by your jurisdiction of tax residence unless: You have not been issued a TIN, or (SSN) (SSA) SS html SS-5 (ITIN) W (f) W-8BEN

18 The jurisdiction does not issue TINs. If you have not provided your jurisdiction of residence TIN on line 6, provide your date of birth in line 8. Line 7. 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 7 for a referencing number or code that will make the association clear. A beneficial owner can use line 7 to include the number of the account for which he or she is providing the form. A foreign single owner of a disregarded entity can use line 7 to inform the withholding agent that the account to which a payment is made or credited is in the name of the disregarded entity (see instructions for line 1). Line 8. If you are providing this Form W-8BEN to document yourself with respect to a financial account that you hold with a U.S. office of a financial institution, provide your date of birth. Use the following format to input your information MM-DD-YYYY. For example, if you were born on April 15, 1956, you would enter Part II Line 9. If you are claiming treaty benefits as a resident of a foreign country with which the United States has an income tax treaty for payments subject to withholding under chapter 3, identify 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. A list of U.S. tax treaties is available at Treaties 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, then you are generally required to file Form 8833, Treaty-Based Return Position Disclosure Under Section 6114 or 7701(b). See the Instructions for Form 8833 for more information on the filing requirements. 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 on line 9 and Part III. For example, persons claiming treaty benefits on royalties must complete this line if the treaty contains different withholding rates for different types of royalties. However, this line should always be completed by foreign students and researchers claiming treaty benefits. See Scholarship and fellowship grants, later, for more information. This line is generally not applicable to treaty benefits under an interest or dividends (other than dividends subject to a preferential rate based on ownership) article of a treaty. Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual can use the terms of a tax treaty to reduce or eliminate U.S. tax on W-8BEN W-8BEN W-8IMY W-8BEN II Treaties 267(b) 707(b) 500, (b) III 10

19 certain types of income. However, most tax treaties contain a provision known as a saving clause which preserves or saves the right of each country to tax its own residents as if no tax treaty existed. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the recipient has otherwise become a U.S. resident alien for tax purposes. The individual must use Form W-9 to claim the tax treaty benefit. See the instructions for Form W-9 for more information. Also see Nonresident alien student or researcher who becomes a resident alien, later, for an example. Scholarship and fellowship grants. A nonresident alien student (including a trainee or business apprentice) or researcher who receives noncompensatory scholarship or fellowship income can 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 compensatory scholarship or fellowship income must use Form 8233, instead of Form W-8BEN, to claim any benefits of a tax treaty that apply to that income. The student or researcher must use Form W-4 for any part of such income for which he or she is not claiming a tax treaty withholding exemption. Do not use Form W-8BEN for compensatory scholarship or fellowship income. See Compensation for Dependent Personal Services in the Instructions for Form If you are a nonresident alien individual who received noncompensatory scholarship or fellowship income and personal services income (including compensatory scholarship or fellowship income) from the same withholding agent, you may use Form 8233 to claim a tax treaty withholding exemption for part or all of both types of income. Completing lines 3 and 9. 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 can provide a U.S. address on line 3 and still be eligible for the exemption if all other conditions required by the tax treaty are met. You must also identify on line 9 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 noncompensatory scholarship or fellowship grant income under a tax treaty. Nonresident alien student or researcher who becomes a resident alien. You must use Form W-9 to claim an exception to a saving clause. See Nonresident alien who becomes a resident alien, earlier, for a general explanation of saving clauses and exceptions to them. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income W-9 W-9 W-8BEN W-8BEN 8233 W-8BEN W-4 W-8BEN W-9 20

20 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 (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. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would complete Form W-9. Part III Form W-8BEN must be signed and dated by the beneficial owner of the amount subject to withholding or the account holder of an FFI (or an agent with legal authority to act on the person s behalf). If Form W-8BEN is completed by an agent acting under a duly authorized power of attorney for the beneficial owner or account holder, 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, can be used for this purpose. The agent, as well as the beneficial owner or account holder, may incur liability for the penalties provided for an erroneous, false, or fraudulent form. If any information on Form W-8BEN becomes incorrect, you must submit a new form within 30 days unless you are no longer an account holder of the requester that is an FFI and you will not receive a future payment with respect to the account. Broker transactions or barter exchanges. Income from transactions with a broker or a barter exchange 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: You are a nonresident alien individual or a foreign corporation, partnership, estate, or trust; 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 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. 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 W-9 III W-8BEN W-8BEN 2848 W-8BEN 30 W-8BEN 183 OMB