*9000000000RRB0010040*
*9000000000RRB0020040*
*9000000000RRB0030040*
*9000000000RRB0040040*
*9000000000RRC0010050*
*9000000000RRC0020050*
*9000000000RRC0030050*
*9000000000RRC0040050*
*9000000000RRC0050050*
*9100000000RRD0010010*
*9200000000RRE0010010*
*0100000000RRF0010040*
*0100000000RRF0020040*
*0100000000RRF0030040* ()
*0100000000RRF0040040* Form W-8BEN (Rev. July 2017) 2017 7 Department of the Treasury Internal Revenue Service 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. Information about Form W-8BEN and its separate instructions is at www.irs.gov/formw8ben. www.irs.gov/formw8ben. Give this form to the withholding agent or payer. Do not send to the IRS. OMB No. 1545-1621 Do NOT use this form if: : Instead, use Form: You are NOT an individual.................................................................................................................................................... W-8BEN-E You are a U.S. citizen or other U.S. person, including a resident alien individual...................................................................................................... W-9 You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S. (other than personal services).................................................................................................................................................... W-8ECI You are a beneficial owner who is receiving compensation for personal services performed in the United States.............................................................. 8233 or W-4 A person acting as an intermediary.............................................................................................................................................. W-8IMY Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence. FATCA(Model I ) Part I Identification of Beneficial Owner (see instructions) () 1 Name of individual who is the beneficial 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 (if different from above) City or town, state or province. Include postal code where appropriate. Country 5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) (SSN ITN) 6 Foreign tax identifying number (see instructions) 7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions) Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) (3)( ) Part III Certification Sign Here For Paperwork Reduction Act Notice, see separate instructions. (IRS)
*0110000000RRG0010260*
*0110000000RRG0020260*
*0110000000RRG0030260*
*0110000000RRG0040260*
*0110000000RRG0050260*
*0110000000RRG0060260*
*0110000000RRG0070260*
*0110000000RRG0080260*
*0110000000RRG0090260*
*0110000000RRG0100260*
*0110000000RRG0110260*
*0110000000RRG0120260*
*0110000000RRG0130260*
*0110000000RRG0140260*
*0110000000RRG0150260*
*0110000000RRG0160260*
*0110000000RRG0170260*
*0110000000RRG0180260*
*0110000000RRG0190260*
*0110000000RRG0200260*
*0110000000RRG0210260*
*0110000000RRG0220260*
*0110000000RRG0230260* FATCA Status Identification Certification (For Individual Client) Does a client hold U.S citizenship or resident alien for tax purposes status? Yes W-9 No W-8BEN Explanation: U.S citizen or resident alien is Any person who holds U.S citizenship (U.S passport holder) or green card holder, or Any person who physically presents in the United States for a total of 183 days or more during the calendar year, or Any person who physically presents in the United States for a total of 31 days or more during the calendar year, and 183 days or more during the 3-year period that includes the current year and the 2 years immediately before that, counting: All the days you were present in the current year, and 1/3 of the days you were present in the first year before the current year, and 1/6 of the days you were present in the second year before the current year. If a client certified that he/she does not hold U.S citizenship or resident alien status for tax purposes, only that the results of personal account profile searching have indicated with U.S indicia. In this case, related ID documentary will be requested from the client later on. W-8-BEN W-8-BEN W-8-BEN W-8-BEN W-8-BEN U.S indicia and requested ID documentary matching: (1) U.S citizen or U.S resident: W-8BEN and passport/id (2) U.S place of birth: passport/id and Individual's Certificate of Loss of Nationality of the United States or W-8BEN and passport/id and Written Explanation ( reasonable explanation of renunciation of U.S citizenship or failure of obtaining U.S citizenship at birth) (3) U.S residence address and U.S mailing address: W-BEN and passport/id (4) U.S phone number: W-8BEN and passport/id (5) Standing instructions: W-8BEN and passport/id (6) A power of attorney with a U.S. address: W-8BEN or passport/id (7) An in-care-of address or hold mail address t: W-8BEN or passport/id
*0110000000RRG0240260*
*0110000000RRG0250260*
*0110000000RRG0260260*