B.1_472719 - Enclosure F_W-8BEN Form.pdf

This is Form W-8BEN, the Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting for individuals, revised October 2021. The form is issued by the Department of the Treasury Internal Revenue Service and has OMB No. 1545-1621.

Form W-8BEN is used by foreign individuals to certify their status for U.S. tax withholding and reporting purposes. The form should not be used if the beneficial owner is not an individual, is a U.S. citizen or resident alien, is claiming income effectively connected with a U.S. trade or business (other than personal services), is receiving compensation for personal services in the United States, or is acting as an intermediary. Part I requires identification of the beneficial owner, including name, country of citizenship, permanent residence address, mailing address, U.S. taxpayer identification number (if required), foreign tax identification number, reference number(s), and date of birth. Part II addresses claims of tax treaty benefits for chapter 3 purposes, allowing the beneficial owner to certify residency in a treaty country and claim special withholding rates under applicable treaty provisions. Part III contains the certification statement, in which the signer must attest under penalties of perjury that the information provided is true, correct, and complete, and must confirm they are authorized to sign the form. The form must be signed and dated by the beneficial owner or an authorized representative, with printed name required.