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

This is Form W-8BEN, a Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting for individuals, issued by the Department of the Treasury Internal Revenue Service in October 2021.

The form is used by foreign individuals to establish their foreign status for U.S. tax withholding purposes and to claim benefits under applicable income tax treaties. 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 identifying number, reference number, and date of birth. Part II addresses the claim of tax treaty benefits, requiring certification of residency in a treaty country and specification of the article and paragraph under which special withholding rates are claimed, along with explanation of eligibility conditions. Part III contains the certification section where the beneficial owner or authorized representative certifies the accuracy and completeness of the information provided, acknowledges penalties for perjury, and confirms authority to sign on behalf of the beneficial owner. The form must be signed and dated by the beneficial owner or authorized representative and submitted to the withholding agent or payer. The instructions direct users to www.irs.gov/FormW8BEN for detailed guidance, and the form is not to be sent directly to the IRS.