B.1_473609 - Enclosure F_W-8BEN Form.pdf

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

The form is used by foreign individuals to certify their status for U.S. tax withholding purposes and to claim benefits under applicable tax treaties. Part I requires identification information including the beneficial owner's name, country of citizenship, permanent residence address, mailing address, U.S. taxpayer identification number (SSN or ITIN) if required, foreign tax identifying number, reference number(s), and date of birth. Part II allows claimants to document tax treaty residency status and claim special withholding rates under specific treaty articles and paragraphs, with space to explain additional conditions for eligibility. Part III contains the certification statement in which the beneficial owner affirms under penalty of perjury that they are the beneficial owner (or authorized representative) of the income documented, that they are not a U.S. person, and that the form correctly identifies income not effectively connected with U.S. trade or business, income subject to treaty provisions, or partnership-related income subject to withholding. The form must be signed by the beneficial owner or authorized representative and includes a checkbox confirming the signatory's capacity to sign. The instructions direct individuals to visit www.irs.gov/FormW8BEN for additional guidance and direct completion to the withholding agent or payer rather than the IRS.