B.1_477787 - 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, used by individuals for tax purposes.

The form is designed for foreign nationals to claim an exemption or reduced withholding rate on U.S.-source income. Part I collects identification information about the beneficial owner, including name, country of citizenship, permanent residence address, mailing address if different, U.S. taxpayer identification number or Individual Taxpayer Identification Number, foreign tax identification number, reference numbers, and date of birth. Part II allows the claimant to certify resident status under an applicable income tax treaty between the United States and another country and to claim special tax treaty rates or conditions by citing the specific article and paragraph of the treaty, along with the requested withholding percentage and income type. Part III contains the certification statement in which the beneficial owner or authorized representative attests under penalty of perjury that the information provided is accurate and complete, confirms the beneficial owner status, acknowledges that the person named is not a U.S. person, and specifies that the form relates to income not effectively connected with U.S. trade or business, income effectively connected but not subject to treaty provisions, partnership interests, or broker transactions. The form requires the signature of the beneficial owner or authorized representative, printed name, and date. Guidance directs users to www.irs.gov/FormW8BEN for instructions and specifies that the completed form should be provided to the withholding agent or payer, not sent directly to the IRS.