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    Substitute Form W-8BEN (Individuals)

    Uploaded by

    hector
    This document is the Substitute Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides identification information for the beneficial owner, allows them to claim tax treaty benefits, and requires certification that the information provided is true and correct. It also authorizes the sharing of the form with withholding agents and agrees to submit an updated form if any information changes.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Substitute Form W-8BEN (Individuals)

    Uploaded by

    hector
    133 views1 page
    This document is the Substitute Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides identification information for the beneficial owner, allows them to claim tax treaty benefits, and requires certification that the information provided is true and correct. It also authorizes the sharing of the form with withholding agents and agrees to submit an updated form if any information changes.

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    This document is the Substitute Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides identification information for the beneficial owner, allows them to claim tax treaty benefits, and requires certification that the information provided is true and correct. It also authorizes the sharing of the form with withholding agents and agrees to submit an updated form if any information changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    133 views1 page

    Substitute Form W-8BEN (Individuals)

    Uploaded by

    hector
    This document is the Substitute Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides identification information for the beneficial owner, allows them to claim tax treaty benefits, and requires certification that the information provided is true and correct. It also authorizes the sharing of the form with withholding agents and agrees to submit an updated form if any information changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Substitute Form W-8BEN

    Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)

    DO NOT USE THIS FORM IF YOU ARE: (i) AN ENTITY; (ii) A U.S. CITIZEN OR OTHER U.S. PERSON; (iii) A BENEFICIAL OWNER CLAIMING THAT
    INCOME IS EFFECTIVELY CONNECTION WITH THE CONDUCT OF A U.S. TRADE OR BUSINESS; (iv) A BENEFICIAL OWNER WHO IS RECEIVING
    COMPENSATION FOR PERSONAL SERVICES PERFORMED IN THE U.S.; or (v) A PERSON ACTING AS AN INTERMEDIARY

    Identification of Beneficial Owner

    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 (do not abbreviate)

    4. Mailing address (if different from above)

    City or town state or province. Include postal code where appropriate. Country (do not abbreviate)

    5. U.S. taxpayer identification number (SSN or ITIN) if required (see instructions for Form W- 6. Foreign tax identifying number if any (see instructions for Form W-8BEN)
    8BEN)
    
    7. Reference number(s) 8. Date of birth (MM-DD-YYYY)

    Claim of Tax Treaty Benefits (for chapter 3 purposes only) (if applicable)

    9. I certify that:

     The beneficial owner is a resident of __________________________ within the meaning of the income tax treaty between the United States and that country.

    10. Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article ______ of the treaty identified on line 9
    above to claim a ___ % rate of withholding on (specify type of income): ________________________________________________________________.

    Explain the reasons the beneficial owner meets the terms of the treaty article:

    ___________________________________________________________________________________________________________________________________
    ___________________________________________________________________________________________________________________________________
    ________________________________________________________________________________________________________________________________

    _______________________________________________________________________________________________________________________________________
    Certification

    Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and
    complete. I further certify under penalties of perjury that:

     I acknowledge receipt of the Instructions for Form W-8BEN.


     (i) I am the individual that is the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates or I am
    using this form to document myself as an individual that is an owner or account holder of a foreign financial institution; (ii) the beneficial owner listed on
    Line 1 of this form is not a U.S. person; (iii) the income to which this form relates is not effectively connected with the conduct of a trade or business in
    the United States, or is effectively connected but is not subject to tax under an applicable income tax treaty, or is the partner’s share of a partnership’s
    effectively connected income; (iv) the person named on line 1 of this form is a resident of the treaty country listed on line 9 of this form (if any) within the
    meaning of the income tax treaty between the United States and that country; and (v) for broker transactions or barter exchanges, the beneficial owner is
    an exempt foreign person as defined in the Instructions to Form W-8BEN.

    Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial
    owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form
    within 30 days if any certification made on this form becomes incorrect.

    The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-
    U.S. person, and, if applicable, obtain a reduced rate of withholding.

    ►Sign Here: ________________________________ Date _______________, _____ ____________________________


    Signature of the beneficial owner or Capacity in which acting (if form is not
    authorized person signed by beneficial owner)

    ________________________________
    Print name of signer

    AFFIDAVIT FOR CALENDAR YEARS 2005-Present: Under penalties of perjury, I declare that I have examined and signed the above Substitute Form W-8BEN
    and that the information and certifications contained therein remained the same and unchanged throughout calendar years 2005 through the present, and were true for
    those years. (Please attach a separate, signed statement if any information has changed.)

    ►Sign Here: __________________________________ Date _________________, ________


    MIADOCS 9177490 2

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