Give this form to the withholding agent or payer. Do not send to the IRS.

Do NOT use this form if:

You are a U.S. citizen or other U.S. person, including a resident alien individual

• Use W-8BEN-E Form

You are a U.S. citizen or other U.S. person, including a resident alien individual 

• Use W-9 Form

You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the United States (other than personal services)

• Use W-8ECI Form

You are a beneficial owner who is receiving compensation for personal services performed in the United States

• Use 8233 or W-4 Form

You are a person acting as an intermediary

• Use W-8IMY Form
  

Note: If you are resident in a FATCA partner jurisdiction (that is, a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.

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 am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income or proceeds to which this form relates or am using this form to document myself for chapter 4 purposes;
• The person named on line 1 of this form is not a U.S. person;
• This form relates to:
  (a) income not effectively connected with the conduct of a trade or business in the United States;
  (b) income effectively connected with the conduct of a trade or business in the United States but is not subject to tax under an applicable income tax treaty;
  (c) the partner’s share of a partnership’s effectively connected taxable income; or
  (d) the partner’s amount realized from the transfer of a partnership interest subject to withholding under section 1446(f);
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country; and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
  

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.