rom W-8BEN| Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (Row. say 2017) > For use by individuals. Enttios must use Form W-8BEN-E. (OM No, 1645-1621 > Go to wi. irs.gov/FormWEBEN for instructions and the latest information. Deparment ol te Teesxy Fara avenue Sere > Give this form to the withholding agent oF payer. Do not send to the 1RS. DoNOT use thie fori Instead, use Form: fMidul 2. REESE SEE Hee Sab a bee Hee WE civeon or other US, person, icing aresen sen indvial peedeseatia ewe + You area beneficial owner claiming that income tect eowenteswin ta cercetof at crbuses vin eS. (etherthan personal services)... RCE aceite scat ct Pe ee + WBECH + You se aberefcle owner who is receiving compensation for personal service pefomedin the Unted Stats . You area person ecting as anintermediay vss + + = ee Here eae eat ote you ae escent n a FATCA peer frelon Go « Madel 1A ueiin with reproci cain tx account rfomaton may be Provided to your jurisdiction of residence. Identification of Beneficial Over (see instructions) SaNari of ahi! wo ee Seta oan Ca CTS NGINEN VAN QUYET \ecg-iecuna 3 Permanent residence address (street, apt. or suite ro., or fural route). Do not use ‘box or in-card-of address. £0, " 1a City or town, state or province. Include postal code where appropriate. ‘Country ug [a Veotuasn. 7g tron abo ‘iyo Ton, ato OF OWED nid poeta Code WheTs BPPTOPTATE, Couniny ‘5 US tapayer enteaton naribor SON or Ty, Hrequred (ee tacos) 5 BUR abs (ee TURE] 7 Raforence number) fee iatuetions) @ Dato of ith (I-DD-YYY) (se nations Aim J AGG Claim of Tax Treaty Benefits (for chapter 3 purposes only) (See Instructions) ‘9 I cerily that te Benofical owner is a resident of Loken ‘within tho meaning ofthe income tax treaty between the United States and that county 10 Special rates and conditions (f applicabio~c0e instructions: The beneficial owner is claiming the provisions of Aticle and paragraph ‘of the treay identified on tine 9 aboveto cima __% rate of withholding on (speci typeof income}: ‘Explain the adéltional conditions In tre Aniole and paragraph the benoticlal owner masts to bo eigibe forthe rato of withholding EAM Ceriification Under panaie of pry, claro that Ihave examined the ntormation on Wis Yom and othe Bes of my mnowadge and bela ls Wu, coroet nd complet. farther cary Under penaes of pany mat + Lam the naval that tho bono owna (orm autorzed to egn fr th Indu thas the benef owne of al tho Income to whieh this erm reales or ‘am using is frm to cocumant mys for cnaptor 4 purposes, ‘+ Thoporscn named on te 1 of is form snot a US. parson, “+ Tho‘nome to wtih his form restos i (not effectively connected with the conduc fs trado or buslness nthe Usted States, (© otetvaly connected buts not subject to tax under an appcaboincare ox eat, or (@)the partners share oa partnership's electvely connected Income, ‘+ Treppersen named on ine 1 of ths form a resdent ofthe Uealy court Ist en Eno of he frm (ary) win the meaning of he income tax teaty between the Gated States ard at court, and ‘+ Ferbrokerransactons or barter sxchangss, to banal onnois an oxomp fosign pean a defied inthe inativtions, Furor | thorn this frm tobe provided to any wither agent that hes corto receipt or custody ofthe incom of utich Lam the beroicll one of fry wiktoiing agent hat can dsbutso or mako payments ofthe Roar cf which lem io bene! owner. agro0 that wil suit anew form within 3O days Way ceriication mada en tis form becomes Incorrect. Sign Here » aaa O4- 6 - OA air aieiailiadiieaminid ie EDO C)ieu Prana oleae ‘apciy whch ating tom et sina by eno owned For Paperwork Reduction Act Notice, see separate instructions, (at No, 250472 Ferm W-BBEN (ov. 7.2017)