vom W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) > For use by individu Entities must use Form W-ABEN-E. cme uo, co to wari gov FormWBEN tor netructions and the latest information. > ive thin form tothe withholding agent or payer. Do not sod to the MS. Do NOT wee ti form Tnatead, vse Form + You wreNOT an indual sa ' wesoen-c * You area US. ctizen oF other U.S. person ncusing & resident allen Inca wo * You are 9 beneficial owner claming that Income is effectively conacted with the conduct of Wad or business within the U.S. (otnerthan personal sewiens) ert - . wesect + You ae a beneficial owner who is receiving compensation for pertonal tances perormedlin the United States Mears + You ae a person acting as an itermacry is s, weanny ‘Note: you ae resent in a FATCA partner jurisdiction (.e., a Modal 1 (GA jurisdiction wih eciprooty), certain tax account formation may be provided to your hneciction of rescence, KEIN _iaentiication of Beneficial Owner (soe matrucions) "Natio of incvdual who isthe Benelical owner 2 Couriny of atzenane Li Wy ‘3 Permanent residence adaress free, apt. of sale no, oF ual Tut). Bo not use a P.O, Box or i-care-o adereas, 1 uy uv ‘GAY or own. sate OF provce. include postal code where aibropriate Couey 22K ALA TeBenacaNy MASA ‘ating address i aterer rom above) ‘iy Town, sate oF prownce. ndude postal code where appropriate Country ‘SUS Taxpayer Geniicaton nariber (SEN or TTR, required we warucuon@) ‘© Foraig tax denying rambo eee aon) 7 Relerence numbers) eve netracions) ‘© Data of bith RAW-DO-VYYY) (soe rstructons) [EMI Gis of Tax Treaty Benefits (or chapter’ purposes onl) (see atTucTONS) 2 leary al the Deets owner a reset of” trety Between the United States and that county 10 Special rates and conditions ( pplcabe see nsroctons}: The bene owner claiming tne proviso ric ana parearach of teeny Gertad en ne above cama” rate ot wth on pec type ot come ‘win the meaning of core tax ‘Expian tre adaional condivons inthe Avice and paragraph he Barefical owner meets tobe age forthe ate of witholang [EMMI _Ceniification ‘Under penaice of perry | ecare a have ecard the Harman nth fem ard to he ber amy Knoladpe and bole, cores and core ater ‘cry ner peal of briny a + Lam be nda tat he bent omer for am authored oon fr he nl at tebe nerf te ncn to whic th om reno terusng i ermto document myseltrcupi «purposes. +The person named enn fi om eet aS. person, (ano eecinay connected wie the conduct oa ade or busines nthe Utd State, {e)etectiay connected but nt suet 10 tax under an apecable nce ax Wey. oF (che parners share of «pannus elec connected cone, ‘Te person named one of is frm saves of ne esty county tec on rw fe arm any) win he mening of the come as ety Dewan the Unted States ana at cour, Sk For rokr transactions or barter exchanges, he bedi owner i a exam foign person as nad nthe incon, urramor.| shore tha lomo be rodeo ay witoling gata he corte ca cad ha ncona of wich ane bec on Ct pet ata Gunes: comone pyres tthe cone tench an beta rer agree a lobe wn fr wthn 90 yp it doy cornea made on form becomes incorrect. Sign Here & Signe banca or Pa nthe HRT Ba ow TOT Sapacay oa cg eo ol ned by ore oe eho ‘Form W-8BEN rev For Paperwork Reduction Act Nolce, see separate instructions or ‘Scanned with CamScanner