=| Certificate of Foreign Status of Beneficial Owner for United rom W-BBEN States Tax Withholding and Reporting (Individuals) (Pew 4992017 > For use by individuals Entities must use Form W-OBEN-E. (ve No. 15451621 ieaiesd abereaaey > Go to wnwairs.gov/FormWBBEN for instructions and the latest information. ‘bea ene Seve > Give this form tothe withholding agent or payer. Donat send tothe IRS. DoNOT use tis form Instead, use Form: + You are NOT an individu WsBeN-e + You ae @ US. citizen or other US. parson, including a resident aben individual wo + You ae a beneficial oer clsning that income is effectively connected with the conduct of rade ox business within the US. (other han persona services) wesect + You ae & beneficial owner whois receiving compensation for parsonal vices performed in the United States... 8233 oc Wt + You are person acting as an intermesary way Note: if you are resident in a PATCA partner jurisdction(.e.,a Meds! 1 IGA jurisdiction with reciprocity), certain tax account information may be Drovided to your jurisciction of residence, Identification of Beneficial Owner (See instructions) "1 Name of indvidual who is the Beneficial owner Country of etizenshio Mauricio Grimberg Largentina ‘3 Permanent residence address Bree, aOk. oF aus or Taral rout), Bo not use @ P.O. box or in-care-of adaress. Pacifico Rodriquez 5904 (old 858) House Giy or town, state or province. Include postal cade where Bppropriais County Vila Ballester- Buenos Aires -B16538LB, Argentina 4 Mailing address (ferent from above) Giy or town, Stata oF province, Include postal code whore appropriate. Country US. taxpayer Gentifeation number SSN or ITN), required eae stuctions) ‘6 Foreign tax dentiving number (aa etractions) 20-10285075-1 7 Reference number(s) (600 instructions) {@ Date of birth (MM-DD-YYY¥) (eee instructions) 11-01-1951, Claim of Tax Treaty Benefits (for chapter 5 purposes only) (see instructions) ‘8 lcority a the beneficial owner Isa resident of within the meaning ofthe income tax treaty between the United States and that country. 10. Special rates and conditions ( applicable see instructions}: The beneficial owner is clalming the provisions of Article and paragraph ofthe treaty identified online 9 above to claim a_96 rate of withholding on (epecty type of income) ‘Explain the additonal conditions inthe Acie and paregraph the beneficial owner meets tobe eligible forthe rate of withholding Certification ‘Unde penaies of py, | doar that Fave exarined the infomsaton on Wis form and te bes of my hnowhdge ard ble tis ue, caret ard corel |Turher ctl inder penal of Perit + Lam te intial thats th beneficial ome fr am autheraed to sgn forthe indi tha sth Benet one) of al he ncometo which this form late “mung his fom o dosimeter chapter # pups, + Thepesonmamedan inet of thisfornisnot US. parson, + Thelncare o which tom rea (no etfctvey connect withthe conduct of ta (2) olectvelycooected but rot bec to tax under anaopiable income tx teat, o (the partners share of a parnerstip's eectvy connected came, or business nthe United States, ‘+ The parson named ante 1 ofthe form reson of he treaty county Hsted on tne a the form any) ult the meaning et the income tax wealy between the Unted Statos and tat county, nd 1+ For broker vansaction o barter exchanges. the beneficial ewner san exem esign person as denen th tuctons. Furthermore, | authorize this for tobe provides to any withing agent that has contro receptor custody of the income of which am the benef ower ‘any witldng agent hat ean cisburso or make payments othe neome of wrch Iam te Bene! Sune. agree thet wil submit anew form within 30 Says an ceriicaion made on thi fore Becomes incorrect Zh Sign Here V4 a Le, 09.08.2001 FIR aR RTT BODO Dae AEE) Mauricio Giebera Fret rae one apap in wien sng or ert sone by Een one For Paperwork Reduction Act Notice, see separate instructions. (a No. 280472 Form W-BBEN (Fev. 7-2017)