rom W-8BEN| Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) > For use by individuals, Entities must use Form W-SBEN-E. ove No 1st5-1821 > co tomrms.gov/FormWBEN for instructions and the laest Information. > Give this form tothe withholding agent or payer. Do not send to the IRS. (Rev. ty 2017 Do NOT use this form if Instead, use Forme *# You are NOT an incvidual W-BBENE *# You are @ U.S. citizen or other U.S. person, including a resident alin individual we + You are a benicial owner claiming that income i ffectely connected with the conduct of trade or business within the U.S. (other than personal services) w.seo! + You are a beneficial owner who is receiving compensation fr personal senices performed in the United States 8239 oF Wea ‘You are person acting 2s an intermesiary weeny Note: yu are resident ina FATCA partner jslcton (a Model IGA usdcton wih reciprocity) cetai tax account infrmaton may be provided to your jursicnon of restanee. Tdentification of Beneficial Owner ase iatructions) i Nao of dca whe he bene owner Cay oT CSR AMAL THOMAS noi Permanent edeTcn SITES Te, ot oT aT, OTT TFA: Bo HOT @ PO, Box oF r-care-oT wae, KUOIVIRIKKA. (HOUSE) NADAVAYAL.NEIKUPPA ior tow, sao rove, ude postal ds Wras So ROpTaTS canny WAYANAD KERALA670721 noi 4 Maing acess REE Tor aBOVe “Gly oF Town, slate ar provinos, elude poral Code where SPBTOBTTS, County 3 T'S: tapayer Garcon Tambor SSN or TN, Wrequred eee sTacTons) 6 Farign tax ering wba ee rato) coversatan 7 Reference mba) ee anit) © ato of bh NEDDYYVY oo htocons) 04.23.2000 Claim of Tax Treaty Benefits for chapter 3 purposes on} (see Instructions) © cory iat the beneficial owner i resident oF INDIA ‘ihn to meaning of the nome tax treat botweon te United Slats and that county rates and condos (f applicable instructions): The beni overs clang the provisions of Article anc paragraph ofthe eat ienitied on ine 8 above to clam a 15 5 rata of wtiholng on pec typeof incor 10 ‘Explain the addtional conditions inthe Arlee and paragraph the benelicial owner meats tobe algibe forthe rate of withheling INO PERMENANT ESTABLISHMENT IN THE USA AS PER ARTICLE V [FIVE] Certification ‘Under penal of parry, declare a have earned the inarmaton on ti form and io We best oy krowedgo and bal Woe, cones, and compe, fothar cart tinder penates of poy ta: ‘+ Lamthe inv thats he Dene one (or am nihorred o sgn for he cit that the bere owner of a te income to which this fxm relates or ‘smuving hs fom to documant myself chapter & puponss ‘+ Thoporson named on ine 1 ofthis fom not U.S. person, [alr eectvey connectod withthe conduct ofa ad o business inthe United States 1) efecto connacte but snot subject to tex under an angable income tx tty. oF (oto partner's shere ofa parrerehips stay ecrnectd income ‘+ Thepersonnamadon in 1 of his frm sa resident othe treaty county tet on ine 9 ofthe form fan thin he msaning of he income tn ey betsan tho United Sates and hat eoury, snd “+ Fortreker taneactora or bene exchangs, the bovefical ners an exametforlgn person a dfnein the Ierctons. Furthermore, authori this form to be posed oa withcking agant hat has convo receptor custedy of the income of hich an the banca owner oe Sy uttaneng agent hat can asbures orale payments of he neem of whch am he enatcal wner. agree tht tw submit anew form within 99 day Wary cortiication mace on this form becomes incorect Sign Here Aroot 7-21-2022 ‘naire of bancial owner or navdual athorsed to ah orbansica Ouray ‘aa IE DOVFY] AMAL THOMAS Individuals ent name of signer ‘Cepcy in wich acing Torn na ined by beni oan) For Paperwork Reduction Act Notice, soe separate instructions. ‘Gat No. 250472 om W-BBEN (he. 7-2017)