com W-BBEN | Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (Pe. October 2021) > For use by individuals. Entities must use Form W-8BEN-E. (OMB No. 1546-1621 auatalauerl > Go to wwu.ies.gov/FormWSBEN for instructions and the latest information. lal Revue Sere > Give this form to the withholding agent or payer. Do not send to the IRS. Do NOT use this formif: Instead, use Form: + You are NOT an individual We8BEN-E + You are a USS. citizen or other U.S. person, including a resident allen incividual wa + You area beneficial onner claiming thet income is effectively connected with the conduct of trade or business within the Uited States, (other than personal services) w-8eol + You are beneficial onner who is receiving compensation fr personal services performed in the United States... 8238 0r Wt + You area person acting as an intermediary Se w-siMy ‘Note: if you are resident in a FATCA partner jurisdiction (What is, a Mode 1 IGA jurisdiction with reciprocity), certain tax account inforration may Be provided to your jurisdiction of resicence. Identification of Beneficial Owner Gee instructions) At Name ofindviual who isthe benef ciner 2 Country of cizensip imson Paul Montachana Cunachi Ecuador 3 Permanent residence adores (ses, ap. Suite 0, oF ral rove), De not use @ P.O, box or in-care-of adress Huapascho - El Mirador ‘iy or town, state or province. elude postal code where appropiate, County ‘Ambato - San Bartolomé de Pinllo . Codigo postal = 180163 Ecuador 4 Waliog adress (ferent fom above) ‘iy or town, tate or province. lade posta code where appropiate, Gounty 5 US. taxpayer denifieation number SEN or TN), required (ee instruction) 6a Foreign tax ontiying number Geeinstructons) Check f FTN nt egal requed a 7 Reference number) (se instructions) Date o ith RIN-DD.YWY¥) (ee instructions) Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 lcery thatthe beneficial owners a resident of treaty between the United States and that county 10 Special rates and conditions (i applicabie—see instructions}: The beneficial owner is claiming the provisions of Article and paragraph of the treaty identifed on ine 8 above to claim a__96 rata of ithhalding an fpecly type of income ‘within the meaning f the income tax ixplain the addtional conditions inthe Aricle and paragraph the beneficial owner meets to be eligible fr the rate of withholding [EMM Certification Uno pais opr, dor atte earned on ineaton ooh fa note estoy knw ane ats comet a ap Iara ceri ris + Lam th indica thts the bene une (am authrizd to son forthe incvidua at's the bens owner al the income a proceeds to which this form rates or amusing ts form to docu yea for chapor 4 purposes +The parson ramic on ina 1 of ns torm nat U.S. zon; (@income ot efectely connect wih the conduct fa rade busines nthe Unted States: {encome etectvety connect win the conduct fa wade or busines inthe Untad State but not subject ax under an sppcabe come a Healy (ome panes share of patersn's etecwey connected taxable income: or (@)the panes amcuntretzec tom the antec a partnership interest subject to wiholcng under sacton 1486 + Tepesenraned one ffm’ of Peay cory td oie 9 ohm an with marin tic xa bse Uo Sates ana courtyard + For tokertansatons or barter exchanges, the beneficial oaneris an exempt foreign parson as dfnein the rsntons. SeEemefaals pres cttcate each ooteoredl afore ogee hath oicdonb ae tons a ep yore made ook nen Pe cont hat have the capacity to person identities on ine tof his form, n Here ) 10-06-2022 ‘Signature of bono ren fica authorized wo in for bene owner ‘ate (une D0.¥7¥V) Jimson Paul Montathana Cunachi Pret name of sane For Paperwork Reduction Act Notice, see separate instructions. ‘Gat. No, 280472 om W-BBEN (fev. 10-2021)