Form W-8ben-E - Certificate Of Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) Page 6

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Form W-8BEN-E (Rev. 4-2016)

Page

Part XV

Exempt Retirement Plans (continued)

I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other

than the requirement that the plan be funded by a trust created or organized in the United States.

I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds

described in this part or in an applicable Model 1 or Model 2 IGA, accounts described in §1.1471-5(b)(2)(i)(A) (referring to retirement and

pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.

I certify that the entity identified in Part I:

• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession

(each as defined in §1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement,

disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor (or persons designated by such

employees); or

• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession

(each as defined in §1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide retirement,

disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in consideration

of personal services performed for the sponsor.

Part XVI

Entity Wholly Owned by Exempt Beneficial Owners

I certify that the entity identified in Part I:

• Is an FFI solely because it is an investment entity;

• Each direct holder of an equity interest in the investment entity is an exempt beneficial owner described in §1.1471-6 or in an applicable

Model 1 or Model 2 IGA;

• Each direct holder of a debt interest in the investment entity is either a depository institution (with respect to a loan made to such entity) or an

exempt beneficial owner described in §1.1471-6 or an applicable Model 1 or Model 2 IGA.

• Has provided an owner reporting statement that contains the name, address, TIN (if any), chapter 4 status, and a description of the type of

documentation provided to the withholding agent for every person that owns a debt interest constituting a financial account or direct equity

interest in the entity; and

• Has provided documentation establishing that every owner of the entity is an entity described in §1.1471-6(b), (c), (d), (e), (f) and/or (g) without

regard to whether such owners are beneficial owners.

Part XVII

Territory Financial Institution

I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under

the laws of a possession of the United States.

Part XVIII

Excepted Nonfinancial Group Entity

I certify that the entity identified in Part I:

• Is a holding company, treasury center, or captive finance company and substantially all of the entity's activities are functions described in

§1.1471-5(e)(5)(i)(C) through (E);

• Is a member of a nonfinancial group described in §1.1471-5(e)(5)(i)(B);

• Is not a depository or custodial institution (other than for members of the entity's expanded affiliated group); and

• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any

investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for

investment purposes.

Part XIX

Excepted Nonfinancial Start-Up Company

I certify that the entity identified in Part I:

• Was formed on (or, in the case of a new line of business, the date of board resolution approving the new line of business)

(date must be less than 24 months prior to date of payment);

• Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of

business other than that of a financial institution or passive NFFE;

• Is investing capital into assets with the intent to operate a business other than that of a financial institution; and

• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any

investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes.

Part XX

Excepted Nonfinancial Entity in Liquidation or Bankruptcy

I certify that the entity identified in Part I:

;

• Filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy on

• During the past 5 years has not been engaged in business as a financial institution or acted as a passive NFFE;

• Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a nonfinancial

entity; and

• Has, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in

bankruptcy or liquidation for more than three years.

W-8BEN-E

Form