Form W-8ben-E - Certificate Of Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) - 2014

Download a blank fillable Form W-8ben-E - Certificate Of Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) - 2014 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form W-8ben-E - Certificate Of Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) - 2014 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

W-8BEN-E

Certificate of Status of Beneficial Owner for

Form

United States Tax Withholding and Reporting (Entities)

(February 2014)

OMB No. 1545-1621

▶

For use by entities. Individuals must use Form W-8BEN.

Section references are to the Internal Revenue Code.

▶

Information about Form W-8BEN-E and its separate instructions is at

▶

Give this form to the withholding agent or payer. Do not send to the IRS.

Do NOT use this form for:

Instead use Form:

• U.S. entity or U.S. citizen or resident

. W-9

• A foreign individual .

. W-8BEN (Individual)

• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S. (unless claiming

treaty benefits) .

. W-8ECI

• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions) .

. W-8IMY

• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or

government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming the applicability of section(s)

115(2), 501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions)

. W-8ECI or W-8EXP

• Any person acting as an intermediary .

. W-8IMY

Part I

Identification of Beneficial Owner

2 Country of incorporation or organization

Name of organization that is the beneficial owner

Name of disregarded entity receiving the payment (if applicable)

Corporation

Chapter 3 Status (entity type) (Must check one box only):

Disregarded entity

Partnership

Simple trust

Grantor trust

Complex trust

Estate

Government

Central Bank of Issue

Tax-exempt organization

Private foundation

If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty claim? If

"Yes" complete Part III.

Yes

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).

City or town, state or province. Include postal code where appropriate.

Country

Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate.

Country

10 Reference number(s) (see instructions)

U.S. taxpayer identification number (TIN), if required

Foreign TIN

Part III

Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only)

I certify that (check all that apply):

The beneficial owner is a resident of

within the meaning of the income tax

treaty between the United States and that country.

The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the requirements of the

treaty provision dealing with limitation on benefits (see instructions).

The beneficial owner is claiming treaty benefits for dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign

corporation and meets qualified resident status (see instructions).

Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article

of the treaty identified on line 14a above to claim a

% rate of withholding on (specify type of income):

Explain the reasons the beneficial owner meets the terms of the treaty article:

Part XXIX

Certification

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under

penalties of perjury that:

•

The entity identified on line 1 of this form is the beneficial owner of all the income to which this form relates, is using this form to certify its status for chapter 4 purposes, or is a

merchant submitting this form for purposes of section 6050W,

•

The entity identified on line 1 of this form is not a U.S. person,

•

The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is not subject

to tax under an income tax treaty, or (c) the partner’s share of a partnership's effectively connected income, and

•

For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which the entity on line 1 is the beneficial owner or any

withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner.

I agree that I will submit a new form within 30 days if any certification on this form becomes incorrect.

Sign Here

Signature of individual authorized to sign for beneficial owner

Print Name

Date (MM-DD-YYYY)

I certify that I have the capacity to sign for the entity identified on line 1 of this form.