Form W-8imy - Certificate Of Foreign Intermediary, Foreign Flow-Through Entity, Or Certain U.s. Branches For United States Tax Withholding - 2006
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1
2W-8IMY
Certificate of Foreign Intermediary,
Form
Foreign Flow-Through Entity, or Certain U.S.
(Rev. February 2006)
OMB No. 1545-1621
Branches for United States Tax Withholding
Section references are to the Internal Revenue Code.
See separate instructions.
Department of the Treasury
Give this form to the withholding agent or payer. Do not send to the IRS.
Internal Revenue Service
Do not use this form for:
Instead, use Form:
● A beneficial owner solely claiming foreign status or treaty benefits
W-8BEN
● A hybrid entity claiming treaty benefits on its own behalf
W-8BEN
● A person claiming that income is effectively connected with the conduct of a trade or business in the United States
W-8ECI
● A disregarded entity. Instead, the single foreign owner should use
W-8BEN or W-8ECI
● A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization,
W-8EXP
foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b)
Part I
Identification of Entity
1
Name of individual or organization that is acting as intermediary
2
Country of incorporation or organization
3
Type of entity—check the appropriate box:
Withholding foreign trust. Complete Part V.
Qualified intermediary. Complete Part II.
Nonwithholding foreign partnership. Complete Part VI.
Nonwithholding foreign simple trust. Complete Part VI.
Nonqualified intermediary. Complete Part III.
U.S. branch. Complete Part IV.
Nonwithholding foreign grantor trust. Complete Part VI.
Withholding foreign partnership. Complete Part V.
4
Permanent residence address (street, apt. or suite no., or rural route). Do not use P.O. box.
City or town, state or province. Include postal code where appropriate.
Country (do not abbreviate)
5
Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate.
Country (do not abbreviate)
6
U.S. taxpayer identification number (if required, see instructions)
7
Foreign tax identifying number, if any (optional)
SSN or ITIN
EIN
QI-EIN
8
Reference number(s) (see instructions)
Part II
Qualified Intermediary
(All qualified intermediaries check here) I certify that the entity identified in Part I:
9a
● Is a qualified intermediary and is not acting for its own account with respect to the account(s) identified
on line 8 or in a withholding statement associated with this form and
● Has provided or will provide a withholding statement, as required.
(If applicable) I certify that the entity identified in Part I has assumed primary withholding responsibility
b
under Chapter 3 of the Code with respect to the account(s) identified on this line 9b or in a withholding
statement associated with this form
(If applicable) I certify that the entity identified in Part I has assumed primary Form 1099 reporting and
c
backup withholding responsibility as authorized in its withholding agreement with the IRS with respect to
the account(s) identified on this line 9c or in a withholding statement associated with this form
Part III
Nonqualified Intermediary
(All nonqualified intermediaries check here) I certify that the entity identified in Part I is not a qualified
10a
intermediary and is not acting for its own account.
(If applicable) I certify that the entity identified in Part I is using this form to transmit withholding certificates
b
and/or other documentary evidence and has provided or will provide a withholding statement, as required.
W-8IMY
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25402Q
Form
(Rev. 2-2006)
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