Form 4 (W-8ben Sub1) - Non-Us Entities Or Individuals Receiving Funds For Work Conducted Wholly Or Partly In The Us Page 2

• The income to which this form relates is not effectively connected

with the conduct of a trade or business in the United States.

Furthermore, I authorize this form to be provided to any withholding agent that has

control, receipt, or custody of the income of which I am the beneficial owner or any

withholding agent that can disburse or make payments of the income of which I am the

beneficial owner.

The Internal Revenue Service does not require your consent to any provisions of this

document other than the certifications required to establish your status as a non-U.S.

person, and, if applicable, obtain a reduced rate of withholding.

Signature:

________________________________________

Date:

________________________________________

DEFINITIONS:

Permanent residence address: Your permanent residence address is the address in the

country where you claim to be a resident for purposes of that country’s income tax. For

purposes of claiming a reduced rate of withholding under an income tax treaty, you must

determine your residency in the manner required by the treaty. Do not show the address

of a financial institution, a post office box, or an address used solely for mailing

purposes.

Beneficial owner: The beneficial owner is generally the person who is required under

U.S. tax principles to include the income in gross income on a tax return. A person is not

a beneficial owner of income, however, to the extent that person is receiving the income

as a nominee, agent, or custodian, or to the extent the person is a conduit whose

participation in a transaction is disregarded. For additional information on the definition

of “beneficial owner” and Form W-8BEN, please see the Instructions for Form W-8BEN,

which can be obtained from Internal Revenue Service ( ).

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Parent category: Financial