Form W-8imy - Certificate Of Foreign Intermediary Foreign Partnership Or Certain U.s. Branches For United States Tax Withholding - 1998
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1
2W-8IMY
Certificate of Foreign Intermediary,
Form
Foreign Partnership, or Certain U.S. Branches
(October 1998)
OMB No. 1545-1621
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:
W-8BEN
A beneficial owner solely claiming foreign status or treaty benefits
W-8BEN
A hybrid entity claiming treaty benefits on its own behalf
A person claiming an exemption from U.S. withholding on income effectively connected with the conduct
W-8ECI
of a trade or business in the United States
A foreign government, international organization, foreign central bank of issue, a foreign tax-exempt organization,
W-8EXP
or a foreign private foundation, claiming the applicability of section(s) 501(c), 892, 895, or 1443(b)
Part I
Identification of Entity
(See instructions.)
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:
Qualified intermediary. Complete Part II.
U.S. branch. Complete Part IV.
Nonwithholding foreign partnership. Complete Part VI.
Nonqualified intermediary. Complete Part III.
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 (see instructions)
7
Foreign tax identifying number, if any (optional)
SSN or ITIN
EIN
8
Account number(s) (optional)
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;
Has obtained the appropriate certificates or other documentation as required in its withholding agreement
for those assets that are identified on the attached statement as being allocable to documented U.S.
account holders and documented foreign account holders; and
Has provided or will provide a statement that furnishes sufficient information for the withholding agent to
determine the correct amount required to be withheld from amounts paid to the intermediary and reported
to the IRS, and agrees to update this statement as required.
(If applicable) I certify that the entity identified in Part I has assumed primary withholding responsibility with
b
respect to the amounts identified in the attached statement.
Part III
Nonqualified Intermediary
(All nonqualified intermediaries check here) I certify that the entity identified in Part I:
10a
Is not a qualified intermediary and is not acting for its own account; and
Has provided or will provide the required statement furnishing sufficient information for the withholding
agent to determine the correct amount required to be withheld from amounts paid to the intermediary and
reported to the IRS, and agrees to update this statement as required.
I certify that the entity identified in Part I is using this form to transmit withholding certificates and other
b
appropriate documentation for the payment(s) to which this form relates.
If box 10b is checked, also check either box 10c OR box 10d:
The withholding certificates and other documentation associated with this form represent all of the persons
c
to which this form relates.
The withholding certificates and other documentation associated with this form do not represent all of the
d
persons to which this form relates. The amounts allocable to persons covered by this form but for which
withholding certificates or other documentation are lacking or unreliable are separately identified.
W-8IMY
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25402Q
Form
(10-98)
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