Form W-8imy - Certificate Of Foreign Intermediary Foreign Partnership Or Certain U.s. Branches For United States Tax Withholding - 1998 Page 2
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Form W-8IMY (10-98)
Page
Part IV
Certain United States Branches
Note: You may use this Part if the entity identified in Part I is a U.S. branch of a foreign bank or insurance company
and is subject to certain regulatory requirements (see instructions).
I certify that the entity identified in Part I is a U.S. branch and that the payments are not effectively
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connected with the conduct of a trade or business in the United States.
Check box 12 OR box 13a, whichever applies:
I certify that the entity identified in Part I is using this form as evidence of its agreement with the
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withholding agent to be treated as a U.S. person with respect to any payments associated with this
certificate.
I certify that the entity identified in Part I:
13a
Is using this form to transmit withholding certificates or other appropriate documentation for the persons
for whom the branch receives a payment, 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 U.S. branch and
reported to the IRS, and agrees to update this statement as required.
If line 13a is checked, also check either box 13b OR box 13c:
The withholding certificates and other documentation associated with this form represent all of the persons
b
to which this form relates.
The withholding certificate and other documentation associated with this form do not represent all of the
c
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.
Withholding Foreign Partnership
Part V
I certify that the entity identified in Part I:
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Is a withholding foreign partnership and will comply with the withholding and reporting provisions under
the Internal Revenue Code except to the extent provided under its withholding agreement, and
Has provided or will provide the required statement furnishing sufficient information for the withholding
agent to determine the correct amount paid to the withholding foreign partnership and reported to the IRS,
and agrees to update this statement as required.
Part VI
Nonwithholding Foreign Partnership
I certify that the entity identified in Part I:
15a
Is a foreign partnership (other than a withholding foreign partnership) and that the payments to which this
certificate relates are not effectively connected with the conduct of a trade or business in the United
States; 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 partnership and
reported to the IRS, and agrees to update this statement as required.
Check either box 15b OR box 15c:
The withholding certificates and other documentation associated with this form represent all of the partners
b
to which this form relates.
The withholding certificate and other documentation associated with this form do not represent all of the
c
partners to which this form relates. The amounts allocable to partners covered by this form but for which
withholding certificates or other documentation are lacking or unreliable are separately identified.
Part VII
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.
Sign Here
Signature of authorized official
Date
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