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that you meet all of the requirements for this certified

Line 24d. Check the box if you do not have any

deemed-compliant classification.

contingent beneficiaries or designated classes with

Part VII – Certified Deemed-Compliant

unidentified beneficiaries. While this certification is not

required, an owner reporting statement provided by an

Sponsored, Closely

owner-documented FFI will remain valid indefinitely for

chapter 4 purposes absent a change in circumstances

Held Investment Vehicle

with respect to offshore obligations (as defined in

Regulations section 1.6049-5(c)(1)) only if this

Line 20. Enter the name of your sponsoring entity that

certification is provided and the account balance of all

has agreed to fulfill the due diligence, reporting, and

accounts held by the owner-documented FFI with the

withholding obligations of the entity identified in line 1 as if

withholding agent does not exceed $1,000,000 on the

the entity in line 1 were a participating FFI. You must also

later of June 30, 2014, or the last day of the calendar year

enter the GIIN of your sponsoring entity on line 9a.

in which the account was opened, and the last day of

Line 21. If you are a sponsored, closely held investment

each subsequent calendar year preceding the payment,

vehicle, you must check the box to certify that you meet all

applying the account aggregation rules of Regulations

of the requirements for this certified deemed-compliant

section 1.1471-5(b)(4)(iii).

status.

Part XI – Restricted Distributor

Part VIII – Certified

Line 25a. If you are a restricted distributor you must

Deemed-Compliant

check the box to certify that you meet all of the

Limited Life Debt

requirements for this status.

Investment Company

Lines 25b and 25c. Check the appropriate box to certify

your status. Do not check both boxes.

Line 22. If you are a limited life debt investment entity,

A restricted distributor may certify only with

you must check the box to certify that you meet all of the

respect to an account it maintains in connection

requirements for this certified deemed-compliant status.

with a distribution agreement with a restricted

Part IX – Certain Investment Entities

CAUTION

fund. A restricted distributor that, in connection with such

That Do Not Maintain Financial

a distribution agreement, receives a payment subject to

chapter 3 withholding or a withholdable payment should

Accounts

complete Form W-8IMY and not this form except to the

extent it holds interests in connection with such an

Line 23. If you are an FFI that is a financial institution

agreement as a beneficial owner.

solely because you are described in Regulations section

1.1471-5(e)(4)(i)(A) and you do not maintain financial

Part XII – Nonreporting IGA FFI

accounts, you must check the box to certify that you meet

all of the requirements for this certified deemed-compliant

Line 26. Check the box to indicate that you are treated as

status.

a nonreporting IGA FFI. You must identify the IGA by

entering the name of the jurisdiction that has the IGA

Part X – Owner-Documented FFI

treated as in effect with the United States, and indicate

whether it is a Model 1 or Model 2 IGA. You must also

Line 24a. If you are an owner-documented FFI, you must

provide the withholding agent with the specific category of

check the box to certify that you meet all of the

FFI described in Annex II of the IGA. In providing the

requirements for this status and are providing this form to

specific category of FFI described in Annex II, you should

a U.S. financial institution, participating FFI, reporting

use the language from Annex II that best and most

Model 1 FFI, or reporting Model 2 FFI that agrees to act as

specifically describes your status. For example, indicate

a designated withholding agent with respect to you. See

“investment entity wholly owned by exempt beneficial

Regulations section 1.1471-5(f)(3) for more information

owners” rather than “exempt beneficial owner.” If you are

about an owner-documented FFI, including with respect to

a nonreporting IGA FFI claiming a deemed-compliant

a designated withholding agent.

status under the regulations, you must instead indicate on

Line 24b. Check the box to certify that you have provided

this line which section of the regulations you qualify under.

or will provide the documentation set forth in the

If you are a nonreporting financial institution under an

certifications, including the FFI owner reporting statement

applicable IGA because you qualify as an

and the valid documentation for each person identified on

owner-documented FFI under the regulations, do not

the FFI owner reporting statement described on line 24b.

check “Nonreporting IGA FFI.” Instead, you must check

Line 24c. Check the box to certify that you have provided

“Owner-documented FFI” and complete Part X rather than

or will provide the auditor’s letter (in lieu of the information

this Part XII.

required by line 24b) that satisfies the requirements

See instructions for line 9a for when a GIIN is required

reflected on this line.

for a nonreporting IGA FFI (including a trustee of a

Check either line 24b or line 24c. Do not check

trustee-documented trust that is a foreign person).

both boxes.

TIP

-12-

Instructions for Form W-8BEN-E (Rev. 7-2017)

Instructions For Form W-8ben(E) - Certificate Of Entities Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) Page 12

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