Instructions For Form W-8imy - Certificate Of Foreign Intermediary, Foreign Flow-Through Entity, Or Certain U.s. Branches For United States Tax Withholding And Reporting Page 10

Form W-8IMY the Forms W-9 (or substitute forms) of

QDD branch of a U.S. person. If you are a foreign branch

persons that are U.S. non-exempt recipients. If you do not

of a U.S. person that is acting as a QDD and you receive a

have a Form W-9 for a non-exempt U.S. payee, you must

payment that otherwise would be subject to withholding

attach to Form W-8IMY any information you do have

except for the U.S. person’s status as a U.S. person, you

regarding that person’s name, address, and TIN for a

may associate this Form W-8IMY with a Form W-9 from the

withholding agent to report the payment.

U.S. person.

Check box 15f to certify that you are a QI that is acting as

Withholding statement of a QI. As a QI, you must provide

a QSL with respect to all payments associated with this form

a withholding statement to each withholding agent from

that are U.S. source substitute dividends made by a party to

which you receive reportable amounts or withholdable

a securities lending transaction (as described in Notice

payments if you have not assumed primary withholding

2010-46) for payments made before January 1, 2018.

responsibility under chapter 3 and chapter 4 with respect to

the payment and, if you are receiving a reportable amount on

Check line 15g to certify that you are a QI that is assuming

behalf of a U.S. non-exempt recipient, you have not assumed

primary withholding responsibility under chapter 3 and

primary Form 1099 reporting and backup withholding

chapter 4 and primary Form 1099 reporting and backup

responsibility for the payment. The withholding statement

withholding responsibility with respect to all payments

becomes an integral part of the Form W-8IMY and, therefore,

associated with this form that are U.S. source interest and

the certification statement that you sign in Part XXIX of the

substitute interest payments, as permitted by (and described

form applies to the withholding statement as well as to the

in) the QI agreement. You may act as a QI with respect to

form.

such substitute interest payments under the QI agreement

regardless of whether you are acting in a principal or

A QI withholding statement must:

intermediary capacity with respect to payments of interest

Designate those accounts for which you act as a QI,

and substitute interest you receive that are associated with

Designate those accounts for which you are assuming

this form.

primary withholding and reporting responsibility under

chapter 3 and chapter 4 of the Code,

Line 16a. Check the box in line 16a to certify that each QDD

If applicable, designate those accounts or payments for

identified on the form or on the withholding statement that is

which you are acting as a QSL with respect to any U.S.

acting as a QDD meets the requirements to act as a QDD in

source substitute dividends, and

Regulations section 1.1441-1(e)(6) and assumes primary

Provide information to allocate the payment, as applicable,

withholding and reporting responsibilities under chapters 3,

to chapter 3 withholding rate pools, chapter 4 withholding

4, and 61, and section 3406 with respect to potential section

rate pools, or other pools of payees permitted under the

871(m) transactions.

chapter 4 regulations. See Regulations section 1.1471-3(c)

A QI that is acting as a QDD should provide this

(3)(iii)(B)(2).

Form W-8IMY only for payments in respect of

For chapter 4 purposes. If you are a QI and you receive

potential section 871(m) transactions and underlying

a withholdable payment, you must provide a withholding

CAUTION

securities. To certify your foreign status for any other

statement which satisfies the requirements of an FFI

payment of U.S. source income you beneficially own, see

withholding statement or chapter 4 withholding statement (if

Who Must Provide Form W-8IMY, earlier.

you are not an FFI) when you do not assume primary

withholding responsibility under chapter 3 and chapter 4 and

Line 16b. Check the box to indicate your status, including if

Form 1099 reporting and backup withholding responsibility

you are a QDD that is a disregarded entity claiming treaty

for the payment.

benefits. If the QDD is a branch other than a disregarded

If you are a QI that is an FFI you may provide an FFI

entity (that is, a branch that is not a separate legal entity from

withholding statement to allocate the payment to chapter 4

its home office), check the box to indicate the status of the

withholding rate pools (as applicable) or other pool of payees

entity identified in Part I.

permitted on an FFI withholding statement under the

Claim of treaty benefits. If you are acting as a QDD, you

chapter 4 regulations. See Regulations section 1.1471-3(c)

may be entitled to claim treaty benefits for certain payments

(3)(iii)(B)(2). You may also provide on the withholding

that are subject to withholding that you receive in your

statement a single pool of nonparticipating FFIs, a single pool

principal capacity (for example, interest payments or

of recalcitrant account holders of yours or of or another

payments of dividends beginning in 2018). To make a claim

intermediary that is a participating FFI or registered

for treaty benefits in such a case, you may provide your

deemed-compliant FFI, and, if you do not assume primary

withholding agent a statement associated with your Form

Form 1099 and backup withholding responsibility, a

W-8IMY that contains the information required in Part III of

chapter 4 withholding rate pool of U.S. payees. A chapter 4

Form W-8BEN-E, including (if applicable) a treaty claim by a

withholding rate pool of U.S. payees may include:

hybrid entity that is a disregarded entity that is identified on a

If you are a reporting Model 1 FFI, an account holder that

QDD's withholding statement described in the instructions to

is not withheld on under chapter 3, chapter 4, or section 3406

Part II. Alternatively, a Form W-8BEN-E may be used for this

that you report as a U.S. account pursuant to the Model 1

purpose.

IGA because the account has U.S. indicia and you have not

obtained appropriate documentation to treat the account as

If you are acting as a QDD and fiscally transparent in

held by other than a specified U.S. person;

your jurisdiction of organization, do not claim treaty

If you are a reporting Model 2 FFI, an account holder that

benefits as described in these instructions. Instead,

CAUTION

is not withheld on under chapter 3, chapter 4, or section 3406

you must include the withholding certificates or documentary

that you report as an account holder of a non-consenting

evidence of the owners claiming treaty benefits and provide

U.S. account as described in the Model 2 IGA;

an allocation on the withholding statement.

If you are a non-U.S. payor (as described in Regulations

section 1.6049-5(c)(5)) that is a participating FFI (including a

-10-

Instructions for Form W-8IMY (Rev. 6-2017)

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