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 13
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18Check box 17d to certify that you are acting as a QSL with
withholding statement must also identify each intermediary or
respect to the accounts identified on this line or in a
flow-through entity that is receiving a payment (excluding any
withholding statement associated with this form with respect
intermediary or flow-through entity that is an account holder
to a payment that is a U.S. source substitute dividend.
or interest holder in a QI, WP, or WT), each such entity’s
chapter 4 status and GIIN (if applicable), and the chapter 4
If you are acting on behalf of another NQI or on behalf of a
withholding rate pools associated with each such entity
foreign partnership or foreign trust that is not a withholding
receiving the payment.
foreign partnership or a withholding foreign trust, you must
A payment that is subject to chapter 3 withholding or
attach to your Form W-8IMY the Form W-8IMY of the other
that should be subject to chapter 4 withholding
!
NQI, foreign partnership, or foreign trust together with the
should not be included in a U.S. payee pool that is
withholding certificates and other documentation attached to
CAUTION
described in Regulations section 1.6049-4(c)(4)(ii). For
that Form W-8IMY that are required for both chapter 3 and
payments made on or after April 1, 2017, an allocation of a
chapter 4 purposes.
payment of an amount subject to chapter 3 withholding to a
Withholding statement of an NQI. If you are an NQI, you
withholding rate pool of U.S. payees must identify the payees
must provide a withholding statement and appropriate
as described in Regulations section 1.1471-3(c)(3)(iii)(B)(2).
documentation to obtain reduced rates of withholding for your
For chapter 3 and chapter 61 purposes. For chapter 3
customers under chapter 3 and chapter 61 and to avoid
and chapter 61 purposes, in the case of a reportable amount
certain reporting responsibilities. However, see the
that is also a withholdable payment, the withholding
paragraph later describing an NQI’s withholding statement
statement should allocate only the portion of the payment
for chapter 4 purposes for when an NQI may provide a
that was not allocated to a chapter 4 withholding rate pool or
chapter 4 withholding rate pool of U.S. payees without such
a pool described in Regulations section 1.1441-1(e)(3)(iv)(C)
documentation. The withholding statement must be provided
or to a payee identified on the withholding statement to whom
prior to a payment and becomes an integral part of the Form
withholding was applied under chapter 4. The withholding
W-8IMY and, therefore, the certification statement that you
statement generally must include the following information.
sign in Part XXIX of the form applies to the withholding
Include the name, address, U.S. TIN (if any), chapter 4
statement as well as to the form.
status (for a foreign person receiving a withholdable
For chapter 4 purposes. If you are an NQI that is a
payment), and the type of documentation (documentary
participating FFI or registered deemed-compliant FFI and
evidence, Form W-9, or type of Form W-8) for every person
you receive a withholdable payment, you must provide a
for whom documentation has been received and state
withholding statement which satisfies the requirements of an
whether that person is a U.S. exempt recipient, a U.S.
FFI withholding statement or chapter 4 withholding
non-exempt recipient, or a foreign person. The statement
statement.
must indicate whether a foreign person is a beneficial owner
An FFI withholding statement may allocate the payment to
or an intermediary, flow-through entity, U.S. branch, or
chapter 4 reporting rate pools (as appropriate), including a
territory financial institution and the type of recipient, based
chapter 4 withholding rate pool for nonparticipating FFIs,
on the recipient codes shown on Form 1042-S.
recalcitrant account holders (in each class of account holders
Allocate each payment by income type to every payee for
described in Regulations section 1.1471-4(d)(6)(i)), or other
whom documentation has been provided. The type of income
pool of payees permitted on an FFI withholding statement
is based on the income codes reported on Form 1042-S (or,
under the chapter 3 or 4 regulations (see Regulations
if applicable, the income categories for Form 1099). If a
sections 1.1471-3(c)(3)(iii)(B) and 1.1441-1(e)(3)(iv)(C)),
payee receives income through another NQI, flow-through
and, for a participating FFI (including a reporting Model 2 FFI)
entity, or U.S. branch acting as an intermediary, the
or a registered deemed-compliant FFI (including a reporting
withholding certificate must also state the name, address,
Model 1 FFI), U.S. payees. However, if you are an NQI, you
U.S. TIN (if known), and, for a withholdable payment, the
may allocate a portion of a reportable amount (regardless of
chapter 4 status (if required) and GIIN (if applicable) of the
whether the payment is a withholdable payment) to a
other NQI or U.S. branch from which the payee directly
chapter 4 withholding rate pool of U.S. payees when you
receives the payment or the flow-through entity in which the
satisfy the requirements to provide such a pool (including the
payee has a direct ownership interest. If another NQI,
requirement to certify to your status as a participating FFI
flow-through entity, or U.S. branch fails to allocate a
(including a reporting Model 2 FFI) or registered
payment, you must provide, for that payment, the name of
deemed-compliant FFI (including a reporting Model 1 FFI)).
the NQI, flow-through entity, or U.S. branch that failed to
The withholding statement must also identify each
allocate the payment.
intermediary or flow-through entity that is receiving a
If a payee is identified as a foreign person, specify the rate
payment (excluding any intermediary or flow-through entity
of withholding under chapter 3 to which the payee is subject,
that is an account holder or interest holder in a QI, WP, or
the payee’s country of residence and, if a reduced rate of
WT), each such entity’s chapter 4 status and GIIN (if
withholding is claimed, the basis for that reduced rate (for
applicable), and the chapter 4 withholding rate pools
example, treaty benefit, portfolio interest, or exemption under
associated with each such entity receiving the payment.
section 501(c)(3), 892, or 895). The statement must also
A chapter 4 withholding statement must contain the name,
include the U.S. or foreign TIN (if required) and, if the
address, TIN (if any), entity type, chapter 4 status of each
beneficial owner is not an individual and is claiming treaty
payee, the amount allocated to each payee, and a valid
benefits, state whether the limitation on benefits and section
withholding certificate or other documentation sufficient to
894 statements have been provided by the beneficial owner.
establish each payee’s chapter 4 status. However, a
You must inform the withholding agent as to which payments
chapter 4 withholding statement may instead include pooled
those statements relate.
information for payees that are nonparticipating FFIs or
Include any other information the withholding agent
another pool of payees as permitted under the chapter 4
requests in order to fulfill its withholding and reporting
regulations for a chapter 4 withholding statement. The
-13-
Instructions for Form W-8IMY (Rev. 6-2017)
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