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 16

participating FFI, or a reporting Model 1 FFI that has agreed

withhold on the payment. You may provide your chapter 4

to act as a designated withholding agent with respect to you

status on this form even if you are not required to do so.

(see Regulations section 1.1471-5(f)(3)).

Certification of Chapter 4 Status:

You must also check either box 24b or 24c. Check

box 24b to certify that you have provided or will provide the

Parts IX Through XXVIII

documentation set forth in the certifications, including the

You should complete only one part certifying to your

owner reporting statement described in this line 24b. Check

chapter 4 status (if required). Identify which part (if any) you

box 24c to certify that you have provided or will provide an

should complete by reference to the box you checked on

auditor’s letter (in lieu of the information required by

line 5.

line 24(b)) that satisfies the requirements described in this

line.

Part IX — Nonparticipating FFI With

Part XII — Certified

Exempt Beneficial Owners

Deemed-Compliant Nonregistering

You are not required to complete this part unless you

Local Bank

are a nonparticipating FFI providing documentation

TIP

on behalf of an exempt beneficial owner.

You must check box 25 to certify that you satisfy all of the

requirements for certified deemed-compliant nonregistering

Check box 22 to certify that you are transmitting

local bank status.

withholding certificates or other documentation for exempt

Part XIII — Certified

beneficial owners for chapter 4 purposes on whose behalf

you are receiving a payment that is a withholdable payment.

Deemed-Compliant FFI with Only

See Regulations section 1.1471-6. You must also certify that

you have provided or will provide a withholding statement (as

Low-Value Accounts

required) allocating a portion of the payment to the exempt

You must check box 26 to certify that you satisfy all of the

beneficial owners as required under Regulations section

requirements for certified deemed-compliant FFI with only

1.1471-3(d)(8)(ii). The withholding statement must include

low-value account status.

the name, address, TIN (if any), entity type, and chapter 4

status of each exempt beneficial owner on behalf of which

Part XIV — Certified

you are receiving the payment, the amount of the payment

Deemed-Compliant Sponsored,

allocable to each exempt beneficial owner, a valid

withholding certificate or other documentation sufficient to

Closely Held Investment Vehicle

establish the chapter 4 status of each exempt beneficial

owner under the requirements of chapter 4, and any other

On line 27a, enter the name of the sponsoring entity that has

information the withholding agent reasonably requests in

agreed to fulfill your chapter 4 due diligence, reporting, and

order to fulfill its obligations under chapter 4. Additionally, the

withholding obligations on your behalf. You must also enter

withholding statement must provide all information required

the GIIN of your sponsoring entity on line 9.

for purposes of chapter 3 with respect to each exempt

You must check box 27b to certify that you satisfy the

beneficial owner if the payment is an amount subject to

requirements for certified deemed-compliant classification as

chapter 3 withholding. The withholding statement must

a sponsored closely held investment vehicle.

allocate the remainder of the payment that is not allocated to

an exempt beneficial owner to you.

Part XV — Certified

Part X — Sponsored FFI

Deemed-Compliant Limited Life Debt

If you are a sponsored FFI described in Regulations section

Investment Entity

1.1471-5(f)(1)(i)(F), on line 23a, enter the name of the

You must check box 28 to certify that you satisfy the

sponsoring entity that has agreed to fulfill your chapter 4 due

requirements for certified deemed-compliant limited life debt

diligence, reporting, and withholding obligations on your

investment entity status.

behalf. You must provide your GIIN on line 9.

Part XVI — Certain Investment

You must check the applicable box in line 23b or 23c to

certify that you are either an investment entity or controlled

Entities that Do Not Maintain

foreign corporation (within the meaning of section 957(a))

Financial Accounts

and satisfy the other relevant requirements for this

classification.

You must check box 29 to certify that you meet all of the

Part XI — Owner-Documented FFI

requirements for certified deemed-compliant status as an

investment entity that does not maintain financial accounts.

An owner-documented FFI should only complete

Part XVII — Restricted Distributor

Form W-8IMY if it is a flow-through entity receiving

income allocable to its partners, owners, or

You must check box 30a to certify that you satisfy the

CAUTION

beneficiaries. An owner-documented FFI is not permitted to

requirements of restricted distributor status.

act as an intermediary with respect to a withholdable

You must also check either box 30b or 30c, as

payment.

appropriate, to certify that your distribution agreement meets

You must check box 24a to certify that you satisfy the

the requirements of this classification.

requirements for owner-documented FFI status and are

providing this form to a U.S. financial institution, a

-16-

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

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