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 17

Part XVIII — Foreign Central Bank of

Part XXII — Excepted Nonfinancial

Issue

Start-Up Company

You must check box 31 to certify that you are a foreign

You must check box 35 to certify that you satisfy the

central bank of issue acting as an intermediary and are an

requirements of excepted nonfinancial start-up company

entity defined in Regulations section 1.1471-6 that is treated

status. You must also provide the date you were formed or

as the beneficial owner of the payment for chapter 4

your board passed a resolution (or equivalent measure)

purposes (applying the rule in Regulations section

approving a new line of business (which cannot be that of a

1.1471-6(d)(4)). You cannot be treated as an intermediary for

financial institution or passive NFFE).

purposes of this Part XVIII if you are receiving the payment in

Part XXIII — Excepted Nonfinancial

connection with a commercial activity described in

Entity in Liquidation or Bankruptcy

Regulations section 1.1471-6(h)(1) or are not receiving

payments subject to chapter 3 withholding.

You must check box 36 to certify that you satisfy the

Part XIX — Nonreporting IGA FFI

requirements of excepted nonfinancial entity in liquidation or

bankruptcy status. You must also provide the date that you

Check box 32 to indicate that you are treated as a

filed a plan of liquidation, plan of reorganization, or

nonreporting IGA FFI. You must identify the IGA by entering

bankruptcy petition.

the name of the jurisdiction that has the applicable IGA in

Part XXIV — Publicly Traded NFFE or

effect with the United States and indicate whether it is a

Model 1 or a Model 2 IGA. You must also provide the

NFFE Affiliate of a Publicly Traded

withholding agent with the specific category of entity

described in Annex II of the IGA applicable to your status. In

Corporation

providing the specific category of FFI described in Annex II,

If you are a publicly traded NFFE, you must check box 37a to

you should use the language from Annex II that best and

certify that you are not a financial institution and provide the

most specifically describes your status in the IGA. For

name of a securities exchange on which your stock is

example, indicate “investment entity wholly owned by exempt

publicly traded. If you are an NFFE that is a member of the

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

same expanded affiliated group (as described in Regulations

you are a nonreporting IGA FFI claiming a deemed-compliant

section 1.1471-5(i)) as a publicly traded U.S. or foreign

status under the regulations, you must instead indicate on

entity, you must check box 37b to certify that you are a NFFE

this line which section of the regulations you qualify under.

affiliate of a publicly traded corporation, provide the name of

If you are a nonreporting financial institution under an

the publicly traded entity, and identify the securities market

applicable IGA because you qualify as an

on which the stock of the publicly traded entity is traded. See

owner-documented FFI under the regulations, do not check

Regulations section 1.1472-1(c)(1)(i) to determine if an entity

“Nonreporting IGA FFI.” Instead you must check

is publicly traded.

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

Part XXV — Excepted Territory NFFE

this Part XIX.

You must check box 38 to certify that you satisfy the

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

requirements for excepted territory NFFE status. See

nonreporting IGA FFI (including a trustee of a

Regulations section 1.1472-1(c)(1)(iii) for the definition of an

trustee-documented trust that is a foreign person).

excepted territory NFFE.

Part XX — Exempt Retirement Plans

Part XXVI — Active NFFE

You must check the appropriate box to certify that you satisfy

You must check box 39 to certify that you satisfy the

the requirements of exempt retirement plan status.

requirements of active NFFE status.

If you are not a flow-through entity or acting as an

Part XXVII — Passive NFFE

intermediary with respect to the payment for

chapter 3 purposes, do not complete Form W-8IMY.

If you are a passive NFFE, you must check box 40 to certify

CAUTION

If you are the beneficial owner of the payment and are

that you are not a financial institution (other than an

claiming an exemption under sections 115(2), 892, or 895 as

investment entity organized in a possession of the United

well as exempt beneficial owner status under Regulations

States). You must also certify that you have provided a

section 1.1471-6 you should provide Form W-8EXP. If you

withholding statement associated with Form W-8IMY to the

are receiving payments which do not qualify for a statutory

extent you are required to provide a withholding statement.

exemption from tax but for which you are claiming benefits

under an applicable income tax treaty, provide Form

Note. If you would be a passive NFFE but for the fact that

W-8BEN-E.

you are managed by certain types of FFIs (see Regulations

section 1.1471-5(e)(4)(i)(B)), you should not complete Part

Part XXI — Excepted Nonfinancial

XXVII as you would be considered a financial institution and

not a passive NFFE.

Group Entity

Part XXVIII— Sponsored Direct

You must check box 34 to certify that you satisfy the

Reporting NFFE

requirements of excepted nonfinancial group entity status.

If you are a sponsored direct reporting NFFE, you must

check the box on line 42 to certify that you are not a financial

institution and that you satisfy all relevant requirements for

-17-

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

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