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 18
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18this classification. Enter the name of the sponsoring entity in
cannot provide the certifications in Parts IX through XXVIII,
line 41.
do not check a box in line 5. However, if you determine your
status under the definitions of the IGA and can certify to a
Part XXIX — Certification
chapter 4 status included on this form, you do not need to
provide the certifications described in this paragraph unless
Form W-8IMY must be signed and dated by a person
required by the FFI to whom you are providing this form.
authorized to sign a declaration under penalties of perjury on
behalf of the person whose name is on the form. By signing
Any certifications provided under an applicable IGA
Form W-8IMY the authorized representative, officer, or agent
remain subject to the penalties of perjury statement and other
also agrees to provide a new form within 30 days following a
certifications made in Part XXIX.
change in circumstances (unless no future payments will be
made to the intermediary or flow-through entity by the
Entities Providing Alternate or Additional
withholding agent and the requestor does not need an
Certifications Under Regulations
updated form for chapter 4 purposes).
If you qualify for a status that is not shown on of this form, you
A withholding agent may allow you to provide this form
may attach applicable certifications for such status from any
with an electronic signature. The electronic signature must
other Form W-8 on which the relevant certifications appear. If
indicate that the form was electronically signed by a person
the applicable certifications do not appear on any Form W-8
authorized to do so (for example, with a time and date stamp
(if, for example, new regulations provide for an additional
and a statement that the form has been electronically
status and this form has not been updated) then you may
signed). Simply typing your name into the signature line is not
provide an attachment certifying that you qualify for the
an electronic signature.
applicable status described in a particular Regulations
Special Instructions
section. Include a citation to the applicable provision in the
Regulations. Any such attached certification becomes an
integral part of this Form W-8IMY and is subject to the
Entities Providing Certifications Under an
penalties of perjury statement and other certifications made
Applicable IGA (Do Not Complete Line 5)
in Part XXIX.
An FFI in an IGA jurisdiction with which you have an account
may provide you with a chapter 4 status certification other
Paperwork Reduction Act Notice. We ask for the
than as shown in Parts IX through XXVIII in order to satisfy its
information on this form to carry out the Internal Revenue
due diligence requirements under the applicable IGA. In such
laws of the United States. You are required to provide the
a case, you may attach the alternative certification to this
information. We need it to ensure that you are complying with
Form W-8IMY in lieu of completing a certification otherwise
these laws and to allow us to figure and collect the right
required in Parts IX through XXVIII provided that you: (a)
amount of tax.
determine that the certification accurately reflects your status
You are not required to provide the information requested
for chapter 4 purposes or under an applicable IGA; and (b)
on a form that is subject to the Paperwork Reduction Act
the withholding agent provides a written statement to you that
unless the form displays a valid OMB control number. Books
it has provided the certification to meet its due diligence
or records relating to a form or its instructions must be
requirements as a participating FFI or registered
retained as long as their contents may become material in
deemed-compliant FFI under an applicable IGA. For
the administration of any Internal Revenue law. Generally,
example, Entity A organized in Country A holds an account
tax returns and return information are confidential, as
with an FFI in Country B. Country B has a Model 1 IGA in
required by section 6103.
effect. The FFI in Country B may ask Entity A to provide a
chapter 4 status certification based on the terms of the
The time needed to complete and file this form will vary
Country B IGA in order to fulfill its due diligence and
depending on individual circumstances. The estimated
documentation requirements under the Country B IGA.
burden for business taxpayers filing this form is approved
under OMB control number 1545-0123. The estimated
You may also provide with this form an applicable IGA
burden for all other taxpayers who file this form is shown
certification if you are determining your chapter 4 status
below. The estimated average time is: Recordkeeping,11
under the definitions provided in an applicable IGA and your
hr., 43 min.; Learning about the law or the form, 5 hr., 55
certification identifies the jurisdiction that is treated as having
min.; Preparing the form, 7 hr., 34 min.
an IGA in effect and describes your status as an NFFE or FFI
in accordance with the applicable IGA. However, if you
If you have comments concerning the accuracy of these
determine your status under an applicable IGA as an NFFE,
time estimates or suggestions for making this form simpler,
you must still determine if you are an excepted NFFE under
we would be happy to hear from you. You can send us
the regulations in order to complete this form unless you are
comments from IRS.gov/FormComments. You can write to
provided an alternative certification by an FFI described in
the Internal Revenue Service, Tax Forms and Publications,
the preceding paragraph that covers your certification as an
1111 Constitution Ave. NW, IR-6526, Washington, DC
NFFE (such as “active NFFE”) as defined in an applicable
20224. Do not send Form W-8IMY to this office. Instead, give
IGA. Additionally, you are required to comply with the
it to your withholding agent.
conditions of your status under the law of the IGA jurisdiction
if you are determining your status under that IGA. If you
-18-
Instructions for Form W-8IMY (Rev. 6-2017)
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