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 9
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18the withholding agent with sufficient information to associate
Complete line 15 only if you are acting as a QI that is not a
the payments with each branch/disregarded entity.
QDD. To the extent you are a QI acting as a QDD, see the
instructions for line 16.
If you are a QDD home office or you are a QI and have
one or more QDD branches, do not complete Part II for any
Check box 15a if you have assumed primary withholding
branches that are acting in their QDD capacities. Instead,
responsibility under both chapter 3 and chapter 4 with
provide the relevant branch information that you would
respect to the account(s). This box may be checked
otherwise provide on Part II (including the information
regardless of which boxes you check for boxes 15b through
required for chapter 4 purposes, as required) on your
15f for any accounts identified on a withholding statement.
withholding statement.
Check box 15b if you have assumed primary Form 1099
Line 11. Check the one box that applies. If no box applies
reporting and backup withholding responsibility with respect
to the disregarded entity, you do not need to complete Part II.
to the accounts identified in a withholding statement
If you check reporting Model 1 FFI, reporting Model 2 FFI, or
associated with this form or if you are a participating FFI or
participating FFI, you must complete line 13. If you are a
registered deemed-compliant FFI that meets the
branch of a reporting IGA FFI that cannot comply with the
requirements to report only under Regulations sections
requirements of an applicable IGA or the regulations under
1.6049-4(c)(4)(i) and (c)(4)(ii). For accounts for which you
chapter 4, you must check branch treated as nonparticipating
check this box 15b, you should not check boxes 15c through
FFI. If you are a QI that is an NFFE and a withholding agent
15f.
requests your chapter 4 status, you may provide a statement
If you checked boxes 15a and 15b with respect to
certifying to your chapter 4 status as an NFFE.
any accounts, you do not have to provide a
TIP
Line 12. Enter the address of the branch or disregarded
withholding statement for payments made to those
entity.
accounts.
Line 13. If you are a reporting Model 1 FFI, a reporting
Check box 15c if you have not assumed primary Form
Model 2 FFI, or a participating FFI, you must enter on line 13
1099 reporting and backup withholding responsibility. If you
the GIIN of your branch that receives the payment. If you are
check box 15c, check the applicable certification(s) in 15d or
a disregarded entity that completed Part I, line 3 of this form
15e.
and are receiving payments associated with this form, enter
your GIIN. Do not enter your GIIN (if any) on line 9. If you are
If you are allocating any portion of the payment on a
a U.S. branch, do not enter a GIIN on line 13.
withholding statement to a chapter 4 withholding rate pool of
U.S. payees in lieu of providing Forms W-9, you must certify
If you are in the process of registering your branch
by checking boxes 15d and/or 15e (as applicable):
with the IRS but have not received a GIIN, you may
TIP
For each account holder included in a chapter 4
complete this line by writing “applied for.” However,
withholding rate pool of U.S. payees who holds an account
the person requesting this form from you must receive and
that you maintain, you are permitted to provide this pool
verify your GIIN within 90 days.
under Regulations section 1.6049-4(c)(4)(iii) (including for
Certification of Chapter 3 Status:
payments of income other than interest for which reporting
would be required under chapter 61 but for a coordination
Parts III Through VIII
rule similar to that provided in Regulations section
1.6049-4(c)(4)(iii)); and/or
You should only complete one part from Parts III through VIII.
For a withholding rate pool of U.S. payees that includes
Generally, if you are acting in multiple capacities, you should
account holders of another intermediary or flow-through
provide separate Forms W-8IMY for each capacity. For
entity, you have obtained or will obtain documentation to
example, if you are acting as a qualified intermediary for one
establish that the intermediary or flow-through entity is a
account, but a nonqualified intermediary for another account,
participating FFI, registered deemed-compliant FFI, or a
you should provide one Form W-8IMY in your capacity as a
qualified intermediary. See Regulations sections 1.1471-3(d)
qualified intermediary and a separate Form W-8IMY in your
(4) and 1.1471-3(e) for more information on the requirements
capacity as a nonqualified intermediary.
for documenting such chapter 4 statuses.
You may, however, provide a single Form W-8IMY that
A payment that is subject to chapter 3 withholding or
covers more than one category of QI provided that you
that should be subject to chapter 4 withholding may
!
properly identify the accounts and/or transactions, as
not be included in a U.S. payee pool that is described
required, on a withholding statement. For example, if you are
CAUTION
in Regulations section 1.6049-4(c)(4)(ii).
a QI that acts as both a QI and a QDD, you may provide a
single Form W-8IMY with a withholding statement
Although, as a QI, you obtain withholding certificates or
designating each type of account or transaction.
appropriate documentation from beneficial owners or
Part III — Qualified Intermediary
payees, as specified in your QI agreement, you do not need
to attach the certificates or documentation to this form.
Check box 14 if you are a qualified intermediary (QI)
However, to the extent you have not assumed primary Form
(whether or not you assume primary withholding
1099 reporting or backup withholding responsibility and are
responsibility) for the payments for which you are providing
not permitted to allocate the payment to a chapter 4
this form. By checking the box, you are certifying to the
withholding rate pool of U.S. payees under Regulations
applicable statements contained on line 14. See the QI
section 1.6049-4(c)(4)(iii), you must disclose the names of
agreement for the definition of “account” for purposes of Part
those U.S. persons for whom you receive reportable amounts
III.
and that are not exempt recipients (as defined in Regulations
section 1.6049-4(c)(1)(ii) or under section 6041, 6042, 6045,
or 6050N). You should make this disclosure by attaching to
-9-
Instructions for Form W-8IMY (Rev. 6-2017)
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