Form W-8imy - Certificate Of Foreign Intermediary, Foreign Flow-Through Entity, Or Certain U.s. Branches For United States Tax Withholding And Reporting - 2017 Page 7
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Form W-8IMY (Rev. 6-2017)
Page
Part XX
Exempt Retirement Plans (continued)
I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds described
e
in this part or in an applicable Model 1 or Model 2 IGA, accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to
retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
f
I certify that the entity identified in Part I:
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S.
possession (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model
2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor
(or persons designated by such employees); or
• Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S.
possession (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model
2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such
sponsor, but are in consideration of personal services performed for the sponsor.
Part XXI
Excepted Nonfinancial Group Entity
34
I certify that the entity identified in Part I:
• Is a holding company, treasury center, or captive finance company and substantially all of the entity’s activities are functions described in
Regulations section 1.1471-5(e)(5)(i)(C) through (E);
• Is a member of a nonfinancial group described in Regulations section 1.1471-5(e)(5)(i)(B);
• Is not a depository or custodial institution (other than for members of the entity’s expanded affiliated group); and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or
any investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital
assets for investment purposes.
Part XXII
Excepted Nonfinancial Start-Up Company
35
I certify that the entity identified in Part I:
• Was formed on (or in the case of a new line of business, the date of board resolution approving the new line of business)
(date must be less than 24 months prior to date of payment);
• Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of
business other than that of a financial institution or passive NFFE; and
• Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or
any investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for
investment purposes.
Part XXIII
Excepted Nonfinancial Entity in Liquidation or Bankruptcy
36
I certify that the entity identified in Part I:
• Filed a plan of liquidation, filed a plan for reorganization, or filed for bankruptcy on the following date:
;
• Has not been engaged during the past 5 years in business as a financial institution or acted as a passive NFFE;
• Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a
nonfinancial entity; and
• Has provided, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if
it remains in bankruptcy or liquidation for more than 3 years.
Part XXIV
Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation
Check box 37a or 37b, whichever applies.
37a
I certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution; and
• The stock of such corporation is regularly traded on one or more established securities markets, including
.
b
I certify that:
• The entity identified in Part I is a foreign corporation that is not a financial institution;
• The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an
established securities market;
• The name of the entity, the stock of which is regularly traded on an established securities market, is
; and
• The name of the securities market on which the stock is regularly traded is
.
▶
Part XXV
Excepted Territory NFFE
38
I certify that:
• The entity identified in Part I is an entity that is organized in a possession of the United States;
• All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated;
and
• The entity identified in Part I:
(i) Does not accept deposits in the ordinary course of a banking or similar business;
(ii)
Does not hold, as a substantial portion of its business, financial assets for the account of others; and
(iii)
Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with
respect to a financial account.
W-8IMY
Form
(Rev. 6-2017)
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