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Form W-8BEN-E (2-2014)

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Part VI

Certified Deemed-Compliant FFI with Only Low-Value Accounts

I certify that the FFI identified in Part I:

• Is not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities, notional

principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security,

partnership interest, commodity, notional principal contract, insurance contract or annuity contract;

• No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of

$50,000 (as determined after applying applicable account aggregation rules); and

• Neither the FFI nor the entire expanded affiliated group, if any, of the FFI, have more than $50 million in assets on its consolidated or

combined balance sheet as of the end of its most recent accounting year.

Part VII

Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle

Name of sponsoring entity:

I certify that the entity identified in Part I:

• Is an FFI solely because it is an investment entity described in §1.1471-5(e)(4);

• Is not a QI, WP, or WT;

• Has a contractual relationship with the above identified sponsoring entity that agrees to fulfill all due diligence, withholding, and reporting

responsibilities of a participating FFI on behalf of this entity; and

• Twenty or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial

institutions, participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an

entity if that entity owns 100 percent of the equity interests in the FFI and is itself a sponsored FFI).

Part VIII

Certified Deemed-Compliant Limited Life Debt Investment Entity

I certify that the entity identified in Part I:

• Was in existence as of January 17, 2013;

• Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and

• Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the

restrictions with respect to its assets and other requirements under § 1.1471-5(f)(2)(iv)).

Part IX

Certified Deemed-Compliant Investment Advisors and Investment Managers

I certify that the entity identified in Part I:

• Is a financial institution solely because it is an investment entity described in §1.1471-5(e)(4)(i)(A); and

• Does not maintain financial accounts.

Part X

Owner-Documented FFI

Note. This status only applies if the U.S. financial institution or participating FFI to which this form is given has agreed that it will treat the FFI as an

owner-documented FFI (see instructions for eligibility requirements). In addition, the FFI must make the certifications below.

24a

(All owner-documented FFIs check here) I certify that the FFI identified in Part I:

• Does not act as an intermediary;

• Does not accept deposits in the ordinary course of a banking or similar business;

• Does not hold, as a substantial portion of its business, financial assets for the account of others;

• 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;

• Is not owned by or in an expanded affiliated group with an entity that accepts deposits in the ordinary course of a banking or similar

business, holds, as a substantial portion of its business, financial assets for the account of others, or is 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; and

• Does not maintain a financial account for any nonparticipating FFI.

W-8BEN-E

Form

(2-2014)

Form W-8ben-E - Certificate Of Status Of Beneficial Owner For United States Tax Withholding And Reporting (Entities) - 2014 Page 4

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