Form W-8exp - Certificate Of Foreign Government Or Other Foreign Organization For United States Tax Withholding And Reporting - 2014 Page 4

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Form W-8EXP (Rev. 4-2014)
Page
Part IV
Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and
belief it is true, correct, and complete. I further certify under penalties of perjury that:
• The organization for which I am signing is the beneficial owner of the income and other payments to which this form relates,
• The beneficial owner is not a U.S. person,
• For a beneficial owner that is a controlled entity of a foreign sovereign (other than a central bank of issue wholly owned by a
foreign sovereign), the beneficial owner is not engaged in commercial activities within or outside the United States, and
• For a beneficial owner that is a central bank of issue wholly owned by a foreign sovereign, the beneficial owner is not
engaged in commercial activities within the United States.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the payments
of which I am the beneficial owner or any withholding agent that can disburse or make payments of the amounts of which I am
the beneficial owner.
I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
Sign
Here
Signature of authorized official
Print name
Date (MM-DD-YYYY)
I certify that I have the capacity to sign for the entity identified on line 1 of this form.
W-8EXP
Form
(Rev. 4-2014)

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