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W-8BEN-E

Certificate of Status of Beneficial Owner for

Form

United States Tax Withholding and Reporting (Entities)

OMB No. 1545-1621

(Rev. July 2017)

▶ For use by entities. Individuals must use Form W-8BEN. ▶ Section references are to the Internal Revenue Code.

Department of the Treasury

▶Go to for instructions and the latest information.

Internal Revenue Service

▶ Give this form to the withholding agent or payer. Do not send to the IRS.

Do NOT use this form for:

Instead use Form:

• U.S. entity or U.S. citizen or resident

W-9

• A foreign individual

W-8BEN (Individual) or Form 8233

• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S.

(unless claiming treaty benefits) .

. W-8ECI

• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions)

. W-8IMY

• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government

of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming the applicability of section(s) 115(2), 501(c), 892, 895,

or 1443(b) (unless claiming treaty benefits) (see instructions for other exceptions) .

W-8ECI or W-8EXP

• Any person acting as an intermediary (including a qualified intermediary acting as a qualified derivatives dealer)

. W-8IMY

Part I

Identification of Beneficial Owner

Name of organization that is the beneficial owner

Country of incorporation or organization

Name of disregarded entity receiving the payment (if applicable, see instructions)

Chapter 3 Status (entity type) (Must check one box only):

Corporation

Disregarded entity

Partnership

Simple trust

Grantor trust

Complex trust

Estate

Government

Central Bank of Issue

Tax-exempt organization

Private foundation

International organization

If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty

claim? If "Yes" complete Part III.

Yes

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).

City or town, state or province. Include postal code where appropriate.

Country

Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate.

Country

U.S. taxpayer identification number (TIN), if required

Foreign TIN

Reference number(s) (see instructions)

Part III

Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only.)

14 I certify that (check all that apply):

The beneficial owner is a resident of