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Additional Documentation for Shareholders Providing either a U.S. Mailing

address or a Permanent and Mailing Address in Differing Countries

Instructions:

A. If a U.S. mailing address is listed in Section 5 of Part I above, you must provide additional information that

supports your claim of foreign status. You do that by completing items 1 and 2 below

B. If you claimed tax treaty benefits by completing Part II above and have listed a country in section 9(a) that is

different than either the Permanent or Mailing address provided in Part 1 above, you must provide additional

documentation to support your claim of treaty eligibility. You can accomplish that by completing items 2

and 3 below.

C. If you listed a U.S. Mailing address in Section 5 above and claimed treaty benefits in section 9(a), you

must complete items 1, 2, and 3 below.

If you have provided a U.S. mailing address or a Permanent or Mailing address in a country different

than the treaty country, US Bancorp Fund Services, LLC (USBFS) cannot accept the exemption

represented by form W-8BEN if you fail to provide the below additional documentation

1. Additional documentary evidence of foreign status: Provide USBFS with a copy of an official document

showing your name and permanent residence address in the country listed above in Section 4. The document must

have been issued within 3 years of the date this form, is signed, and must display your permanent residence

address. Please check the appropriate box below that identifies the type of document you are furnishing.

Please attach copies of this documentation when you return the completed W-8BEN form.

Passport

Identity card

Student Visa

Diplomatic credentials

Professional license

Other (describe) ___________________________________________

________________________________________________________________________________

2. Reasonable written statement supporting foreign status: Provide a written description of your reason for

either providing a (1) U.S. mailing address or (2) providing a country in section 9(a) that is different from either

the Permanent or Mailing address countries listed in Part 1 above

________________________________________________________________________________

3. Eligibility for treaty benefits: If the country in section 9(a) is different than either the Permanent or Mailing

address Countries provided in Part 1 above you must provide USBFS with sufficient documentation to

support your residency in a treaty country listed in section 9(a). Please attach copies of this documentation

when you return the completed W-8BEN form.

Affidavit of Retroactive Application of Certificate of Foreign Status of

Part III

Beneficial Owner

I certify that the information contained on this form also applied from the date of my account opening through the date of this

certification, or from the date _____________________ through the date of this certification, whichever is later.

I do not retroactively certify this information

Part IV

Certification

Under penalties of perjury, I declare that I have examined the information on this form and any related documents and to

the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:

•

I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,

•

The beneficial owner is not a U.S. person,

The income to which this form relates is not effectively connected with the conduct of a trade or business in the United States, is effectively

•

connected but is not subject to tax under an income tax treaty, or the partner’s share of a partnership’s effectively connected income and

•

For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the

beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.

The United States Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required

to establish your status as a non-U.S. person and, if applicable, to obtain a reduced rate of withholding.

_____________________________ ________ _____________

Sign Here

Signature of beneficial owner

Date

Capacity in which acting

(or individual authorized to sign

)

(MM-DD-YYYY)

POA – copy of authorization must be attached

Substitute Form W-8ben - Certificate Of Foreign Status Of Beneficial Owner For United States Tax Withholding Page 2

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