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Form W-8EXP (Rev. 4-2014)

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本人保證第一部份所列示之法人為符合第 892 節定義之外國政府，且支付款項符合第 892 節所述之豁免範圍。

Check box 10b or 10c, whichever applies: 依適用條件勾選 10b 或 10c

b □ The entity identified in Part I is an integral part of the government of ______________________________________________________.

第一部份所列示之法人為_________________________________________________政府不可或缺的一部份。

c □ The entity identified in Part I is a controlled entity of the government of ____________________________________________________.

第一部份所列示之法人為受_________________________________________政府控制之法人。

11 For an international organization: 國際組織：

□ I certify that : 本人保證：

 The entity identified in Part I is an international organization within the meaning of section 7701(a)(18) and

第一部份所列示之法人係符合第 7701(a)(18)節所指之國際組織；且

 The payments are within the scope of the exemption granted by section 892. 該支付款項符合第 892 節所述之豁免範圍。

12 For a foreign central bank of issue (not wholly owned by the foreign sovereign): 外國中央銀行(非由外國主權國家完全持有)：

□ I certify that : 本人保證：

 The entity identified in Part I is a foreign central bank of issue, 第一部份所列示之法人為發行貨幣的外國中央銀行，

 The entity identified in Part I does not hold obligations or bank deposits to which this form relates for use in connection with the conduct of a

commercial banking function or other commercial activity, and

第一部份所列示之法人未持有與本表相關且涉及商業銀行或其他商業活動之義務或銀行存款，且

 The payments are within the scope of the exemption granted by section 895. 該支付款項符合第 895 節所述之豁免範圍。

13 For a foreign tax-exempt organization, including foreign private foundations: 外國免稅組織，包含外國私人基金會：

If any of the income to which this certification relates constitutes income includible under section 512 in computing the entity’s unrelated business

taxable income, attach a statement identifying the amounts.

倘此證明相關的任何收入在第 512 節下，可計入與該法人業務無關之應稅所得，須附上可供辨識金額的聲明。

Check either box 13a or box 13b: 勾選 13a 或 13b:

a □ I certify that the entity identified in Part I has been issued a determination letter by the IRS dated __________________________ that is

currently in effect and that concludes that it is an exempt organization described in section 501(c).

本人保證，第一部份所列示之法人已取得美國國稅局於______________________(日期)核發且目前仍有效的確認函，且該確認函可斷定其為第

501(c)節所述之免稅組織。

b □ I have attached to this form an opinion from U.S. counsel concluding that the entity identified in Part I is described in section 501(c).

本人已隨表附上美國律師意見函確認第一部分列示之法人符合第 501(c)節規範。

For section 501(c)(3) organizations only, check either box 13c or box 13d: 限第 501(c)(3)節組織，勾選 13c 或 13d:

c □ If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that the

organization is not a private foundation described in section 509. I have attached an affidavit of the organization setting forth sufficient facts for

the IRS to determine that the organization is not a private foundation because it meets one of the exceptions described in section 509(a)(1), (2),

(3), or (4).

倘律師確認函或意見函可斷定第一部分列示之法人符合第 501(c)(3)節規範，本人保證，該組織非為第 509 節所述之私人基金會。本人已附上該組

織之誓詞，可向美國國稅局提供充分事實，以確認該組織因符合第 509(a)(1), (2), (3), or (4)節所述之例外規範，故非一私人基金會。

d □ If the determination letter or opinion of counsel concludes that the entity identified in Part I is described in section 501(c)(3), I certify that

the organization is a private foundation described in section 509.

若確認函或律師意見函斷定第一部分列示之法人符合第 501(c)(3)節規範，本人保證，此組織為第 509 節所述之私人基金會。

14 For a government of a U.S. possession: 美國屬地政府：

□ I certify that the entity identified in Part I is a government of a possession of the United States, or is a political subdivision thereof, and is

claiming the exemption granted by section 115(2).

本人保證，第一部份所列示之法人為一美國屬地政府或其政治分支機構，且該法人主張其符合第 115(2)節之豁免規範。

Part III

Qualification Statement for Chapter 4 Status (if required)

第三部分

第四章狀態資格聲明 (倘必要)

15 For a nonreporting IGA FFI: 在跨政府協議下毋須申報的外國金融機構：

□ I certify that the entity identified in Part I: 本人保證第一部份列示之法人:

 Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States

and_________________________. 符合美國及_______________________跨政府協議條款中被視為免申報的金融機構條件。

 Is treated as a _____________________ under that provisions of the applicable IGA (see instructions); and

於適用的跨政府協議條款(詳見說明)中被視為一_____________________;且

 If you are an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 IGA, provide your GIIN:

► _________________________.

倘您為在模式二跨政府協議下被視為註冊視同合規的外國金融機構，請提供全球中間機構識別號碼: ► _________________________。

16 For a territory financial institution: 美國屬地金融機構：

□ I certify that the entity identified in Part I is a financial institution that is incorporated or organized under the laws of a possession of the United

States. 本人保證第一部份列示之法人為一註冊或成立於美國屬地之金融機構。

17 For a foreign government (including a political subdivision), government of a U.S. possession, or foreign central bank of issue:

外國政府(包括政治分支機構)、美國屬地政府或發行貨幣的外國中央銀行：

□ I certify that the entity identified in Part I is the beneficial owner of the payment and is not engaged in commercial financial activities of a type

engaged in by an insurance company, custodial institution, or depository institution with respect to the payments, accounts, or obligations for which

this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)).

本人保證第一部份列示之法人為款項之最終受益人且該法人未從事商業金融活動，該商業金融活動為一類由保險公司、保管機構或存款機構所從事之

與此表格所提交之款項、帳戶或其他義務相關之業務(美國稅法第 1.1471-6(h)(2)節核准者除外).

18 For an exempt retirement plan of a foreign government: 外國政府的豁免的退休計畫：

□ I certify that the entity identified in Part I: 本人保證第一部份列示之法人: