Attachment To Form W-8 Ben - Bac Florida Bank printable pdf download

Attachment To Form W-8 Ben - Bac Florida Bank

ATTACHMENT TO FORM W-8 BEN

NOTE:

Every account holder who has completed, signed and

presented to BAC Florida Bank a Form W-8BEN claiming foreign status

must also complete both parts (Part I and Part II) of this “Attachment

to Form W-8BEN” if the foreign person has a U.S. mailing address

shown on the Form W-8BEN presented in order to explain the reason

for having such U.S. address.

TO:

BAC Florida Bank

RE:

EXPLANATION FOR U.S. MAILING ADDRESS SHOWN ON FORM W-8BEN PROVIDED

TO BAC FLORIDA BANK

_________________________________________________________________________

(Name of individual or entity that is beneficial owner of the account at BAC Florida Bank)

I have completed, signed under penalties of perjury, and presented to BAC Florida Bank a

Form W-8BEN claiming foreign status for purposes of U.S. income tax, because I am not a

U.S. citizen, U.S. resident alien or other U.S. person for these purposes. However, having

provided a U.S. mailing address on the Form W-8BEN, I submit this “Attachment to Form

W-8BEN” to explain the circumstances thereof.

Part I. Please check the appropriate box below and provide the information requested:

The U.S. mailing address provided on my Form W-8BEN presented to BAC Florida Bank

is not my permanent residence address and is used for convenience purposes only, such

as a vacation home, the home of a relative or some other address where receipt of mail

and similar notices is particularly convenient.

Other – I explain below the reason for using the U.S. mailing address provided on my

Form W-8BEN presented to BAC Florida Bank, despite the fact that such address is not

my permanent residence address:

______________________________________________________________________

I hereby provide a copy of one or both of the documents listed below (see document(s)

checked) to support further my claim of foreign status.

Driver's License

Passport

Signature:

_________________________

Name:

________________________________

Capacity Acting: _______________________

Date:

____________________________

Attachment To Form W-8 Ben - Bac Florida Bank