Instructions For The Requester Of Forms W-8ben, W-8ben-E, W-8eci, W-8exp, And W-8imy

Content of Substitute Form

W-8BEN-E, earlier in these instructions. The certifications

in Part III must be included only if treaty benefits are

Form W-8BEN. The substitute Form W-8BEN must

claimed, and then only to the extent that the certifications

contain all of the information required in Part I, lines 1

are required. See

Alternative Certifications Under an

through 7, and line 8. The certifications in Part II must be

Applicable

IGA, earlier in these instructions, for

included in a substitute form only if treaty benefits are

circumstances in which the chapter 4 certifications may

claimed, and then only to the extent that the certifications

be replaced with alternative certifications.

are required. For example, Form W-8BEN, line 10, special

Penalties of perjury statement. The design of the

rates and conditions (applicable to a claim for treaty

substitute Form W-8BEN-E must be such that the

benefits), is not required if this form is being requested

information and certifications that are being attested to by

from an individual receiving a payment of U.S. source

the penalties of perjury statement clearly stand out from

dividends from stocks that are actively traded on an

any other information contained on the form. Additionally,

established securities market.

the following statement must be presented in the same

Penalties of perjury statement. The design of the

manner as in the preceding sentence and must appear

substitute Form W-8BEN must be such that the

immediately above the single signature line: “The Internal

information and certifications that are being attested to by

Revenue Service does not require your consent to any

the penalties of perjury statement clearly stand out from

provisions of this document other than the certifications

any other information contained on the form. Additionally,

required to establish your status as a non-U.S. person,

the following statement must be presented in the same

establish your chapter 4 status (if required), and, if

manner as in the preceding sentence and must appear

applicable, obtain a reduced rate of withholding. ”

immediately above the single signature line: “The Internal

Form W-8ECI. The substitute Form W-8ECI must contain

Revenue Service does not require your consent to any

all of the information required in Part I other than line 9.

provisions of this document other than the certifications

The certifications in Part II of Form W-8ECI must be

required to establish your status as a non-U.S. individual

included in a substitute form.

and, if applicable, obtain a reduced rate of withholding.”

Penalties of perjury statement. The design of the

substitute Form W-8ECI must be such that the information

Non-IRS Form for Individuals

and certifications that are being attested to by the

A withholding agent may also substitute its own form for

penalties of perjury statement clearly stand out from any

an official Form W-8BEN, regardless of whether the

other information contained on the form. Additionally, the

substitute form is titled as a Form W-8. The form must

following statement must be presented in the same

include the name and address of the individual that is the

manner as in the preceding sentence and must appear

payee or beneficial owner, all countries in which the

immediately above the single signature line: “The Internal

individual is resident for tax purposes, the individual’s city

Revenue Service does not require your consent to any

and country of birth, and a tax identification number, if

provisions of this document other than the certifications

any, for each country of residence. The form may also

required to establish your status as a non-U.S. person and

request other information required for purposes of tax or

that the income for which this form is provided is

anti-money laundering (AML) due diligence in the United

effectively connected with the conduct of a trade or

States or in other countries.

business within the United States.”

Penalties of perjury statement. A non-IRS form for

Form W-8EXP. The substitute Form W-8EXP must

individuals must contain a signed and dated certification

contain all of the information required in Part I, lines 1

made under penalties of perjury that the information

through 5, line 7, if a U.S. TIN is required, and line 8. The

provided on the form is accurate and will be updated by

substitute Form W-8EXP must also contain all of the

the individual within 30 days of a change in circumstances

statements and certifications contained in Parts II and III

that causes the form to become incorrect. However, the

as applicable with respect to the purpose for which the

signed certification provided on a form need not be signed

form is provided, but a specific statement needs to be

under penalties of perjury if the form is accompanied by

included (in its entirety) only if it is relevant to the type of

documentary evidence that supports the individual’s claim

entity providing the form. For example, if the only

of foreign status. Such documentary evidence may be the

beneficial owners a U.S. withholding agent has as

same documentary evidence that is used to support

account holders are foreign governments for purposes of

foreign status in the case of a payee whose account has

both chapters 3 and 4, the withholding agent may use a

U.S. indicia as described in Regulations sections

substitute Form W-8EXP that contains the required

1.1471-3(e) and 1.1471-4(c)(4)(i)(A).

information in Part I, plus the required statements and

Form W-8BEN-E. The substitute Form W-8BEN-E must

certifications from Parts II and III that are related to foreign

contain all of the information required in Part I, lines 1

governments, as opposed to the certifications for other

through 6, and lines 8 and 9 if a U.S. or foreign TIN (or a

types of entities that would otherwise be providing the

GIIN) is required. The certifications in Part II must be

Form W-8EXP.

included in a substitute form if you are making a

Penalties of perjury statement. The design of the

withholdable payment to a branch or disregarded entity

substitute Form W-8EXP must be such that the

owned by the payee that is a class of FFI identified in Part

information and certifications that are being attested to by

II operating in a jurisdiction other than the jurisdiction of

the penalties of perjury statement clearly stand out from

residency of the entity named in Part I of the form. See

any other information contained on the form. Additionally,

discussion regarding payments to branches or

the following statement must be presented in the same

disregarded entities in

Further Notes for Validating Form

-14-

Instructions for the Requester of Forms W-8 (Rev. 7-2014)

Instructions For The Requester Of Forms W-8ben, W-8ben-E, W-8eci, W-8exp, And W-8imy - 2014 Page 14

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