Instructions For Form W-8imy - Certificate Of Foreign Intermediary, Foreign Flow-Through Entity, Or Certain U.s. Branches For United States Tax Withholding And Reporting - 2016 Page 12

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Example 4. The facts are the same as Example 1,
potential section 871(m) transactions or underlying securities
except the QI is a non-U.S. payor that does not assume
(as defined in Regulations section 1.871-15(a)(15)),
primary withholding and reporting responsibility under
respectfully, as a QDD;
chapter 3 and chapter 4. The QI also does not assume
Designate the accounts for which the QDD is receiving
primary Form 1099 and backup withholding responsibility.
dividend equivalents with respect to potential section 871(m)
transactions as a QDD (and that are not underlying
If the QI does not assume primary withholding and
securities) for which withholding is not required;
reporting responsibility under chapter 3 and chapter 4 as well
Designate the accounts for which the QDD is receiving
as primary Form 1099 reporting and separate backup
payments with respect to underlying securities for which
withholding responsibilities, the QI will provide an FFI
withholding is required as a QDD; and
withholding statement with the following pools:
Identify the home office or branch that is treated as the
Nonparticipating FFI Pool — $20 (which is subject to
owner for U.S. income tax purposes.
chapter 4 withholding);
Recalcitrant Account Holder Pool — $20 (which is subject
If you are acting as a QDD that meets the conditions
to chapter 4 withholding and which is aggregated in a single
described below, you must provide on your QDD withholding
pool of recalcitrant account holders rather than each class
statement your taxpayer identification number (TIN) issued
described in Regulations section 1.1471-4(d)(6));
by the jurisdiction in which you are tax resident identified on
Chapter 4 Withholding Rate Pool of U.S. Payees — $10
line 6, unless you were not issued a TIN (including if the
(for the portion of the payment allocable to A and B);
jurisdiction does not issue TINs). If you do not provide your
Chapter 3 30% Rate Pool — $10;
TIN, you must provide on your QDD withholding statement
Chapter 3 15% Rate Pool — $10; and
an explanation of why you have not been issued a TIN. For
0% Rate Pool — $10 (for the portion of the payment
this purpose, an explanation is a statement that you are not
allocable to C).
legally required to obtain a TIN in your jurisdiction of tax
residence. Do not write “not applicable.” If you are acting as a
The QI will also be required to allocate $20 to a separate
QDD, you are required to provide your TIN or an explanation
withholding rate pool for D because D is a U.S. non-exempt
of why you have not been issued a TIN if:
recipient who cannot be included in a chapter 4 withholding
You are providing this Form W-8IMY to document yourself
rate pool of U.S. payees (because D’s account is maintained
as an account holder (as defined in Regulations section
by a certified deemed-compliant FFI). The QI will provide
1.1471-5(a)(3)) with respect to a financial account (as
Form W-8IMY and check boxes 14, 15c, and 15d.
defined in Regulations section 1.1471-5(b)) that you hold at a
Alternative procedure for U.S. non-exempt recipients.
U.S. office of a financial institution (including a U.S. branch of
If approved by the withholding agent, you can establish:
an FFI);
A single pool (not subject to backup withholding) for all
You receive U.S. source income reportable on a Form
U.S. non-exempt recipient account holders for whom you
1042-S associated with this form; and
have provided Forms W-9 or are includible in a chapter 4
This form is treated as a beneficial owner withholding
withholding rate pool of U.S. payees prior to the withholding
certificate under Regulations section 1.1441-1(e)(2)(i).
agent making any payments. Alternatively, you may include
Part IV — Nonqualified Intermediary
such U.S. non-exempt recipients in a zero rate withholding
pool that includes U.S. exempt recipients and foreign
If you are providing Form W-8IMY as a nonqualified
persons exempt from non-resident alien withholding provided
intermediary (NQI), you must check box 17a. By checking
all the conditions of the alternative procedure are met; and
this box, you are certifying to all of the statements on
A separate pool for all U.S. non-exempt recipient account
line 17a.
holders subject to backup withholding for whom you have not
provided Forms W-9 prior to the withholding agent making
If you are required to provide a chapter 4 status on
any payments.
line 5 and are acting as an intermediary for a
TIP
withholdable payment, you must provide your
If you elect the alternative procedure, you must provide
chapter 4 status on line 5 or as otherwise permitted in these
the allocation information required by your QI withholding
instructions to avoid withholding at the chapter 4 rate of 30%
agreement to the withholding agent no later than January 15
being applied to any withholdable payment you receive from
of the year following the year in which the payments are paid.
the withholding agent regardless of whether you check
Failure to provide this information may result in penalties
box 17b (except for documentation provided with respect to
under sections 6721 and 6722 and termination of your
exempt beneficial owners).
withholding agreement with the IRS.
The amount allocable to these two pools under the
Check box 17b if you are using this form to transmit
alternative procedure excludes amounts allocated to
!
withholding certificates or other documentation along with a
the chapter 4 withholding rate pool of U.S. payees.
withholding statement that satisfies the requirements of
CAUTION
chapters 3 and 4 (including if you are providing pooled
Updating the statement. Your withholding statement must
information for purposes of chapter 61 under the alternative
be updated as often as is necessary to allow the withholding
procedure for U.S. non-exempt recipients, or chapter 4
agent to withhold at the appropriate rate on each payment
withholding rate pools (as applicable) for a withholdable
and to correctly report the income to the IRS. The updated
payment).
information becomes an integral part of Form W-8IMY.
Check box 17c to certify that you are permitted under
QDD withholding statement. In addition to the information
Regulations section 1.6049-4(c)(4) to provide a chapter 4
required on a withholding statement (if any) you provide in
withholding rate pool of U.S. payees to which a payment is
your QI capacity, a QDD withholding statement should (as
allocated on a withholding statement associated with the
applicable) for each QDD:
Form W-8IMY.
Designate the accounts for which the QDD is receiving
dividend equivalent or dividend payments with respect to
-12-
Instructions for Form W-8IMY (Rev. 6-2017)

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