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 16

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participating FFI, or a reporting Model 1 FFI that has agreed
withhold on the payment. You may provide your chapter 4
to act as a designated withholding agent with respect to you
status on this form even if you are not required to do so.
(see Regulations section 1.1471-5(f)(3)).
Certification of Chapter 4 Status:
You must also check either box 24b or 24c. Check
box 24b to certify that you have provided or will provide the
Parts IX Through XXVIII
documentation set forth in the certifications, including the
You should complete only one part certifying to your
owner reporting statement described in this line 24b. Check
chapter 4 status (if required). Identify which part (if any) you
box 24c to certify that you have provided or will provide an
should complete by reference to the box you checked on
auditor’s letter (in lieu of the information required by
line 5.
line 24(b)) that satisfies the requirements described in this
line.
Part IX — Nonparticipating FFI With
Part XII — Certified
Exempt Beneficial Owners
Deemed-Compliant Nonregistering
You are not required to complete this part unless you
Local Bank
are a nonparticipating FFI providing documentation
TIP
on behalf of an exempt beneficial owner.
You must check box 25 to certify that you satisfy all of the
requirements for certified deemed-compliant nonregistering
Check box 22 to certify that you are transmitting
local bank status.
withholding certificates or other documentation for exempt
Part XIII — Certified
beneficial owners for chapter 4 purposes on whose behalf
you are receiving a payment that is a withholdable payment.
Deemed-Compliant FFI with Only
See Regulations section 1.1471-6. You must also certify that
you have provided or will provide a withholding statement (as
Low-Value Accounts
required) allocating a portion of the payment to the exempt
You must check box 26 to certify that you satisfy all of the
beneficial owners as required under Regulations section
requirements for certified deemed-compliant FFI with only
1.1471-3(d)(8)(ii). The withholding statement must include
low-value account status.
the name, address, TIN (if any), entity type, and chapter 4
status of each exempt beneficial owner on behalf of which
Part XIV — Certified
you are receiving the payment, the amount of the payment
Deemed-Compliant Sponsored,
allocable to each exempt beneficial owner, a valid
withholding certificate or other documentation sufficient to
Closely Held Investment Vehicle
establish the chapter 4 status of each exempt beneficial
owner under the requirements of chapter 4, and any other
On line 27a, enter the name of the sponsoring entity that has
information the withholding agent reasonably requests in
agreed to fulfill your chapter 4 due diligence, reporting, and
order to fulfill its obligations under chapter 4. Additionally, the
withholding obligations on your behalf. You must also enter
withholding statement must provide all information required
the GIIN of your sponsoring entity on line 9.
for purposes of chapter 3 with respect to each exempt
You must check box 27b to certify that you satisfy the
beneficial owner if the payment is an amount subject to
requirements for certified deemed-compliant classification as
chapter 3 withholding. The withholding statement must
a sponsored closely held investment vehicle.
allocate the remainder of the payment that is not allocated to
an exempt beneficial owner to you.
Part XV — Certified
Part X — Sponsored FFI
Deemed-Compliant Limited Life Debt
If you are a sponsored FFI described in Regulations section
Investment Entity
1.1471-5(f)(1)(i)(F), on line 23a, enter the name of the
You must check box 28 to certify that you satisfy the
sponsoring entity that has agreed to fulfill your chapter 4 due
requirements for certified deemed-compliant limited life debt
diligence, reporting, and withholding obligations on your
investment entity status.
behalf. You must provide your GIIN on line 9.
Part XVI — Certain Investment
You must check the applicable box in line 23b or 23c to
certify that you are either an investment entity or controlled
Entities that Do Not Maintain
foreign corporation (within the meaning of section 957(a))
Financial Accounts
and satisfy the other relevant requirements for this
classification.
You must check box 29 to certify that you meet all of the
Part XI — Owner-Documented FFI
requirements for certified deemed-compliant status as an
investment entity that does not maintain financial accounts.
An owner-documented FFI should only complete
Part XVII — Restricted Distributor
Form W-8IMY if it is a flow-through entity receiving
!
income allocable to its partners, owners, or
You must check box 30a to certify that you satisfy the
CAUTION
beneficiaries. An owner-documented FFI is not permitted to
requirements of restricted distributor status.
act as an intermediary with respect to a withholdable
You must also check either box 30b or 30c, as
payment.
appropriate, to certify that your distribution agreement meets
You must check box 24a to certify that you satisfy the
the requirements of this classification.
requirements for owner-documented FFI status and are
providing this form to a U.S. financial institution, a
-16-
Instructions for Form W-8IMY (Rev. 6-2017)

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