Specific Instructions

Table of Contents

Part I — Identification of Entity

Line 1.   Enter your name. By doing so, you are representing to the payer or withholding agent that you are not the beneficial owner of the amounts that will be paid to you (unless you are acting as a QSL for certain payments associated with this form). If you are a disregarded entity, do not enter the business name of the disregarded entity here. Instead, enter the legal name of the entity that owns the disregarded entity (looking through multiple disregarded entities, if applicable).

Line 2.   If you are a corporation, enter the country of incorporation. If you are another type of entity, enter the country under whose laws you are created, organized, or governed. If you are an individual, provide your country of residence for tax purposes.

Line 3.    If you are a disregarded entity receiving a payment, enter your name (if required). You should complete line 3 only if you are a disregarded entity receiving a withholdable payment or hold an account with an FFI requesting this form and you:
  • Have registered with the IRS and been assigned a GIIN associated with the legal name of the disregarded entity; and

  • Are a reporting Model 1 FFI or reporting Model 2 FFI .

  If you are not required to provide the legal name of the disregarded entity, however, you may want to notify the withholding agent that you are a disregarded entity receiving a payment or maintaining an account by indicating the name of the disregarded entity on line 10. However, do not enter the name of the disregarded entity on this line except in the circumstances described.

Line 4.   Complete this line to establish your entity status for purposes of chapter 3. Check the one box that applies. If you are a foreign partnership receiving the payment on behalf of your partners, check the “Withholding foreign partnership” box or the “Nonwithholding foreign partnership” box, whichever is appropriate. If you are a foreign simple trust or foreign grantor trust receiving the payment on behalf of your beneficiaries or owners, check the “Withholding foreign trust” box, the “Nonwithholding foreign simple trust” box, or the “Nonwithholding foreign grantor trust” box, whichever is appropriate. If you are a foreign partnership (or a foreign trust) receiving a payment on behalf of persons other than your partners (or beneficiaries or owners), check the “Qualified intermediary” box or the “Nonqualified intermediary” box, whichever is appropriate. A foreign reverse hybrid entity that is providing documentation from its interest holders to claim a reduced rate of withholding under a treaty should check the appropriate box (including “Withholding foreign partnership” or “Withholding foreign trust” if the entity has entered into a withholding agreement). See Parts III through VIII, later, if you are acting in more than one capacity. A partnership or grantor trust submitting Form W-8IMY solely because it is allocated income effectively connected with a U.S. trade or business as a partner in a partnership should check the box for nonwithholding foreign partnership or nonwithholding foreign grantor trust and, if it is submitting or will submit documentation for its partners or owners, it should complete Part VIII.

  
Form W-8IMY may be submitted and accepted to satisfy documentation requirements for purposes of withholding on certain partnership allocations to foreign partners under section 1446. Section 1446 generally requires withholding when a partnership is conducting a trade or business in the United States and allocates income effectively connected with that trade or business (ECI) to foreign persons that are partners in the partnership. Section 1446 can also apply when certain income is treated as effectively connected income of the partnership and is so allocated.

  
An upper-tier partnership that is allocated ECI as a partner in a partnership may, in certain circumstances, have the lower-tier partnership perform its withholding obligation. Generally, this is accomplished by the upper-tier partnership submitting withholding certificates of its partners (for example, Form W-8BEN) along with a Form W-8IMY, which identifies itself as a partnership, and identifying the manner in which ECI of the upper-tier partnership will be allocated to the partners. For further information, see Regulations section 1.1446-5. A foreign grantor trust that is allocated ECI as a partner in a partnership should provide the withholding certificates of its grantor (for example, Form W-8BEN) along with its Form W-8IMY which identifies the trust as a foreign grantor trust. See Regulations section 1.1446-1(c)(2(ii)(E) for the rules requiring it to provide additional documentation to the partnership.

Line 5.   Check the one box that applies to your chapter 4 status. You are not required to provide a chapter 4 status if you are providing this form with respect to a preexisting entity account (as described in Regulations section 1.1471-1(b)(102)) prior to July 1, 2016 (or, if you are a prima facie FFI, prior to January 1, 2015). Additionally, you are only required to provide a chapter 4 status if you are acting as an intermediary with respect to a withholdable payment, you are a flow-through entity receiving a withholdable payment on behalf of your owners (including a reverse hybrid entity providing documentation on behalf of its owners to claim treaty benefits), you are providing a withholding statement associated with this form that allocates a portion of the payment to a chapter 4 withholding rate pool of U.S. payees with respect to your direct account holders (as described in Regulations section 1.6049-4(c)(4), or you are providing this form to an FFI requesting this form to document your chapter 4 status. By checking a box on this line, you are representing that you qualify for this classification.

  
For most of the chapter 4 classifications, you are required to complete additional certifications found in a separate part of this form (see Parts IX through XXVII). Complete the appropriate part of this form certifying that you meet the conditions of the status indicated on line 5 (as defined under Regulations sections 1.1471-5 or 1.1471-6). Make sure you complete the required portion of this form before signing and providing it to the withholding agent.

FFIs Covered by IGAs and Related Entities

A reporting FFI resident in, or established under the laws of, a jurisdiction covered by a Model 1 IGA should check “Reporting Model 1 FFI.” A reporting FFI resident in, or established under the laws of, a jurisdiction covered by a Model 2 IGA should check “Reporting Model 2 FFI.” If you are treated as a registered deemed-compliant FFI under an applicable IGA, you should check “Nonreporting IGA FFI” rather than “registered deemed-compliant FFI.” See the specific instructions for Part XVIII. An FFI that is related to a reporting IGA FFI and that is treated as a nonparticipating FFI in its country of residence should check nonparticipating FFI in line 5. An FFI that is related to a reporting IGA FFI and that is a participating FFI, deemed-compliant FFI, or exempt beneficial owner under the U.S. Treasury regulations or an applicable IGA should check the appropriate box depending on its chapter 4 status rather than the box for nonparticipating FFI.

See www.treasury.gov/resource-center/tax-policy/treaties/Pages/FATCA-Archive.aspx for a list of jurisdictions treated as having an IGA in effect.

Line 6.   Enter the permanent address of the entity identified on line 1. Your permanent residence address is the address in the country where you claim to be a resident for purposes of that country's income tax. Do not show the address of a financial institution (other than yourself), a post office box, or an address used solely for mailing purposes unless such address is the only permanent address you use and it appears in your organizational documents (i.e., your registered address). If you do not have a tax residence in any country, the permanent residence address is where you maintain your principal office or, if you are an individual, where you normally reside.

Line 7.   Enter your mailing address only if it is different from the address you show on line 6.

Line 8.   You must provide an employer identification number (EIN) if you are a U.S. branch or territory financial institution that agrees to be treated as a U.S. person under Regulations section 1.1441-1(b)(2)(iv)(A), an upper-tier partnership that is allocated ECI as a partner in a partnership, or a foreign grantor trust that is allocated ECI as a partner.

   If you are acting as a qualified intermediary, withholding foreign partnership, or withholding foreign trust, check the appropriate box and enter the EIN that was issued to you in such capacity (your “QI-EIN,” “WP-EIN,” or “WT-EIN”). If you are not acting in that capacity, you must use your U.S. taxpayer identification number (TIN), if any, that is not your QI-EIN, WP-EIN, or WT-EIN.

  A nonqualified intermediary, a nonwithholding foreign partnership, or a nonwithholding foreign simple or grantor trust is generally not required to provide a U.S. TIN. However, a QSL providing this form with respect to a U.S. source substitute dividend must provide an EIN (including a QI-EIN if the QSL is a QI).

Line 9.   If you are a participating FFI (including reporting Model 2 FFI), registered deemed-compliant FFI (including a reporting Model 1 FFI), direct reporting NFFE (including a sponsored direct reporting NFFE), or trustee of a trustee documented FFI, you are required to enter your GIIN (with regard to your country of residence) on line 9.

  For payments made prior to January 1, 2015, however, a Form W-8IMY provided by a reporting Model 1 FFI need not contain a GIIN. For payments made prior to January 1, 2016, a sponsored direct reporting NFFE or sponsored FFI that has not obtained a GIIN may provide the GIIN of its sponsoring entity.

If you are in the process of registering with the IRS as a participating FFI, registered deemed-compliant FFI, reporting Model 1 FFI, reporting Model 2 FFI, direct reporting NFFE, or sponsored direct reporting NFFE but have not received a GIIN, you may complete this line by writing “applied for.” However, the person requesting this form from you must receive and verify your GIIN within 90 days.

Line 10.   This line may be used by the filer of Form W-8IMY or by the withholding agent to whom it is provided to include any referencing information that is useful to the withholding agent in carrying out its reporting and withholding obligations. For example, a withholding agent who is required to associate a particular Form W-8BEN or Form W-8BEN-E with this Form W-8IMY may want to use line 10 for a referencing number or code that will make the association clear.

Part II — Disregarded Entity or Branch Receiving Payment

Only complete Part II if you are a branch of an FFI identified in line 1 receiving a withholdable payment as an intermediary (including a branch that is a disregarded entity) and you operate in a jurisdiction other than the country of residence identified on line 2. For example, assume ABC Co., which is a participating FFI resident in Country A, operates through a branch in Country B (which is a Model 1 IGA jurisdiction) and the branch is treated as a reporting Model 1 FFI under the terms of the Country B Model 1 IGA. ABC Co. should not enter its GIIN on line 9, and the Country B branch should complete this Part II by identifying itself as a reporting Model 1 IGA FFI and providing its GIIN on line 13. Furthermore, if the Country B branch receiving the payment is a disregarded entity you may be required to provide its legal name on line 3. See the instructions for Part I, line 3.

Line 11.   Check the one box that applies. If you check reporting Model 1 FFI, reporting Model 2 FFI, participating FFI, or U.S. branch claiming a chapter 4 status other than that of nonparticipating FFI, you must complete line 13. If you are a limited branch or branch of a reporting IGA FFI that cannot comply with the requirements of an applicable IGA or the regulations under chapter 4, you must check nonparticipating FFI.

Line 12.   Enter the address of the branch or disregarded entity.

Line 13.   If you are a reporting Model 1 FFI, reporting Model 2 FFI, or participating FFI, you must enter on line 13 the GIIN of your branch that receives the payment. If you are a disregarded entity that completed Part I, line 3 of this form and are receiving payments associated with this form, enter your GIIN. Do not enter your GIIN (if any) on line 9. If you are a U.S. branch, enter a GIIN applicable to any other branch of the FFI (including in its residence country) of which the branch is a part. For payments made prior to January 1, 2015, however, a GIIN is not required if you check reporting Model 1 FFI on line 11. If you are a QI that is an NFFE and a withholding agent requests your chapter 4 status, you may provide a statement certifying to your chapter 4 status as an NFFE.

  
If you are in the process of registering with the IRS as a participating FFI, reporting Model 1 FFI, or reporting Model 2 FFI but have not received a GIIN, you may complete this line by writing “applied for.” However, the person requesting this form from you must receive and verify your GIIN within 90 days.

Certification of Chapter 3 Status: Parts III Through VIII

You should only complete one part from Parts III through VIII. If you are acting in multiple capacities, provide separate Forms W-8IMY for each capacity. For example, if you are acting as qualified intermediary for one account, but a nonqualified intermediary for another account, provide one Form W-8IMY in your capacity as a qualified intermediary and a separate Form W-8IMY in your capacity as a nonqualified intermediary.

Part III — Qualified Intermediary

Check box 14a if you are a qualified intermediary (QI) (whether or not you assume primary withholding responsibility) for the income for which you are providing this form. A QI that is an FFI receiving a withholdable payment must be a participating FFI, registered deemed-compliant FFI, exempt beneficial owner that is a central bank of issue that meets the requirements of and agrees to be treated as a participating FFI (including a reporting Model 2 FFI) or a registered deemed-compliant FFI (including a reporting Model 1 FFI) with respect to any account that it maintains and that is held in connection with a commercial financial activity described in Regulations section 1.1471-6(h) and for which it receives a withholdable payment, or FFI treated as a deemed-compliant FFI under an applicable IGA that is subject to due diligence and reporting requirements similar to those applicable to a registered deemed-compliant FFI. By checking the box, you are certifying to all of the statements contained on line 14a.

Check box 14b only if you are not providing a withholding statement with this form because you have assumed primary withholding responsibility under both chapter 3 (nonresident alien withholding) and chapter 4 with respect to the account(s) and you are either assuming primary Form 1099 reporting and backup withholding responsibility or are permitted to satisfy and do satisfy your chapter 61 requirements as a participating FFI or registered deemed-compliant FFI as described in Regulations section 1.6049-4(c)(4).

Check box 14c if you have assumed only primary withholding responsibility under both chapter 3 (nonresident alien withholding) and chapter 4 with respect to the account(s) identified on this line or in a withholding statement associated with this form.

Check box 14d if you have assumed only primary Form 1099 reporting and backup withholding responsibility with respect to the accounts identified on this line or in a withholding statement associated with this form (including satisfying as a participating FFI or registered deemed-compliant FFI your Form 1099 reporting to the extent permitted under Regulations sections 1.6049-4(c)(4)(i) and (c)(4)(ii)).

Check box 14e only if you have not assumed primary Form 1099 reporting and backup withholding responsibility and are transmitting Forms W-9 (or otherwise providing information for the withholding agent to report on Form 1099, including when backup withholding applies or withholding under chapter 4 with respect to recalcitrant account holders) with respect to each U.S. non-exempt recipient account identified on this line or in a withholding statement associated with this form. If you are allocating any portion of the payment on a withholding statement to a chapter 4 withholding rate pool of U.S. payees in lieu of providing Forms W-9, you must additionally certify that (as applicable):

  • For each account holder included in a chapter 4 withholding rate pool of U.S. payees who holds an account that you maintain, you are permitted to provide this pool under Regulations section 1.6049-4(c)(4)(iii) (including for payments of income other than interest for which reporting would be required under chapter 61 but for a coordination rule similar to that provided in Regulations section 1.6049-4(c)(4)(iii)); and/or

  • For a withholding rate pool of U.S. payees that includes account holders of another intermediary or flow-through entity, you have obtained or will obtain documentation to establish that the intermediary or flow-through entity is a participating FFI, registered deemed-compliant FFI, or a qualified intermediary. See Regulations sections 1.1471-3(d)(4) and 1.1471-3(e) for more information on the requirements for documenting such chapter 4 statuses.

Check box 14f to certify that you are a QI that is acting as a QSL with respect to all payments associated with this form that are U.S. source substitute dividends made by a party to a securities lending transaction (as described in Notice 2010-46).

Although a QI obtains withholding certificates or appropriate documentation from beneficial owners, payees, and, if applicable, shareholders, as specified in its withholding agreement with the IRS, a QI does not need to attach the certificates or documentation to this form. However, to the extent you have not assumed primary Form 1099 reporting or backup withholding responsibility and are not permitted to allocate the payment to a chapter 4 withholding rate pool of U.S. payees under Regulations section 1.6049-4(c)(4)(iii), you must disclose the names of those U.S. persons for whom you receive reportable amounts and that are not exempt recipients (as defined in Regulations section 1.6049-4(c)(1)(ii) or under section 6041, 6042, 6045, or 6050N). You should make this disclosure by attaching to Form W-8IMY the Forms W-9 (or substitute forms) of persons that are U.S. non-exempt recipients. If you do not have a Form W-9 for a non-exempt U.S. payee, you must attach to Form W-8IMY any information you do have regarding that person’s name, address, and TIN for a withholding agent to report the payment.

Withholding statement of a QI.    As a QI, you must provide a withholding statement to each withholding agent from which you receive reportable amounts or withholdable payments if you have not assumed primary reporting and withholding responsibility under chapter 3 and chapter 4 with respect to the payment and, if you are receiving a reportable amount on behalf of a U.S. nonexempt recipient, you have not assumed primary Form 1099 reporting and backup withholding responsibility for the payment. The withholding statement becomes an integral part of the Form W-8IMY and, therefore, the certification statement that you sign in Part XXVII of the form applies to the withholding statement as well as to the form.

See your QI Agreement for a more comprehensive description of the rules applicable to your withholding statement, including the requirements of the statement under both chapter 3 and chapter 4 for reportable amounts that are also withholdable payments.

A QI withholding statement must:

  • Designate those accounts for which you act as a QI (QI designated account),

  • Designate those accounts for which you are assuming primary withholding and reporting responsibility under chapter 3 and chapter 4 of the Code,

  • If applicable, certify that you are acting as a QSL with respect to any U.S. source substitute dividends, and

  • Provide information to allocate the payment, as applicable, to chapter 3 withholding rate pools and to chapter 4 withholding rate pools.

For chapter 4 purposes.   A QI receiving a withholdable payment must provide a withholding statement which satisfies the requirements of an FFI withholding statement or chapter 4 withholding statement (if the QI is not an FFI) when the QI does not assume primary withholding responsibility under chapter 3 and chapter 4 and Form 1099 reporting and backup withholding responsibility for the payment.

  A QI that is an FFI may provide an FFI withholding statement to allocate the payment to chapter 4 withholding rate pools (as applicable), including a single pool of nonparticipating FFIs, a single pool of recalcitrant account holders of the QI or another intermediary that is a participating FFI or registered deemed-compliant FFI, and, if the QI does not assume primary Form 1099 and backup withholding responsibility, a chapter 4 withholding rate pool of U.S. payees. See also Form 1099 reporting, later. A chapter 4 withholding rate pool of U.S. payees may include:
  • If the QI is a reporting Model 1 FFI, an account holder that is not withheld on under chapter 3, chapter 4, or section 3406 that the QI reports as a U.S. account pursuant to the Model 1 IGA because the account has U.S. indicia and the QI has not obtained appropriate documentation to treat the account as held by other than a specified U.S. person;

  • If the QI is a reporting Model 2 FFI, an account holder that is not withheld on under chapter 3, chapter 4, or section 3406 that the QI reports as an account holder of a non-consenting U.S. account as described in the Model 2 IGA;

  • For a non-U.S. payor (as described in Regulations section 1.6049-5(c)(5)) that is a participating FFI (including a reporting Model 2 FFI), registered deemed-compliant FFI, or reporting Model 1 FFI, an account holder not withheld on under chapter 4 or section 3406 who the QI reports under chapter 4 or an applicable IGA (including the account holder’s TIN).

  An FFI withholding statement must also identify each intermediary or flow-through entity that is receiving a payment on behalf of a payee and include such entity’s chapter 4 status and GIIN (if applicable), excluding any intermediary or flow-through entity that is an account holder or interest holder in another QI, WP, or WT. An FFI withholding statement of a QI may combine withholding rate pool information provided by such an entity to the QI with withholding rate pools comprised of accounts that the QI maintains.

  A QI that is not an FFI and that does not assume primary withholding responsibility under chapter 3 and chapter 4 must provide a chapter 4 withholding statement that contains the name, address, TIN (if any), entity type (if applicable), and chapter 4 status of each payee, the amount allocated to each payee, a valid withholding certificate or other documentation sufficient to establish the payee’s chapter 4 status. However, a chapter 4 withholding statement may include pooled information for payees that are nonparticipating FFIs that hold accounts that the QI maintains or hold accounts with an intermediary or flow-through entity receiving the payment from the QI. See Regulations section 1.1474-1(d)(3).

For chapter 3 purposes.   In the case of a reportable amount that is a withholdable payment, any portion of the payment for which you are acting as a QI that is not allocated to a chapter 4 withholding rate pool or a U.S. non-exempt recipient (including for backup withholding purposes) must be allocated to a chapter 3 withholding rate pool or pool of U.S. exempt recipients. A chapter 3 withholding rate pool is a payment of a single type of income, based on the categories of income reported on Form 1042-S or Form 1099 (for example, interest or dividends), that is subject to a single rate of withholding and is exempt from chapter 4 withholding. The chapter 3 withholding rate pool may be established by any reasonable method agreed upon by you and the withholding agent. For example, you may agree to establish a separate account for a single chapter 3 withholding rate pool or you may agree to divide a payment made to a single account into portions allocable to each chapter 3 withholding rate pool. You must provide the chapter 3 withholding rate pool information that is required for the withholding agent to meet its withholding and reporting obligations. A withholding agent may request any information reasonably necessary to withhold and report payments correctly.

Form 1099 reporting.   If you do not assume primary Form 1099 reporting and backup withholding responsibility, you must provide payee specific information for each U.S. non-exempt recipient account holder (other than those U.S. payees included in a chapter 4 withholding rate pool of U.S. payees (described in Regulations section 1.6049-4(c)(4)(iii) and earlier in these instructions) or when the alternative procedure is used (see later)). The pools are based on valid documentation that you obtain under your withholding agreement with the IRS or, if a payment cannot be reliably associated with valid documentation, under the applicable presumption rules.

Example 1.

A QI that is a participating FFI receives a $100 payment of U.S. source dividends on an account that is a QI designated account held with the withholding agent for the following recipients:

  • $20 to NPFFI, a nonparticipating FFI that is an account holder of the QI;

  • $10 each on behalf of two recalcitrant account holders of the QI ($20 total), each with U.S. indicia (as described in Regulations section 1.1441-7(b)(5)) associated with the account;

  • $5 each on behalf of A and B, U.S. individual account holders of the QI that the QI reports as U.S. accounts pursuant to its chapter 4 reporting obligations as a participating FFI ($10 total);

  • $10 on behalf of C, a U.S. exempt recipient that is not a specified U.S. person and is an indirect account holder of the QI (who beneficially owns the payment through an account with another participating FFI);

  • $20 on behalf of D, a U.S. non-exempt recipient that is a specified U.S. person who is an indirect account holder of the QI (that beneficially owns the payment through an account with a certified deemed-compliant FFI described in Regulations section 1.1471-5(f)(2)); and

  • $10 each on behalf of two nonresident alien individuals who are account holders of the QI, one of whom is entitled to a 15% rate of withholding under an applicable income tax treaty.

The dividend payment is both a withholdable payment under chapter 4 and a reportable amount under chapter 3. The QI assumes primary withholding and reporting responsibility under chapter 3 and chapter 4 as well as primary Form 1099 reporting and backup withholding responsibility. As a result, the QI is not required to provide a withholding statement allocating the payment to specific payees or withholding rate pools. The QI will provide Form W-8IMY and check boxes 14a and 14b.

Example 2.

The facts are the same as Example 1, except QI is a non-U.S. payor under Regulations section 1.6049-5(c)(5) and does not assume primary Form 1099 and backup withholding responsibility but reports the accounts of A and B as U.S. accounts under Regulations section 1.1471-4(d).

QI must provide a withholding statement allocating $20 of the payment to D, and $10 to a chapter 4 withholding rate pool of U.S. payees. QI need not allocate any portion of the payment specifically to A or B because QI is a non-U.S. payor that is permitted to include A and B in a chapter 4 withholding rate pool of U.S. payees under Regulations section 1.6049-4(c)(4)(i). The QI will provide Form W-8IMY and check boxes 14a, 14c, 14e, and 14e(i).

Example 3.

The facts are the same as Example 1, except QI is a U.S. payor and does not assume primary Form 1099 and backup withholding responsibility.

Because QI is a U.S. payor, it is not permitted to, under Regulations section 1.6049-4(c)(4)(i) and (iii), to include A and B in a chapter 4 withholding rate pool of U.S. payees. QI must provide a withholding statement allocating $5 of the payment to A, $5 of the payment to B, $10 of the payment to C, and $20 of the payment to D along with Forms W-9 for each of them. QI will provide Form W-8IMY and check boxes 14a, 14c, and 14e.

Example 4.

The facts are the same as Example 1, except QI is a non-U.S. payor that does not assume primary withholding and reporting responsibility under chapter 3 and chapter 4. QI also does not assume primary Form 1099 and backup withholding responsibility.

If the QI does not assume primary withholding and reporting responsibility under chapter 3 and chapter 4 as well as primary Form 1099 reporting and separate backup withholding responsibilities, the QI will provide an FFI withholding statement with the following pools:

  • Nonparticipating FFI Pool — $20 (which is subject to chapter 4 withholding);

  • Recalcitrant Account Holder Pool — $20 (which is subject to chapter 4 withholding and which is aggregated in a single pool of recalcitrant account holders rather than each class described in Regulations section 1.1471-4(d)(6));

  • Chapter 4 Withholding Rate Pool of U.S. Payees — $10 (for the portion of the payment allocable to A and B);

  • Chapter 3 30% Rate Pool — $10;

  • Chapter 3 15% Rate Pool — $10; and

  • 0% Rate Pool — $10 (for the portion of the payment allocable to C).

QI will also be required to allocate $20 to a separate withholding rate pool for D because D is a U.S. non-exempt recipient who cannot be included in a chapter 4 withholding rate pool of U.S. payees (because D’s account is maintained by a certified deemed-compliant FFI). See Regulations section 1.6049(c)(4)(iii), but see the alternative procedure for U.S. non-exempt recipients, later.

Alternative procedure for U.S. non-exempt recipients.

If approved by the withholding agent, you can establish:

  • A single pool (not subject to backup withholding) for all U.S. non-exempt recipient account holders for whom you have provided Forms W-9 or are includible in a chapter 4 withholding rate pool of U.S. payees prior to the withholding agent making any payments. Alternatively, you may include such U.S. non-exempt recipients in a zero rate withholding pool that includes U.S. exempt recipients and foreign persons exempt from non-resident alien withholding provided all the conditions of the alternative procedure are met; and

  • A separate pool for all U.S. non-exempt recipient account holders subject to backup withholding for whom you have not provided Forms W-9 prior to the withholding agent making any payments.

If you elect the alternative procedure, you must provide the information required by your QI withholding agreement to the withholding agent not later than January 15 of the year following the year in which the payments are paid. Failure to provide this information may result in penalties under sections 6721 and 6722 and termination of your withholding agreement with the IRS.

The amount allocable to these two pools under the alternative procedure excludes amounts allocated to the chapter 4 withholding rate pool of U.S. payees.

Updating the statement.   The statement by which you identify the relevant withholding rate pools must be updated as often as is necessary to allow the withholding agent to withhold at the appropriate rate on each payment and to correctly report the income to the IRS. The updated information becomes an integral part of Form W-8IMY.

Part IV — Nonqualified Intermediary

If you are providing Form W-8IMY as a nonqualified intermediary (NQI), you must check box 15a. By checking this box, you are certifying to all of the statements on line 15a.

If you are required to provide a chapter 4 status on line 5 (see specific instructions for line 5) and are acting as an intermediary for a withholdable payment, you must provide your chapter 4 status on line 5 or as otherwise permitted in these instructions to avoid withholding at the chapter 4 rate of 30% being applied to any withholdable payment you receive from the withholding agent regardless of whether you check box 15b (except for documentation provided with respect to exempt beneficial owners). See the specific instructions for Part IX.

Check box 15b if you are using this form to transmit withholding certificates or other documentation along with a withholding statement (subject to the certifications on this form) that satisfies the requirements of chapters 3 and 4 (including if you are providing pooled information for purposes of chapter 61 under the alternative procedure for U.S. non-exempt recipients, discussed later, or chapter 4 withholding rate pools (as applicable) for a withholdable payment).

Check box 15c to certify that you are permitted under Regulations section 1.6049-4(c)(4) to provide a chapter 4 withholding rate pool of U.S. payees to which a payment is allocated on a withholding statement associated with the Form W-8IMY.

Check box 15d to certify that you are acting as a QSL with respect to the accounts identified on this line or in a withholding statement associated with this form with respect to a payment that is a U.S. source substitute dividend.

If you are acting on behalf of another NQI or on behalf of a foreign partnership or foreign trust that is not a withholding foreign partnership or a withholding foreign trust, you must attach to your Form W-8IMY the Form W-8IMY of the other NQI, foreign partnership, or foreign trust together with the withholding certificates and other documentation attached to that Form W-8IMY that is required, as applicable, for both chapter 3 and chapter 4 purposes.

Withholding statement of an NQI.   An NQI must provide a withholding statement and appropriate documentation to obtain reduced rates of withholding for its customers under chapter 3 and chapter 61 and to avoid certain reporting responsibilities. However, see the paragraph later describing an NQI’s withholding statement for chapter 4 purposes for when an NQI may provide a chapter 4 withholding rate pool of U.S. payees without such documentation. The withholding statement must be provided prior to a payment and becomes an integral part of the Form W-8IMY and, therefore, the certification statement that you sign in Part XXVIII of the form applies to the withholding statement as well as to the form.

For chapter 4 purposes.

An NQI receiving a withholdable payment must provide a withholding statement which satisfies the requirements of an FFI withholding statement or chapter 4 withholding statement (if the NQI is not a participating FFI or registered deemed-compliant FFI).

An FFI withholding statement may allocate the payment to chapter 4 reporting rate pools (as appropriate), including a chapter 4 withholding rate pool for nonparticipating FFIs, recalcitrant account holders (in each class of account holders described in Regulations section 1.1471-4(d)(6)(i)), and, for an NQI that is a participating FFI (including a reporting Model 2 FFI) or a registered deemed-compliant FFI (including a reporting Model 1 FFI), U.S. payees (see the description of the chapter 4 withholding rate pool of U.S. payees described in Withholding statement of a QI, earlier). However, an NQI may allocate a portion of a reportable amount (regardless of whether the payment is a withholdable payment) to a chapter 4 withholding rate pool of U.S. payees when the NQI satisfies the requirements to provide such a pool (including the requirement to certify to its status as a participating FFI (including a reporting Model 2 FFI) or registered deemed-compliant FFI (including a reporting Model 1 FFI)). The withholding statement must also identify each intermediary or flow-through entity that is receiving a payment (excluding any intermediary or flow-through entity that is an account holder or interest holder in another QI, WP, or WT), each such entity’s chapter 4 status and GIIN (if applicable), and the chapter 4 withholding rate pools associated with each such entity receiving the payment.

A chapter 4 withholding statement must contain the name, address, TIN (if any), entity type, chapter 4 status of each payee, the amount allocated to each payee, and a valid withholding certificate or other documentation sufficient to establish each payee’s chapter 4 status. However, a chapter 4 withholding statement may instead include pooled information for payees that are nonparticipating FFIs. The withholding statement must also identify each intermediary or flow-through entity that is receiving a payment (excluding any intermediary or flow-through entity that is an account holder or interest holder in another QI, WP, or WT), each such entity’s chapter 4 status and GIIN (if applicable), and the chapter 4 withholding rate pools associated with each such entity receiving the payment.

For chapter 3 and chapter 61 purposes.

For chapter 3 and chapter 61 purposes, a withholding statement for a reportable amount must include the information described later. For such payments that are also withholdable payments, the withholding statement should allocate only the portion of the payment that was not allocated to a chapter 4 withholding rate pool (as described earlier) or to a payee identified on the withholding statement to whom withholding was applied under chapter 4, as follows:

  • Include the name, address, U.S. TIN (if any), chapter 4 status (for a foreign person receiving a withholdable payment), and the type of documentation (documentary evidence, Form W-9, or type of Form W-8) for every person for whom documentation has been received and must state whether that person is a U.S. exempt recipient, a U.S. non-exempt recipient, or a foreign person. The statement must indicate whether a foreign person is a beneficial owner or an intermediary, flow-through entity, U.S. branch, or territory financial institution and the type of recipient, based on the recipient codes shown on Form 1042-S;

  • Allocate each payment by income type to every payee for whom documentation has been provided. The type of income is based on the income codes reported on Form 1042-S (or, if applicable, the income categories for Form 1099). If a payee receives income through another NQI, flow-through entity, or U.S. branch acting as an intermediary, your withholding certificate must also state the name, address, U.S. TIN (if known), and, for a withholdable payment, the chapter 4 status (if required) and GIIN (if applicable) of the other NQI or U.S. branch from which the payee directly receives the payment or the flow-through entity in which the payee has a direct ownership interest. If another NQI, flow-through entity, or U.S. branch fails to allocate a payment, you must provide, for that payment, the name of the NQI, flow-through entity, or U.S. branch that failed to allocate the payment;

  • If a payee is identified as a foreign person, you must specify the rate of withholding under chapter 3 to which the payee is subject, the payee’s country of residence and, if a reduced rate of withholding is claimed, the basis for that reduced rate (for example, treaty benefit, portfolio interest, or exemption under section 501(c)(3), 892, or 895). The statement must also include the U.S. or foreign TIN (if required) and, if the beneficial owner is not an individual and is claiming treaty benefits, state whether the limitation on benefits and section 894 statements have been provided by the beneficial owner. You must inform the withholding agent as to which payments those statements relate; and

  • Include any other information the withholding agent requests in order to fulfill its withholding and reporting obligations under chapters 3 and 4 of the Code and/or Form 1099 reporting and backup withholding responsibility.

Alternative procedure for NQIs.

To use the alternative procedure you must inform the withholding agent on your withholding statement that you are using the procedure and the withholding agent must agree to the procedure.

Under this procedure, you must provide a withholding agent with all the information required on the withholding statement (see Withholding statement of an NQI, earlier) and all payee documentation, except the specific allocation information for each payee, prior to the payment of a reportable amount. In addition, you must provide the withholding agent with withholding rate pool information. The withholding statement must assign each payee that is not subject to withholding under chapter 4 to a chapter 3 withholding rate pool prior to the payment of a reportable amount. The withholding rate pool may be established by any reasonable method agreed upon by you and the withholding agent. For example, you may agree to establish a separate account for a single withholding rate pool, or you may agree to divide a payment made to a single account into portions allocable to each withholding rate pool. You must determine withholding rate pools based on valid documentation or, to the extent a payment cannot be reliably associated with valid documentation, the applicable presumption rules.

You must provide the withholding agent with sufficient information to allocate the income in each withholding rate pool to each payee (including U.S. exempt recipients) within the pool no later than January 31 of the year following the year of payment. If you fail to provide allocation information, if required, by January 31 for any withholding rate pool, you may not use this procedure for any payment made after that date for all withholding rate pools. You may remedy your failure to provide allocation information by providing the information to the withholding agent no later than February 14.

In the case of a reportable amount that is also a withholdable payment, an NQI may include amounts allocable to a chapter 4 withholding rate pool (other than a chapter 4 withholding rate pool of U.S. payees) and payees subject to chapter 4 withholding for whom the NQI will provide payee specific information in a 30-percent rate pool together with payees subject to chapter 3 withholding at the 30-percent rate and may not otherwise apply these provisions for payments made to U.S. non-exempt recipients (regardless of whether the payment is a withholdable payment). For the amount of the payment allocable to a chapter 4 withholding rate pool of U.S. payees, an NQI may include such an amount in the withholding rate pool that is exempt from withholding (an NQI can include such payees in an exempt pool regardless of whether the payment is a withholdable payment). The NQI must identify prior to the payment each chapter 4 withholding rate pool to be allocated a portion of the payment and must also allocate by January 31 the portion of the payment to each such pool in addition to allocating the payment to each other payee as described in the preceding paragraph. See Regulations section 1.1441-1(e)(3)(iv)(D)(2) for further information on alternative procedures for an NQI.

Part V — Territory Financial Institution

Line 16

Check box 16a to certify that you are a financial institution (other than an investment entity that is not also a depository institution, custodial institution, or specified insurance company) incorporated or organized under the laws of a possession of the United States.

You must also check either box 16b or 16c. Check box 16b to certify that you have agreed to be treated as a U.S. person for purposes of both chapter 3 and chapter 4 with respect to payments associated with this Form W-8IMY. In this case, you will be responsible for chapter 3 withholding and reporting, backup withholding under section 3406, and chapter 4 withholding and reporting for any payments you make to persons for whom you are receiving a reportable amount or withholdable payment. If you check this box 16b, you must provide an EIN on line 8.

Check box 16c to certify that you are a territory financial institution that has not agreed to be treated as a U.S. person. You must certify that you are transmitting withholding certificates or other documentation for persons for whom you are receiving a payment (as required for chapter 3, chapter 61, and section 3406 purposes, and, in the case of a withholdable payment, documentation required for chapter 4 withholding and reporting purposes). See Regulations section 1.1471-3(a)(3)(iv). You must also certify that you have provided or will provide a withholding statement (as required). The withholding statement must provide the same information outlined under Withholding statement of an NQI, earlier, including the applicable chapter 4 information if you are receiving a withholdable payment.

A territory entity that is a flow-through entity but is not a territory FI may not complete this Part V and agree to be treated as a U.S. person. Instead, complete Part IV or Part VIII, as appropriate.

Part VI — Certain U.S. Branches

Line 17

Check box 17a to certify that you are a U.S. branch described in Regulations section 1.1441-1(b)(2)(iv) receiving income that is not effectively connected with the conduct of a trade or business in the United States.

You must also check either box 17b or 17c. Check box 17b to certify that you are a U.S. branch of a foreign bank or insurance company described in this certification that is a participating FFI, registered deemed-compliant FFI, or NFFE that has agreed with the withholding agent to be treated as a U.S. person with respect to payments associated with this Form W-8IMY. In such case, you will be responsible for chapter 3 withholding and reporting, backup withholding under section 3406, chapter 4 withholding and reporting for any payments you make to persons for whom you are receiving a withholdable payment, and will be treated as a U.S. payor for chapter 61 purposes. See Regulations section 1.6049-5(c)(5)(i)(F). You must provide your EIN on line 8 and, if you are a branch of an FFI receiving a withholdable payment, a GIIN on line 9 of another branch of the FFI of which you are a part.

Check box 17c to certify that you are a U.S. branch that does not have an agreement with the withholding agent to be treated as a U.S. person. You must certify that you are transmitting withholding certificates or other documentation for persons for whom you are receiving the payment. You must also certify that you have provided or will provide a withholding statement (as required) and, if you are receiving a withholdable payment, provide your chapter 4 status in Part I, line 5 (if required). The withholding statement must provide the same information outlined under Withholding statement of an NQI, earlier, including the applicable chapter 4 information required for the withholding statement if you are receiving a withholdable payment. See the information for an FFI withholding statement or a chapter 4 withholding statement in Withholding statement of an NQI, earlier.

Part VII — Withholding Foreign Partnership (WP) or Withholding Foreign Trust (WT)

Check box 18 if you are a WP or a WT for the accounts for which you are providing this form and you are receiving the income on behalf of your partners, beneficiaries, or owners. If you are not receiving the income on behalf of your partners, beneficiaries, or owners, do not complete this Part VII. Instead, complete Part III or Part IV, whichever is appropriate.

If you are acting as a WP or WT, you must assume primary withholding and reporting responsibility under chapter 3 and chapter 4 for all payments that are made to you for your partners, beneficiaries, or owners. Therefore, you are not required to provide information to the withholding agent regarding each partner’s, beneficiary’s, or owner’s distributive share of the payment and the information for the withholding agent to report under section 1472 (if otherwise required). If you are also receiving payments from the same withholding agent for persons other than your partners, beneficiaries, or owners, you must provide a separate Form W-8IMY for those payments. If you are receiving a withholdable payment, you must provide a chapter 4 status in line 5 other than that of a nonparticipating FFI and provide your GIIN (if applicable).

Part VIII — Nonwithholding Foreign Partnership, Simple Trust, or Grantor Trust

Check box 19 if you are a foreign partnership or a foreign simple or grantor trust that is not a WP or WT. By checking this box, you are certifying to both of the statements on line 19.

Note.

If you are receiving income that is effectively connected with the conduct of a trade or business in the United States, provide Form W-8ECI (instead of Form W-8IMY). If you are not receiving the income on behalf of your partners, beneficiaries, or owners, do not complete Part VIII. Instead, complete Part III or Part IV, whichever is appropriate. If you are a hybrid entity claiming treaty benefits, provide Form W-8BEN-E. However, if you are receiving a withholdable payment you may also be required to provide this Form W-8IMY and disclose your chapter 4 status and the chapter 4 status of each of your owners. See the instructions to Form W-8BEN-E for more information about hybrid entities claiming treaty benefits.

If you are acting on behalf of an NQI or another foreign partnership or foreign trust that is not a withholding foreign partnership or a withholding foreign trust, you must associate with your Form W-8IMY the Form W-8IMY of the other foreign partnership or foreign trust together with the withholding certificates and other documentation attached to that other form.

If you are receiving a withholdable payment, you must provide a chapter 4 status in line 5 other than that of a nonparticipating FFI and provide your GIIN (if applicable) and the information required for the withholding agent to report under section 1472.

Withholding statement of nonwithholding foreign partnership or nonwithholding foreign trust.   You must provide the withholding agent with a withholding statement to obtain reduced rates of withholding and relief from certain reporting obligations. The withholding statement must provide the same information outlined under Withholding statement of an NQI, earlier. The withholding statement becomes an integral part of the Form W-8IMY. Thus, if you are an FFI and allocate any portion of the payment to a chapter 4 withholding rate pool of U.S. payees with respect to accounts that you maintain, you must meet the requirements of Regulations section 1.6049-4(c)(4)(iii) and certify to your status in Part I, line 5 as a participating FFI, registered deemed-compliant FFI, reporting Model 1 FFI, or reporting Model 2 FFI. By providing a withholding statement making such an allocation with this form, you certify that you meet the requirements outlined for an NQI withholding statement described earlier.

Certain special rules for partnerships and trusts.   Under certain conditions, a QI, WT, or WP may apply special provisions of the relevant withholding agreement to certain partnerships and trusts that are not acting as a WP or WT. See the QI agreement, WP agreement, or WT agreement (as applicable) specifying these special procedures.

Certification of Chapter 4 Status: Parts IX Through XXVII

You should complete only one part certifying to your chapter 4 status (if required). Identify which part (if any) you should complete by reference to the box you checked on line 5.

Part IX — Nonparticipating FFI With Exempt Beneficial Owners

You are not required to complete this part unless you are a nonparticipating FFI providing documentation on behalf of an exempt beneficial owner.

Check box 20 to certify that you are transmitting withholding certificates or other documentation for exempt beneficial owners for chapter 4 purposes on whose behalf you are receiving a payment that is a withholdable payment. See Regulations section 1.1471-6. You must also certify that you have provided or will provide a withholding statement (as required) allocating a portion of the payment to the exempt beneficial owners as required under Regulations section 1.1471-3(d)(8)(ii). The withholding statement must include the name, address, TIN (if any), entity type, and chapter 4 status of each exempt beneficial owner on behalf of which the nonparticipating FFI is receiving the payment, the amount of the payment allocable to each exempt beneficial owner, a valid withholding certificate or other documentation sufficient to establish the chapter 4 status of each exempt beneficial owner under the requirements of chapter 4, and any other information the withholding agent reasonably requests in order to fulfill its obligations under chapter 4. Additionally, the withholding statement must provide all information required for purposes of chapter 3 with respect to each exempt beneficial owner if the payment is subject to withholding under chapter 3. The withholding statement must allocate the remainder of the payment that is not allocated to an exempt beneficial owner to the nonparticipating FFI receiving the payment.

Part X — Sponsored FFI That Has Not Obtained a GIIN

On line 21a, enter the name of the sponsoring entity that has agreed to fulfill your chapter 4 due diligence, reporting, and withholding obligations on your behalf. You must provide the sponsoring entity’s GIIN on line 9. However, you will be required to obtain a GIIN by January 1, 2016.

You must check the applicable box in line 21b or 21c to certify that you are either an investment entity or controlled foreign corporation (within the meaning of section 957(a)) and satisfy the other relevant requirements for this classification.

Part XI — Owner-Documented FFI

An owner-documented FFI should only complete Form W-8IMY if it is a flow-through entity receiving income allocable to its partners, owners, or beneficiaries. An owner-documented FFI is not permitted to act as an intermediary with respect to a withholdable payment.

All owner-documented FFIs must check box 22a to certify that you satisfy the requirements for this classification and are providing this form to a U.S. financial institution, participating FFI, or reporting Model 1 FFI that has agreed to act as a designated withholding agent with respect to the entity identified on line 1 (see Regulations section 1.1471-5(f)(3)).

You must also check either box 22b or 22c. Check box 22b to certify that you have provided or will provide the documentation set forth in the certifications, including the owner reporting statement described in this line 22b. Check box 22c to certify that you have provided or will provide an auditor’s letter (in lieu of the information required by line 22(b)) that satisfies the requirements described in this line.

Part XII — Certified Deemed-Compliant Nonregistering Local Bank

All nonregistering local banks must check box 23 to certify that you satisfy all of the requirements for this certified deemed-compliant classification.

Part XIII — Certified Deemed-Compliant FFI with Only Low-Value Accounts

All FFIs with only low-value accounts must check box 24 to certify that you satisfy all of the requirements for this certified deemed-compliant classification.

Part XIV — Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle

On line 25a, enter the name of the sponsoring entity that has agreed to fulfill your chapter 4 due diligence, reporting, and withholding obligations on your behalf. You must also enter the GIIN of your sponsoring entity on line 9.

All sponsored, closely held investment vehicles must check box 25b to certify that you satisfy the requirements for certified deemed-compliant classification as a sponsored entity.

Part XV — Certified Deemed-Compliant Limited Life Debt Investment Company

All limited life debt investment entities must check box 26 to certify that you satisfy the requirements for this certified deemed-compliant classification.

Part XVI — Restricted Distributor

All restricted distributors must check box 27a to certify that you satisfy the requirements for this classification.

You must also check either box 27b or 27c, as appropriate, to certify that your distribution agreement meets the requirements of this classification.

Part XVII — Foreign Central Bank of Issue

A foreign central bank of issue must check box 28 to certify that you are acting as an intermediary and are an entity defined in Regulations section 1.1471-6 that is treated as the beneficial owner of the payment for chapter 4 purposes (applying the rule in Regulations section 1.1471-6(d)(4)). You cannot be treated as an intermediary for purposes of this Part XVII if you are receiving the payment in connection with a commercial activity described in Regulations section 1.1471-6(h)(1) or are not receiving payments subject to chapter 3 withholding.

Part XVIII — Nonreporting IGA FFI

Check box 29 to indicate that you are treated as a nonreporting IGA FFI under an applicable IGA, including an entity treated as a registered deemed-compliant FFI under an applicable IGA. You must identify the applicable IGA by entering the name of the jurisdiction that has the applicable IGA in effect with the United States. You must also provide the withholding agent with the class of entity described in Annex II of the IGA applicable to your status. If you are an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 IGA, you must provide your GIIN in the space provided. The GIIN does not need to be provided on line 9. See www.treasury.gov/resource-center/tax-policy/treaties/Pages/FATCA-Archive.aspx for a list of jurisdictions treated as having an IGA in effect for purposes of making this certification.

If you are a sponsored FFI in a Model 1 IGA jurisdiction or other nonreporting FFI in a Model 1 IGA jurisdiction that is required to report an account, you are currently not required to provide a GIIN in this Part XII. However, a future version of this form may require you to provide a GIIN.

Part XIX — Exempt Retirement Plans

All exempt retirement plans must check the appropriate box to certify that you satisfy the requirements for this classification.

If you are not a flow-through entity or acting as an intermediary with respect to the payment for chapter 3 purposes, do not complete Form W-8IMY. If you are the beneficial owner of the payment and are claiming an exemption under sections 115(2), 892, or 895 as well as exempt beneficial owner status under Regulations section 1.1471-6 you should provide Form W-8EXP. If you are receiving payments which do not qualify for a statutory exemption from tax but for which you are claiming benefits under an applicable income tax treaty, provide Form W-8BEN-E.

Part XX — Excepted Nonfinancial Group Entity

All excepted nonfinancial group entities must check box 31 to certify that you satisfy the requirements for this classification.

Part XXI — Excepted Nonfinancial Start-Up Company

All excepted nonfinancial start-up companies must check box 32 to certify that you satisfy the requirements for this classification. You must also provide the date you were formed or your board passed a resolution (or equivalent measure) approving a new line of business (which cannot be that of a financial institution or passive NFFE).

Part XXII — Excepted Nonfinancial Entity in Liquidation or Bankruptcy

All excepted nonfinancial group entities in liquidation or bankruptcy must check box 33 to certify that you satisfy the requirements for this classification. You must also provide the date that you filed a plan of liquidation, plan of reorganization, or bankruptcy petition.

Part XXIII — Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation

All publicly traded NFFEs must check box 34a to certify that you are not a financial institution and provide the name of a securities exchange on which the stock of the NFFE is publicly traded.

An NFFE that is a member of the same expanded affiliated group (as described in Regulations section 1.1471-5(i)) as a publicly traded U.S. or foreign entity must check this box, provide the name of the publicly traded entity, and identify the securities market on which the stock of the publicly traded entity is traded. See Regulations section 1.1472-1(c)(1)(i) to determine if an entity is publicly traded.

Part XXIV — Excepted Territory NFFE

All excepted territory NFFEs must check box 35 to certify that you satisfy the requirements for this classification. See Regulations section 1.1472-1(c)(1)(iii) for the definition of an excepted territory NFFE.

Part XXV — Active NFFE

All active NFFEs must check box 36 to certify that you satisfy the requirements for this classification.

Part XXVI — Passive NFFE

All passive NFFEs must check box 37 to certify that you are not a financial institution (other than an investment entity organized in a possession of the United States). You must also certify that you have provided a withholding statement associated with Form W-8IMY to the extent you are required to provide a withholding statement.

Part XXVII — Sponsored Direct Reporting NFFE

All sponsored direct reporting NFFEs must certify that you are not a financial institution and provide the name of your sponsoring entity. Provide your GIIN or, prior to January 1, 2016, the GIIN of your sponsor on line 9.

Part XXVIII — Certification

Form W-8IMY must be signed and dated by a person authorized to sign a declaration under penalties of perjury on behalf of the person whose name is on the form. By signing Form W-8IMY the authorized representative, officer, or agent also agrees to provide a new form within 30 days following a change in circumstances (unless no future payments will be made to the intermediary or flow-through entity by the withholding agent and the requestor does not need an updated form for chapter 4 purposes).

Special Instructions

Entities Providing Certifications Under an Applicable IGA (Do Not Complete Line 5)

A withholding agent that is an FFI may provide you with a chapter 4 status certification other than as shown in Parts IX through XXVII in order to satisfy its due diligence requirements under an applicable IGA. In such a case, you may attach the alternative certifications to this Form W-8IMY in lieu of completing a certification otherwise required in Parts IX through XXVII provided that you: 1) determine that the certification accurately reflects your status for chapter 4 purposes or under an applicable IGA; and 2) the withholding agent provides a written statement to you that it has provided the certification to meet its due diligence requirements as a participating FFI or registered deemed-compliant FFI under an applicable IGA.

You may also provide with this form an applicable IGA certification if you are determining your chapter 4 status under the definitions provided in an applicable IGA and your certification identifies the jurisdiction that is treated as having an IGA in effect and describes your status as an NFFE or FFI in accordance with the applicable IGA. However, if you determine your status under an applicable IGA as an NFFE, you must still determine if you are an excepted NFFE under the regulations in order to complete this form. Additionally, you are required to comply with the conditions of your status under the law of the IGA jurisdiction if you are determining your status under an applicable IGA. If you cannot provide the certifications in Parts IX through XXVII, do not check a box in line 5. However, if you determine your status under the definitions of the IGA and can certify to a chapter 4 status included on this form, you do not need to provide the certifications described in this paragraph unless required by the withholding agent or FFI to whom you are providing this form.

Any certifications provided under an applicable IGA remain subject to the penalty of perjury statement and other certifications made in Part XXVIII.

Entities Providing Alternate Certifications Under Regulations

If you qualify for a chapter 4 status that is not shown in Part I, line 5, of this form, you may attach applicable certifications for such status from any other Form W-8 on which the relevant certifications appear. For example, if you are a certified deemed-compliant investment advisor or investment manager described in Regulations section 1.1471-5(f)(2)(v) that is a flow-through entity, you may attach the certifications found in Part IX of Form W-8BEN-E. If the applicable certifications do not appear on any Form W-8 (if, for example, new regulations provide for an additional chapter 4 status and this form has not been updated) then you may provide an attachment certifying that you qualify for the applicable status described in a particular Regulations section in lieu of checking a box in Part I, line 5. Include a citation to the applicable provision in the Regulations. Any such attached certification becomes an integral part of this Form W-8IMY and is subject to the penalty of perjury statement and other certifications made in Part XXVIII.


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