Informe

Form

W-8BEN

(Rev. February 2006)
Department of the Treasury
Internal Revenue Service

Certificate of Foreign Status of Beneficial Owner
for United States Tax Withholding

OMB No.1545-1621

Section references are to the Internal Revenue Code.
See separate instructions.
Give this form to the withholding agent or payer. Do not send to the IRS.

Do not use this form for:
● A U.S.citizen or other U.S. person, including a resident alien individual
● A person claiming that income is effectively connected with the conduct
of a trade or business in the United States
● Aforeign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)
● A foreign government, international organization, foreign central bank of issue, foreigntax-exempt organization,
foreign private foundation, or government of a U.S. possession that received effectively connected income or that is
claiming the applicability of section(s) 115(2), 501(c), 892,895, or 1443(b) (see instructions)
Note: These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only to
claim they are a foreign person exempt from backupwithholding.
● A person acting as an intermediary
Note: See instructions for additional exceptions.

W-8ECI
W-8ECI or W-8IMY
W-8ECI or W-8EXP

W-8IMY

Identification of Beneficial Owner(See instructions.)

Part I
1

Name of individual or organization that is the beneficial owner

3

Type of beneficial owner:
Grantor trust
Central bank of issue

4

Instead, use Form:
W-9Individual

2

Country of incorporation or organization

Disregarded entity

Complex trust

Estate

Tax-exempt organization

Partnership

Government

Corporation

Internationalorganization

Simple trust

Private foundation

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or...