Fillable Form W-8 BEN (2017)

What is Form W-8 BEN?

Form W-8 BEN is formally known as the Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals). Withholding agents or payers use it to request a foreign person their taxpayer information. The foreign person then fills out the form. After filling out the form, they will return it to the withholding agent or payer who will then use it to report the foreign person’s income from non-US sources.

Non-US sources of income include:

You're required to submit a Form W-8 BEN to the withholding agent or payer if:

Whether or not you're eligible and are claiming a reduction or exemption from withholding, you're required to submit a Form W-8EN when requested by the withholding agent, payer, or FFI if:

Write Form W-8 BEN to the withholding agent or payer before you receive your income. Failure to provide a Form W-8 BEN when requested may lead to the maximum withholding rate of 30% or the backup withholding rate.

Take note, do NOT use Form W-8BEN if:

How to Fill Out Form W-8 BEN?

Keep in mind that before you complete and submit Form W-8 BEN, ascertain whether all information provided on this form is correct. The presence of any incorrect information will require you to submit a new Form W-8 BEN within 30 days.

The form consists of the following: the identification of the beneficial owner, the claim of tax treaty benefits, and certification.

Part I. Identification of the Beneficial Owner

1. Name

2. Country of citizenship

3. Permanent residence address

4. Mailing address

5. US TIN (SSN or ITIN)

— Claiming an exemption from withholding for certain annuities received under qualified plans, or

— Submitting the form to a partnership that conducts a trade or business in the US.

— Dividends and interest from stocks and debt obligations that are actively traded.

— Dividends from any redeemable security issued by an investment company registered under the Investment Company Act of 1940 (mutual fund).

— Dividends, interest, or royalties from units of beneficial interest in a unit investment trust that are (or were upon issuance) publicly offered and are registered with the SEC under the Securities Act of 1933.

— Income related to loans of any of the above securities.

6. Foreign tax identifying number

7. Reference number/s (if applicable)

8. Date of birth

Part II. Claim of Tax Treaty Benefits (for chapter 3 purposes only)

9. Resident Country that has a tax treaty with the US

10. Special rates and conditions

Part III. Certification

— The individual that is the beneficial owner (or are authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or are using this form to document yourself for chapter 4 purposes,

— The person named on line 1 of this form is not a U.S. person,

— The income to which this form relates is:

a. Not effectively connected with the conduct of a trade or business in the United States,

b. Effectively connected but is not subject to tax under an applicable income tax treaty, or

c. The partner’s share of a partnership's effectively connected income,

— The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country, and

— For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions

— Write your signature.

— Write your full legal name in print

— Write the date when you accomplished your Form W-8 BEN in the following format: (MM-DD-YYYY).

— Only write your answers only until to the capacity in which you're acting if you're signing for the person on line 1.

Submission

Do not submit your Form W-8 BEN to the IRS. Submit your completed form to the withholding agent or payer that has asked for your taxpayer information through this form to you.