Fillable Form W-8 BEN (2014-2016)

What is Form W-8BEN?

Form W-8BEN is used by withholding agents or payers to collect a foreign person’s taxpayer information. After the foreign person has filled out the form, the withholding agent or payer will then use it to report the foreign person’s income from foreign sources.

Foreign sources of income include:

• Interest
• Dividends
• Rents
• Royalties
• Premiums
• Annuities
• Service Revenue
• Substitute payments in a securities lending transaction
• Other fixed or determinable annual or periodical gains, profits, or income.

Submit Form W-8BEN to the withholding agent or payer if:

• you are a nonresident alien who is the beneficial owner of any amount subject to withholding; or
• you are an account holder in a Foreign Financial Institution (FFI) documenting yourself as a nonresident alien.

Submit Form W-8EN when requested by the withholding agent, payer, or FFI whether or not you are claiming a reduction or exemption from withholding if:

• you are the single owner of a disregarded entity; or
• you are considered the beneficial owner of income received by the disregarded entity.

Provide Form W-8BEN to the withholding agent or payer before your income is paid to you. Failing to provide a Form W-8BEN when requested may lead to a withholding rate of 30% or the backup withholding rate.

Also, do NOT use Form W-8BEN if:

• you are NOT an individual — use Form W-8BEN-E; or
• you are a US citizen or a resident alien — use Form W-9; or
• your source of income is within the US (other than personal services) — use Form W-8 ECI; or
• your source of income is within the US and for personal services — use Form 8233 or Form W-4; or
• you are acting as an intermediary — use Form W-8 IMY.

How to Fill Out Form W-8BEN?

Before accomplishing Form W-8BEN, check whether all information written on this form is correct. If any information is incorrect, you are required to submit a new Form W-8BEN within 30 days.

Form W-8BEN has three parts: the identification of beneficial owner, the claim of tax treaty benefits, and certification.

Part I

Identification of Beneficial Owner
1 Name
Provide your full legal name.
2 Country of citizenship
Provide the country you are a citizen of and where you are currently residing.
3 Permanent residence address
Provide your full address in your country of residence. Do not use a P.O. box or in-care-of address.
4 Mailing address
Only provide your mailing address if it is different from your permanent residence address.
5 US TIN (SSN or ITIN)
Provide your social security number (SSN). If you do not have an SSN, provide your individual taxpayer identification number (ITIN).
Note that you are required to provide an SSN or ITIN if you are:

• 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.

The TINs are not required if you want to claim treaty benefits regarding:

• 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
Provide your TIN as issued by your country’s department which has jurisdiction on your taxes.
7 Reference number/s (if applicable)
Provide any referencing information that may be useful to the withholding agent that will carry out their obligations.
8 Date of birth
Provide your date of birth (MM-DD-YYYY).

Part II

Claim of Tax Treaty Benefits (for chapter 3 purposes only)
9 Resident Country that has a tax treaty with the US
If you are claiming tax treaty benefits and you reside in a country that has a tax treaty with the US, provide your country of residence.
10 Special rates and conditions
Only provide information on this line if there are conditions you have to fulfill that are not included on line 9 and Part III.

Part III

Certification
This section certifies that you are:

• 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

Signature
Provide your signature.
Print name of signer
Provide your full legal name in print
Date
Provide the date of when you accomplished your Form W-8BEN (MM-DD-YYYY).
Capacity in which acting
Only provide the capacity in which you are acting if you are signing for the person on line 1.

Submission

Submit your accomplished Form W-8BEN to the withholding agent or payer that has requested this form to you. Do not submit this form to the IRS.