Form

W-8

Certificate of Foreign Status

(Rev. November 1992)

Department of the Treasury

Internal Revenue Service

Name of owner (If joint account, also give joint owner’s name.) (See Specific Instructions.)

U.S. taxpayer identification number (if any)

	

	

List account information

Account number

Account type

Account number

Account type

here (Optional, see

Specific Instructions.)

Notice of Change in Status.—To notify the payer, mortgage interest recipient, broker, or barter exchange that you no longer

qualify for exemption, check here

	

If you check this box, reporting will begin on the account(s) listed.

Please

Certification.—(Check applicable box(es)). Under penalties of perjury, I certify that:

For INTEREST PAYMENTS, I am not a U.S. citizen or resident (or I am filing for a foreign corporation, partnership,

estate, or trust).

For DIVIDENDS, I am not a U.S. citizen or resident (or I am filing for a foreign corporation, partnership, estate, or

trust).

For BROKER TRANSACTIONS or BARTER EXCHANGES, I am an exempt foreign person as defined in the

instructions below.

Signature

Date

Sign

Here

General Instructions

See Pub. 519, U.S. Tax Guide for Aliens, for more information on resident and

generally remains in effect for three calendar years. However, the payer may require you to file a new certificate each time a payment is made to you.
Where To File.—File this form with the payer of the qualifying income who is the withholding agent (see Withholding Agent on page 2). Keep a copy for your own records.

(Section references are to the Internal Revenue Code unless otherwise noted.)

nonresident alien status.

Purpose

Note: If you are a nonresident alien individual married to a U.S. citizen or resident and have made an election under section 6013(g) or (h), you are treated as a U.S. resident and may not use Form W-8.

Use Form W-8 or a substitute form containing a substantially similar statement to tell the payer, mortgage interest recipient, middleman, broker, or barter exchange that you are a nonresident alien individual, foreign entity, or exempt foreign person not subject to certain U.S. information return reporting or backup

Exempt Foreign Person

For purposes of this form, you are an “exempt foreign person” for a calendar

Backup Withholding

year in which:

A U.S. taxpayer identification number or Form W-8 or substitute form must be given to the payers of certain income. If a taxpayer identification number or Form W-8 or substitute form is not provided or the wrong taxpayer identification number is provided, these payers may have to withhold 20% of each payment or transaction. This is called backup

withholding rules.

1. You are a nonresident alien individual or a foreign corporation, partnership,

Caution: Form W-8 does not exempt the payee from the 30% (or lower treaty) nonresident withholding rates.

estate, or trust,

2. You are an individual who has not
been, and plans not to be, present in the
United States for a total of 183 days or

Nonresident Alien Individual
For income tax purposes, “nonresident alien individual” means an individual who is neither a U.S. citizen nor resident. Generally, an alien is considered to be a

more during the calendar year, and

3. You are neither engaged, nor plan to be engaged during the year, in a U.S. trade or business that has effectively connected gains from transactions with a

withholding.

Note: On January 1, 1993, the backup withholding rate increases from 20% to

U.S. resident if:

31%.

•	The individual was a lawful permanent resident of the United States at any time during the calendar year, that is, the alien held an immigrant visa (a “green card”), or
•	The individual was physically present in

broker or barter exchange.

Reportable payments subject to backup

If you do not meet the requirements of 2 or 3 above, you may instead certify on Form 1001, Ownership, Exemption, or Reduced Rate Certificate, that your country has a tax treaty with the United States that exempts your transactions from U.S. tax.

withholding rules are:

• Interest payments under section 6049(a). • Dividend payments under sections

6042(a) and 6044.

the United States on:

• Other payments (i.e., royalties and payments from brokers and barter exchanges) under sections 6041, 6041A(a), 6045, 6050A, and 6050N.

(1) at least 31 days during the calendar

year, and

Filing Instructions

(2) 183 days or more during the current year and the 2 preceding calendar years (counting all the days of physical presence in the current year, one-third the number of days of presence in the first preceding year, and only one-sixth of the number of days in the second preceding year).

When To File.—File Form W-8 or substitute form before a payment is made. Otherwise, the payer may have to withhold and send part of the payment to the Internal Revenue Service (see Backup Withholding below). This certificate

If backup withholding occurs, an exempt foreign person who is a nonresident alien individual may get a refund by filing Form 1040NR, U.S. Nonresident Alien Income

Tax Return, with the Internal Revenue

(Continued on back.)

Cat. No. 10230M

Form W-8 (Rev. 11-92)

Permanent address (See Specific Instructions.) (Include apt. or suite no.)

City, province or state, postal code, and country

Current mailing address, if different from permanent address (Include apt. or suite no., or P.O. box if mail is not delivered to street address.)

City, town or post office, state, and ZIP code (If foreign address, enter city, province or state, postal code, and country.)

□
□
□
□

Form W-8 (Rev. 11-92)

Page 2

Service Center, Philadelphia, PA 19255, even if filing the return is not otherwise required.

See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Corporations, for registered obligations targeted to foreign markets and when Form W-8 or substitute form is not

substitute form unless your payer requires you to file a separate certificate for each

account.

U.S. Taxpayer Identification Number

If you have more than one payer, file a separate Form W-8 with each payer. Signature.—If only one foreign person owns the account(s) listed on this form, that foreign person should sign the Form

required on these payments.

The Internal Revenue law requires that certain income be reported to the Internal Revenue Service using a U.S. taxpayer identification number (TIN). This number can be a social security number assigned to individuals by the Social Security Administration or an employer identification number assigned to businesses and other

Bearer obligations.—The interest from bearer obligations targeted to foreign markets is treated as portfolio interest and is not subject to 30% withholding. Form W-8 or substitute form is not required.
Dividends.—Any distribution or payment of dividends by a U.S. corporation sent to a foreign address is subject to the 30% (or lower treaty) withholding rate, but is not subject to backup withholding. Also, there is no backup withholding on dividend payments made to a foreign person by a foreign corporation. However, the 30% withholding (or lower treaty) rate applies to dividend payments made to a foreign

W-8.

If each owner of a joint account is a foreign person, each should sign a

separate Form W-8.

entities by the Internal Revenue Service.

Notice of Change in Status.—If you become a U.S. citizen or resident after you have filed Form W-8 or substitute form, or you cease to be an exempt foreign person, you must notify the payer in writing within

Payments to account holders who are foreign persons (nonresident alien individuals, foreign corporations, partnerships, estates, or trusts) generally

30 days of your change in status.

are not subject to U.S. reporting

To notify the payer, you may check the box in the space provided on this form or

requirements. Also, foreign persons are not generally required to have a TIN, nor are they subject to any backup withholding because they do not furnish a TIN to a

person by a foreign corporation if:

use the method prescribed by the payer.

•	25% or more of the foreign corporation’s gross income for the three preceding taxable years was effectively connected with a U.S. trade or business, and
•	The corporation was not subject to the branch profits tax because of an income

Reporting will then begin on the account(s) listed and backup withholding may also begin unless you certify to the

payer or broker.

However, foreign persons with income effectively connected with a trade or business in the United States (income subject to regular (graduated) income tax), must have a TIN. To apply for a TIN, use Form SS-4, Application for Employer Identification Number, available from local Internal Revenue Service offices, or Form SS-5, Application for a Social Security Card, available from local Social Security Administration offices.

payer that:

(1) The U.S. taxpayer identification

number you have given is correct, and

tax treaty (see section 884(e)).

(2) The Internal Revenue Service has not notified you that you are subject to backup withholding because you failed to report

If a foreign corporation makes payments to another foreign corporation, the recipient must be a qualified resident of its country of residence to benefit from that

certain income.

You may use Form W-9, Request for Taxpayer Identification Number and

country’s tax treaty.

Broker or Barter Exchanges.—Income from transactions with a broker or barter exchanges is subject to reporting rules and backup withholding unless Form W-8 or substitute form is filed to notify the broker or barter exchange that you are an exempt foreign person as defined on page 1.

Certification, to make these certifications.

Special Rules

If an account is no longer active, you do not have to notify a payer of your change in status unless you also have another account with the same payer that is still

Mortgage Interest.—For purposes of the reporting rules, mortgage interest is interest paid on a mortgage to a person engaged in a trade or business originating mortgages in the course of that trade or business. A mortgage interest recipient is one who receives interest on a mortgage that was acquired in the course of a trade

active.

Specific Instructions

False Certificate.—If you file a false certificate when you are not entitled to the exemption from withholding or reporting, you may be subject to fines and/or imprisonment under U.S. perjury laws.

Name of Owner.—If Form W-8 is being filed for portfolio interest, enter the name

or business.

of the beneficial owner.

Instructions to Withholding Agents

Mortgage interest is not subject to backup withholding rules, but is subject to reporting requirements under section 6050H. Generally, however, the reporting requirements do not apply if the payer of record is a nonresident alien individual who pays interest on a mortgage not secured by real property in the United States. Use Form W-8 or substitute form to notify the mortgage interest recipient that the payer is a nonresident alien individual.
Portfolio Interest.—Generally, portfolio interest paid to a nonresident alien individual or foreign partnership, estate, or trust is not subject to backup withholding rules. However, if interest is paid on portfolio investments to a beneficial owner that is neither a financial institution nor a member of a clearing organization, Form

U.S. Taxpayer Identification Number.—If you have a U.S. taxpayer identification number, enter your number in this space (see the discussion earlier).
Permanent Address.—Enter your complete address in the country where you reside permanently for income tax purposes.

Withholding Agent.—Generally, the person responsible for payment of the items discussed above to a nonresident alien individual or foreign entity is the

withholding agent (see Pub. 515).

If you are:

Show the

Retention of Statement.—Keep Form W-8 or substitute form in your records for at least four years following the end of the last calendar year during which the

address of:

An individual

Your permanent

payment is paid or collected.

residence

Portfolio Interest.—Although registered obligations not targeted to foreign markets are not subject to 30% withholding, you must file Form 1042S, Foreign Person’s

A partnership

Principal office

or corporation

An estate or

Permanent residence

U.S. Source Income Subject to Withholding, to report the interest payment. Both Form 1042S and a copy of Form W-8 or substitute form must be attached to Form 1042, Annual Withholding Tax Return for U.S. Source Income of Foreign Persons.

trust

or principal office of

any fiduciary

W-8 or substitute form is required.

Also show your current mailing address if it differs from your permanent address. Account Information (optional).—If you have more than one account (savings, certificate of deposit, pension, IRA, etc.) with the same payer, list all account numbers and types on one Form W-8 or

Registered obligations not targeted to foreign markets qualify as portfolio interest not subject to 30% withholding, but require the filing of Form W-8 or substitute form. See Instructions to Withholding Agents on this page for reporting rules.