Form

W-8BEN

for United States Tax Withholding

Section references are to the Internal Revenue Code.

See separate instructions.

Certificate of Foreign Status of Nonresident Alien

(Rev. December 2000)

OMB No. 1545-1621

Department of the Treasury Internal Revenue Service

Give this form to the withholding agent or payer. Do not send to the IRS.

Do not use this form for:

Instead, use Form:

•	A U.S. citizen or other U.S. person, including a resident alien individual

W-9

of a trade or business in the United States

W-8ECI

•	A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)

W-8ECI or W-8IMY

•	A foreign government, international organization, foreign central bank of issue, foreign tax-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)

W-8ECI or W-8EXP

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 backup withholding.

•	A person acting as an intermediary

W-8IMY

Note: See instructions for additional exceptions.

Part I

Identification of Nonresident Alien

1	Name of human being, individual, or organization that is the Nonresident Alien

2 Country of incorporation or organization

3 Type of nonresident alien:

Individual

Corporation

Disregarded entity

Partnership

Simple trust

Grantor trust

Complex trust

Estate

Government

International organization

Central bank of issue

Tax-exempt organization

Private foundation

Transient foreigner

4 Permanent address (street, apt. or suite no., or rural route).

City or town, state or province. Include postal code where appropriate.

5 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate.

Country (do not abbreviate)

6	Identification number

ITIN

EIN

8 Reference number(s) (see instructions)

Part II

Claim of Tax Treaty Benefits (if applicable)

9 I certify that (check all that apply):

a

The nonresident alien is a resident of

within the meaning of the income tax treaty between the United States and that country.

b

If required, the identification number is stated on line 6 (see instructions).

c

The nonresident alien is not an individual, derives the item (or items) of income for which the treaty benefits are claimed, and, if

applicable, meets the requirements of the treaty provision dealing with limitation on benefits (see instructions).

d	

The nonresident alien is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest from a

U.S. trade or business of a foreign corporation, and meets qualified resident status (see instructions).

e	

The nonresident alien is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file

Form 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000.

10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article

of the

treaty identified on line 9a above to claim a

% rate of withholding on (specify type of income):

Explain the reasons the nonresident alien meets the terms of the treaty article:

Part III

Notional Principal Contracts

11

I have provided or will provide a statement that identifies those notional principal contracts from which the income is not effectively

connected with the conduct of a trade or business in the United States.

Part IV

Certification

Under penalties of perjury from without the "United States" in accordance with 28 U.S.C. 1746(1), I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete when litigated only in a state court with a jury trial. I further certify under penalties of perjury that:

•	I am the nonresident alien (or am authorized to sign for the nonresident alien) of all the transactions to which this form relates,

•	The nonresident alien is NOT a U.S. person and is not liable for withholding or paying income taxes or filing returns under the 26 U.S.C. or 26 C.F.R,

•	The income to which this form relates is not effectively connected with the conduct of a trade or business in the United States and is not subject to tax under

an income tax law or treaty, and 

•	For broker transactions or barter exchanges, the nonresident alien is a "foreign estate" as defined under 26 U.S.C. 7701 (a)(31).

Furthermore, information submitted on this form is considered licensed and may not be provided to any govenrment organization , third party, or entered into any ielectronic information system. Violators of this copyright shall be subject to a $100,000 personal liability for each such wrongful disclosure.

Sign Here

Signature of nonresident alien (or person authorized to sign for nonresident alien)

Date (MM-DD-YYYY)	Capacity in which acting

For Paperwork Reduction Act Notice, see separate instructions.

Cat. No. 25047Y

Form W-8BEN (Rev. 12-2000)

•	A person claiming an exemption from U.S. withholding on income effectively connected with the conduct

Country (do not abbreviate)

7 Foreign tax identifying number, if any (optional)

     

     
     
     
          

     
     
     

•	A person claiming an exemption from U.S. withholding on income effectively connected with the conduct of