W'8IMYGertificate of Foreign Intermediary, Foreign … · ls a nonwithholding foreign partnership,...

8
Depadment of the Treasury Internal Revenue Sefvice *,,, W'8IMY iflev Do not use this form {or: . A beneficialowner solely claiming foreign status or treaty benefits . A hybrid entity claiming treaty benefits on its own behall . A foreign person claiming that income is ef{ectively connected wlth the conduct of a trade or buslnessin the United Sta'tes . A disregaroed ent ty wrth a singiefore:gn owner thal s the oene{icial ownerof tne income lo wh'cnthis iorm relales. lnstead. the single toreign owner snoulo use . A foreign government. ;nlernational organ,zation. foreign cenlrar oank ot issue.to.e gn ta. exemot organization. fore'gn pr vate foundatiön, or government of a U.S. possession claiming the applicabillty of section(s)I 1 5(2), 501 {c), 892. 895, or 1443(b) . U.S. entity or U.S. citizen or resident Gertificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding andReporting > Section references are to the Internai Revenue Code. ) lnformation about Form W'8IMY and its separate inslructions is al www.irs.govlformwgimy. ) Give this form to the withholding agent or payer. Do not send to the lRS. Otu4B Nc. 1545 162i Instead, use Form: W-8BEN or W-8BEN-E W.8BEN-E , W-8ECI W-8BEN, W-BECl, or W-8BEN-E . W-8EXP \^/-o W-8BEN, W-BBEN-E, or W-8ECl A foreign person themselves for ourooses of section 6050W ldentification of 1 Name of individualor organization that is actinq as intermediary Volksbank Salzburo eG 3 Name of disregardedentity (ii applicable) Country of .lco'porat,on or organ./alron 4 Chapter 3 Status: I Qualified intermediary. Complete Part lll. E Nonqualified intermediary. Complete Pad lV. n* Lj Territory financial institution.Cornplete Pafi V. I U.S. branch.CompletePail Vl. E Withholding foreign padnership. Complete Part Vtl. 5 Chantcr 4 Statr rc' -., L l Nonpadicipating FFI (incluciing a limited FFI or limited branch) Complete Pad lX (if applicablel. I Pafticipating FFl. fl Reporting Model 1 FFl. Z neportlng Model 2 FFl. I Registered deemed-compliant FFI (oiherthan a reportinc lloclel 1 FFI or sponsored FFI that has not obtained a GllN). ! Territory financialinstitution.Complete Pan V. I Sponsored FFI that has not obtained a GllN (otherthan a cenified deemed-compliant sponsored, closely held investment vehicle). Complete Part X. f Ce.titieCdeemed-compliant nonregisteringlocal bank. Complete Parl xil. I CerfineO deemed-compliant FFI with only Iow-value accounis. Complete Parl Xlll I Certitied deemed-compliant sponsored, closely held investment vehicle. Complete Part XlV. I C"ttlfl"d deemed-compliant limiied life debt investmententrty. Complete Part XV. Ü witfrholaingforeign trust. Complete Part Vll. I Nonwithholding foreign partnership. Complete Pad Vlll. n Nonwithholding foreign sirnple trust.Complete Pad Vlll. E Nonwithholding foreign grantor trust. Compleie Part Vlll . ;,Jwner-documented FFl. Complete Pafi Xl. i--i Restricted distribuior. Complete Pad XVl. i,l Foreign central bank of issue.Complete Parl XVll. I Nonreporting IGA FFl.Complete Pad XVlll. Il Exempt retirernent plans. Complete Paft XlX. i] ExcepteO nonfinancial group entity. Complete PartXX. Ü Exceptednonfinancial stad-up company. CompletePart XXI i .l fxcepted nonfinancial entity in liquidationor bankruptcy Complete Part XXll. .--J erUtictytraded NFFE or NFFEaffiliateof a publicly traded corporation. CompletePartXXlll. L-: ExcepteA territory NFFE.Complete Parl XXIV. t- nctiue NFFE.Complete Part XXV. l=l PassiveNFFE.Complete Pad XXVI. ' i Directreporting NFFE. ' lsponsored direct repodingNFFE. Complete Part XXVII. 6 Permanent residence address(street, apt. or sujte no., or rural rouiel.Do not use a P.O,box or in-care-of address (other than a registered address). St.Julienstr. 12 iof,r'ate' 5020 Salzburo 7 N4ailing address (if different from above) City or town, state or province. lnclude postal code where app'oi.riatr I U.S. taxpayer identification number. if required ) I ot-erru I wp-etru l--lwr-etru Ü EIN N SSN or ITIN I GllN (if applicable) FAU BQY.S9939"SL"04 10 Reference numbe(s) (see instructions) For Paperwork Reduction Act Notice, see separate instructions, .rt. No. 25402Q ro,'" W-8|MY (Fe!. 4-2or4r

Transcript of W'8IMYGertificate of Foreign Intermediary, Foreign … · ls a nonwithholding foreign partnership,...

Depadment of the TreasuryInternal Revenue Sefvice

*,,, W'8IMYiflev

Do not use this form {or:. A beneficial owner solely claiming foreign status or treaty benefits

. A hybrid entity claiming treaty benefits on its own behall

. A foreign person claiming that income is ef{ectively connected wlth the conduct of a trade or buslness in the United Sta'tes

. A d is regaroed en t ty wr th a s ing ie fo re :gn owner tha l s the oene{ ic ia l owner o f tne income lo wh 'cn th is io rm re la les . lns tead.

the single toreign owner snoulo use

. A foreign government. ;nlernational organ,zation. foreign cenlrar oank ot issue. to.e gn ta. exemot organization. fore'gn pr vatefoundatiön, or government of a U.S. possession claiming the applicabil lty of section(s) I 1 5(2), 501 {c), 892. 895, or 1 443(b)

. U.S. entity or U.S. cit izen or resident

Gertificate of Foreign Intermediary, Foreign Flow-Through Entity, or CertainU.S. Branches for United States Tax Withholding and Reporting

> Section references are to the Internai Revenue Code.

) lnformation about Form W'8IMY and its separate inslructions is al www.irs.govlformwgimy.

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

Otu4B Nc. 1545 162 i

Instead, use Form:

W-8BEN or W-8BEN-E

W.8BEN-E, W-8ECI

W-8BEN, W-BECl, or W-8BEN-E

. W-8EXP\^/-o

W-8BEN, W-BBEN-E, or W-8EClA foreign person themselves for ourooses of section 6050W

ldentification of1 Name of individual or organization that is actinq as intermediary

Volksbank Salzburo eG3 Name of disregarded entity (i i applicable)

Country of . lco'porat,on or organ./alron

4 Chapter 3 Status:

I Qualified intermediary. Complete Part lll.

E Nonqualified intermediary. Complete Pad lV.n *Lj Territory financial institution. Cornplete Pafi V.

I U.S. branch. Complete Pai l Vl .

E Withholding foreign padnership. Complete Part Vtl.5 C h a n t c r 4 S t a t r r c '

- . ,L l Nonpadic ipat ing FFI ( inc luci ing a l imi ted FFI or l imi ted branch)

Complete Pad lX ( i f appl icable l .

I Pafticipating FFl.

f l Report ing Model 1 FFl .

Z neport lng Model 2 FFl .

I Registered deemed-compliant FFI (oiherthan a reportinc lloclel 1 FFIor sponsored FFI that has not obtained a GllN).

! Territory financial institution. Complete Pan V.

I Sponsored FFI that has not obtained a GllN (other than a cenifieddeemed-compliant sponsored, closely held investment vehicle).Complete Part X.

f Ce.titieC deemed-compliant nonregistering local bank. Complete Parlxil.

I CerfineO deemed-compliant FFI with only Iow-value accounis. Complete Parl Xlll

I Certitied deemed-compliant sponsored, closely held investmentvehicle. Complete Part XlV.

I C"ttlfl"d deemed-compliant limiied life debt investment entrty.Complete Part XV.

Ü witfrholaing foreign trust. Complete Part Vll.

I Nonwithholding foreign partnership. Complete Pad Vl l l .

n Nonwithholding foreign s i rnple t rust . Complete Pad Vl l l .

E Nonwithholding foreign grantor t rust . Compleie Part Vl l l

. ;,Jwner-documented FFl. Complete Pafi Xl.

i--i Restricted distribuior. Complete Pad XVl.

i,l Foreign central bank of issue. Complete Parl XVll.

I Nonreport ing IGA FFl . Complete Pad XVl l l .

Il Exempt retirernent plans. Complete Paft XlX.

i] ExcepteO nonfinancial group entity. Complete Part XX.

Ü Excepted nonfinancial stad-up company. Complete Part XXI

i .l fxcepted nonfinancial entity in liquidation or bankruptcyComplete Part XXll.

.--J erUticty traded NFFE or NFFE affiliate of a publicly tradedcorporat ion. Complete Part XXl l l .

L-: ExcepteA territory NFFE. Complete Parl XXIV.

t- nctiue NFFE. Complete Part XXV.

l=l Passive NFFE. Complete Pad XXVI.'

i Direct reporting NFFE.'

lsponsored di rect repoding NFFE. Complete Part XXVII .

6 Permanent residence address (street, apt. or sujte no., or rural rouiel. Do not use a P.O, box or in-care-of address (other than a registered address).

St. Jul ienstr. 12iof,r'ate'

5020 Salzburo7 N4ailing address (if different from above)

City or town, state or province. lnclude postal code where app'oi.riatr

I U.S. taxpayer ident i f icat ion number. i f required )

I ot-erru I wp-etru l--lwr-etru Ü EIN N SSN or ITINI Gl lN ( i f appl icable)

FAU BQY.S9939"SL"0410 Reference numbe(s) (see instructions)

For Paperwork Reduction Act Notice, see separate instructions, . r t . No. 25402Q ro, ' " W-8|MY (Fe! . 4-2or4r

F"or rn \ \ -B IMY Fe i 4 2a , r4 j t l o e 4

FFi in a country other"ihan ihe FFI's country of residence.)1 1 Chapter 4 Status (FATCA staius) of drsregarded eniity or branch receiving payment

l--l Lirlited branch. I Reporting MÖdel i FFi

f Repo*lng Model 2 FFI

t l u.5. brancnr--t ̂ ,. ..L j Hanrcrpai lnq FFtAddress of branch (sireet. apt. or suite no.. or rural route). Do riot use a P.O, box or in-care-of address (other than a reoistered address).

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

13 Gl lN ( i f qny) >

Country

Ghapter 3 Status Gertifications

liEElJI Qualified lntermediary14a L-l (All qualified intermediaries check here) I certify that the entity identified jn Part I (or branch. if relevant):

' ls a qualified intermediary and is not acting for its own account with respect to the account(s) identified on line 10 or in a withholdingstatement associated with this form: and' Has provided or will provide a withholding siatement. as required, ior purposes of chapters 3 and 4 that is subject to the certifications made

on thrs form.

Check all that apply:

b I I certify that the entity identified in Part i of this form is not providing a withholding statement associated with thls form because it assumes

pr imary wi thholding r-esponsibi l r ty for purposes of chapters 3 and 4, and ei ther:. Primary Form 1099 repoding and backup withholding responsjbilrty: or. Reporting responsibility as a participating FFI or registered deemed-cc.npliant FFI with respect to accounts that it maintains and that areheld by specified U.S. persons as permitted under Regulations sections 1.6049-4(cX4Xi) or (c)(4)(ii) in lieu of Form 1099 reporling.

" ! t certify ihat the entity identified in Part I of this form assumes primary withholding responsibility under chapters 3 and 4 with respect ro

payments made to each account identified on this line 1 4c (or on an attachment to this form) )

o L--1 I certify that the entity ideniified in Parl I of this forrr' assumes primary Form 1099 reporting and backup withholding responsibility withi"espect to payments made to each account identifred cn this line 14i or on an attachment to this form or repoding responsibility as aparticipating FFI or registered deemed-compliant Fi:i ririth respect t. accounts that it maintains and that are held by specilied U.S. personsaspe rm i t t edunde rRegu la t i onssec t rons -1 . 6049 -4 (c ) i 1 t { i t o r f c ) ( 4 l ( r i ; , | ] l i eL ,o f Fo rm1099 repo r t r ng }

e I t cedify that the entity identified in Part I of this forr;; d{ieb NOT assume pnmary Form 1 099 reporling and backup withholding responsibilit,and is using th is form to t ransmit Forms W-9 wi th rc-rect tc eaclr ar , . :ount is) held by a U.S. non-exempt recip ient ideni i f ied cn th is I 'ne 14eor in a withholding statement associated with this fcrm )

| f t n e e n t i t y i d e n t i f i e d o n P a r 1 | o f t h i S f o r m h a s a | | o c a t e d o , * i r r J t o " "

U.S. payees on a withholding statement associated with this form (check all that apply):

(i) I I certify that the entity meets the requirements of Regulations section 1 -6049-4(cX4)[ii) with respect to any account holder of anaccount it maintains that is included in a wiihholding rate pool of U.S. payees provided on a withholding statemeni associatedwith th is form.

(ii) Ü fo the extent the entity is providing a v/ithholding statemeni that includes a chapter 4 withholding rate pool of U.S. payees thatare accountholders of an intermediary or flow{hrough entity receiving a payment from the entity identified on line 1, I certifythat the entity on line t has obtained or will obtain documentation sufficient to establish each such intermediary or flow-through entity's status as a participating FFl, registered deemed-compliant FFl, or FFI that is a qualified intermediary.

f n I ceftify that the entity identified in Part I of this form is acting as Qualified Securities Lender with respect to payments associaied with thisform that are U.S. source substitute dividends received from the withholdino aqent.

Check all that apply:

15a E lAt t nonqual i f iedintermediar iesandqual i f iedintermediar iesthatarenotact ingintheircapaci tyassuchcheckhere) lcedi fythat theent i tyidentified in Pad I of this form is not acting as a qualified intermediary with respect to each account(s) for which this form is provided and isnot acting for its own account.

b E I ceftify that the entity identified in Parl I of this form is using this form to transmit withholding cedificates and/or other documentation andhas provided, or will provide, a withholding statement, as required.

c Z t certify that the entity identified in Paft I of this form meets the requirements of Regulations section 1.6049-a(cXa)flii) with respect to anyaccount holder of an account it maintains that is includecj ;n a withholding rate pool of U.S. payees provided on a withholding statementassociated with this form.

d [ | certify that the entity identified in Pari I of this forrn is acting as a Qualified Securiiies Lender with respect to payments associated withth is form that are U.S. source subst i tute d iv idends received f rom the wi thholdinq aqent.

rorm W-8|MY (Rev. 4-2014)

Forn vlr 'Bll\4'/ tRev. J 2014)

Territorv Financial lnstitution

. ls using this form to transmit withholding certificates and/or other documentation and has provided or will provide a withholding

statement, as required for purposes of chapters 3 and 4, that is subjeci to the cenifications made on this form

Page \)

Check whichever box appl ies:

O D f further:certify that the entity identified in Part I is using this form as evidence of its. agreement with the withholding agent to be treated as

_ a U.S.. person ior purposes of 6hap].ers 3::d 4 with respect to any payments assooateq with this withholding certificate.

c I t further cerlify that the entity identified in Part l:.

. ls using this form to transmit withholding cedificates andlor other documentation for the persons for whom it receiv€s a payment; and

16 a D t ce. t , fy rhat tne ent i tv iCenl i f ied in Pad I rs a f rnancia l ,nsuturron (orne' r ' ran an invesTmenr ent i t ) ' that is not a lso a deposi ic l , i4st i tut ion.

custodial institution. or specified insurance company) that is incorporaied or organized under the laws of a possession of the Uniied States.

L,J I certify that the entity identiiied in Paft l:

. ls a nonwithholding foreign partnership, a nonwithholding foreign simple trust, or a nonwithholding foreign grantor trust and that the

payments to which this cedificate relates are not effectively connected, cr are not treated as effectively connected, with the conduct of a

trade or business in the United States: and

. Has orovided or will orovid6 a as required

Certain U.S. Branches17 a I t certify that the,entity identified in Part I is receiving payments that are not effectively connected with the conduct of a trade or business in

. lll l"l"i lll'_*Check whichever box applies:

b n I certify that tne entity identifled in Parl I is a U.S. branch of a foreign bank or insurance company described in Regulations

section 1.144.1-f (b)t2XivXA) that is a participating FFI (including a reporling Model 2 FFI), registered deemed-compliant FFI (including a

report ing Model 1 FFI) , or NFFF that is using th is form as evidence o ' i ls agreement wi th the wi thholding agent to be t reated as a U.S.

person witn respect to any payments associared wilh this withholding certificate.

c tr t certify that the entity ideniified in Part l:

. ts using this form to transmit withholding cedifi-ates and,/or ot.}er dfcumentation for the persons for whom the oranch receives a

payment; and

. Has or wi l l

Partnership (WP) or Foreiqn Trust1 8

1 9

I t certify that the entity identified in Paft | is a withholding foreign partnership or a withholding foreign trust that is compliant with the terms

of its WP or WT agreement

Partnership, Trust, or

Ghapter 4 Status Geftifications

21 a

b

Beneficial Owners20 fJ t certifu that the entity identified in Part I is using this form to transmit withholding cedificates and/or other documentation and has provided

or will provide a withholding statement that indicates the portion of the payment allocated to one or more exempt beneficial owners.

FFI That Has Not Obtained aName of sponsoring entity: >

Check whichever box applies.

I I certify that the entity identified in Pad l:. ls an FFI solely because it is an investmeni entity;. ls not a Ql , WP, or WT; and. Has agreed with the entity identified above (that is not a nonpartrcipating FFI) to act as the sponsoring entity for this entity'

E I certify that the entity identified in Part l:

. ls a controlled foreign corporation as defined in section 957(a);

. ls not a Ql , WP, or WT;

. ls wholly owned, directly or indirectly, by the U.S. financial institution ;dentified above that agrees to act as the sponsoring entity for this

entity; and

. Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all

account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not

limited to, customer identification information, customer documentation. account balance, and all payments made to account holders or

payees.

Fcrm W-8 lMY tRe! . .1 - ,23 i .1 i H ä q e +

Note. This status only applles if the U.S. financial i""tii;;;. p"'il;"*g ;är=p"ril"s to-oet t tä - r"p"nrs M"d"p FFn" -r,rch th,. i;* "giverr has agreed that it rvill treat the FFI as an owner-docurnented FFl. The owner-documented FFI must make ihe certificaiions below.

22a [- l certify that the FFI identified in Part l:o Does not act as an intermediary:. Does not accept deposits in the ordinary course of a banking or similar business;. Does not hold, as a substantial portion of its business, financial assets for the account oJ others;. ls not an insurance company (or the holding compeny of an insui'ance company) that issues or is obligated to make payments withrespect to a financial account;

. ls not affiliated with an entity (other than an FFI tiiat is also treated as an owner-documented FFI) that accepts deposits in the ordinarycourse of a banking or srmilar business, holds, as a substantial portion of its business, financial assets for the account of others, or is aninsurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to afinancial account: and

. Does not maintain a financial account for any nonpadicipating FFl.

Check whichever box applies:

b I I certify that the FFI identified in Parl l:. Has provided, or will provide, an FFI owner repoding statement {inciuding any applicable owner documentatton) that contains:

(i) The name, address. TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specifiedU.S. person that owns a direct or indirect ?quity interest in the owner-documented FFI (looking through all entitres other thanspecif ied U-S. persons);

(ii) The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specifiedU.S. person that owns a debt interest in the owner-documented FFI (including any indirect debt interest, which includes debt interestsin any entity that directly or indirectly owns the payee or any direct or indrrect equity interest in a debt holder of the payee) thatconstitutes a financial account in excess of $50,000 (disregarding all such debt interests owned by participating FFfs, registereddeemed-compliant FFls, cerlified deemed cornpliant FFls. excepted NFFEs. exempt beneficial owners, or U.S. persons other ihanspeci t ied U.S- persons): and

( i i i ) Any addi t ional informat ion the wi ihholding agent requests in orderto fu l f i l l i ts obl igat ions wi th respect to the ent i ty ,

c L l I cer t i {y that the FFI ident i f ied in Pan l :

. Has provided, or will provide, an auditor s letter. signed no rnore than four years prior to the date of payment, from an independentaccouniing firm or legal representative with a locatic,r in the Uuire'l .i1ates stating that the firm or representative has reviewed the FFI'sdocumentation with respect to all of its owners anc debt 5ell6'r-5 sde:rtili€d in Regulations section 1..1471-3(dX6XivXA)(2) and that the FFImöets all the requirements to be an owner-documr., " :,J trFl. -'re :i, :lr,ntified in Pad I has also provided, or will provide, an FFI ownerreport ing statement and Form W-9, wi th appl icable i - i i ivers, as oesir r i , jed in Regulat ions sect ion l .1471-3(dX6Xiv) .

29 D I certify that the FFI identified in Part l:. .1n6rätac .n.1 is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its countryof incorporaiion or organization,

. Engages primarily in the business of receiving deposits from and making loans to. with respect to a bank, retail customers unrelated tosuch bank and, with respect to a credit union or srmilar cooperative credit organization, members, provided that no member has a greaterthan five percent interest in such credit union or cooperative credit organization:

. Does not solicit account holders outside its country c,f organization;

. Has no fixed place of business outside such countrl (for this purpose, a fixed place of business does not include a Iocation that is notädvedised to the public and from which the FFI performs solely administrative suppoft functions);

. Has no more than $175 million in assets on its balance sheet and. ii tr is a member of an expanded affiliated group, the group has nomore than $500 million in total assets on its consolidated orcombineo balance sheets; and

. Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institutionthat is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements set fonh in this Part Xll.

24 [ I certify that the FFI identified in Pad l:

. ls not engaged primarily in the busrness of investlng, reinvesting, or trading in securitres, paftnership lnterests, commodities, notionalprincipal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such security,partnership inierest, commodity, notional principal contract, insurance contract or annuity contract;

. No financial account maintained by the FFI or any menrber of its expanded affiliated group, if any, has a balance or value in excess of$50,000 (as determined after applying applicable account aggregation rules); and

o Nerther the FFI nor the FFI'S entire expanded affiliated group, if any, have more than $50 million in assets on its consolidated orcombined balance sheet as of the end of its most recent accountino vear.

rorm W-8lMY (Rev.4 2014)

Form W-BIMY {Rev. 4 20141

25a

b lName of sponsor i ' lg ent i ty : )

I cedify that the FFI identified in Part l:

: i: ::,'j:l'fi1,:"|."ff:" it is an ilvestnent entrtv cescribed in BesJratrons secticn 1 1471 's(e){4):

. Will have all of its uy Oii19e19e, withholding, and reporting responsibilities (determined asrif the FFI weie a participating FFI) fulfilled bytheSponsor ingeni i ty ident i f iedin| ine25a;and

. Twenty or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by.U.S. financialinstitutions, participating FFls, registered deemed-compliant FFls, and certified deemed-compliant FFls and equity interests owned by anentity that owns 1 00 percent of the equity interests in the FFI identified in Part I and is itself a sponsored FFI)-

Certified Deemed-Compliant Limited Life Debt Investment Ent26 I cedify that the FFI identified in Part l:

. Was in existence as of January 17.2013;

. lssued all classes of its debt.or equity interests to investors on or before January 17.2013 pursuant to a trust indenture or similaragreement: and

. ls certified deemed-compliant because ii satisfies the requirements to be treated as a limited life debt investment entity (such as therestrictions with respect to its assets and other requirements uüder Regulations section 1.1471-a{fl(2)(iv)).

Restricted Distributor(All restricted distributors check here) | certiiy that the entity identifiecj in Part I:. Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;

. Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to eachother,

. ls required to perform AML due diligence procedures under the anti-money laundering laws of its country of organization (which is aFATF-compl iant jur isdict ion):

. Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same

country of incorporation or organization as all members of its affiliated group. lf any;

. Does not solrcit customers outside its country of incorporation or organization;

. Has no more than $-175 million in total assets under managemeni and no more than $7 million in gross revenue on its income statementfor the most recent accounting year;. ls not a member o{ an expanded affiliated group that has more than $500 million in total assets under management or more than $20million in gross revenue for its most recent accounting year on a combined or consolidated income statement; and

. Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantialU.S. owners, or nonparticipating FFls.

Check whichever box applies:

I fudher certify that with respect to all sales of debt or equity interests in the restricteC f'rnd with respect to which this form is furnished that are made

after December 31 , 201 1, the entity identified in Pad l:

n I Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S.resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any

specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonpafticipating FFI.

" f] t. currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U-S. person,

passive NFFE with one or more substantial U.S. owners, or nonparti(;ipating FFI and, for all sales made prior to the time that such a

restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures

identified in Fegulations section 1.1471 -4(c) applicable to preexisting accounts and has redeemed or retired any securities which were sold

to specified U.S. persons, passive NFFEs with one or ntore substantiai U.S. owners, or nonpadicipating FFls, or will transfer the securities

to a distributor that is a participating FFI reporting Model 1 FFl, or repofting Model 2 FFl.

Gentral Bank of lssue2A n I cedify that ihe entity identified in Parl I is treated as the beneficial owner of the payment solely for purposes of chapter 4 under

Regulations section 1.1 471 -6(d)(4).

rorm W-8lMY (Rev. 4-2014)

Form \a,r 8llv1Y (Rev. 4-20i4) page 6

29 r- I "".t'tr,',nut

tf,. . Pun f .' Meets the requirements to be considerecl a nonreporting financial institution pursuant to an IGA between the United States and

' ls entitled to the provisions of the IGA because the entity (or relevant branch) is considered aunder the provisions of the applicable IGA; and' lf you are an FFI treated as a registered deemed-compliant FFI under an applicable Model 2 lGA, provide your GllN

Retirement PlansCheck whichever box applies.30a tr I certify that the entity identified in Part I

. ls established in a country with which the United States has an income tax treaty in force;' ls operated principally to administer or provide pension or retirement benefits; and

' ls entitled to treaty benefits on income that the ftrnd derives from U.S. sources (or would be entitled to benefits if it derived any suchi ^ ^ ^ n ^ \ ^ ^ ^ - ^ ^ : r .trrcorne,l as a resloent of the other country which salisfies any applicable limitation on benefits requirement.

b D I certify that the entity identified jn Pad t:' ls organized for the provision of retirement, disabiiiiy, or.Ceath' benefits (or any combination thereof) to beneficiaries that are formeremployees of one or more employers in consideration foi- services rcndered;

' . No single beneficiary has a right to more than syo oi ihe FF|'s'assets: 'i

' ls sub.iect to government regulation and provides annual informatron reporting about its beneficiaries to the relevant tax authorities in thecountry in which the fund is established or operated: and

(i) ls generally exempt from tax on investment income under the laws of the country in which it is established or operates due to itsstatus as a retirement or pension plan;

(ii) Receives at least 5Oo/o of its total contributions from sponsoring employers (disregarding transfers of assets from other plansdescribed in this pad. retirement and pension accounts described in an applicable Model 1 or Model 2 lGA. other retirement fundsdescribed in an applicable Model 1 or Model 2 IGA. oraccounts described in Regulations section 1.1471-5(b)(2Xi)(A));

(iii) gitner does not permit or penalizes drstributions or withdrawais made before the occurrence of specified events related toretirement, disability, or death (except rollo;er distributions to accounts described in Regulations section 1.1471-5(bX2XD(A)(referring to retirement and pension accounta.l iö retirernent antJ pension accounts described in an applicable Model 1 or Model 2lGA, or to other retirement funds described I this part or In afr nl,olicable Model 1 or Model 2 IGA); or

(iv| limits contributions by employees to the furi: ,,v reference ro earned income of the employee or may not exceed $50,000 annually.

" f I cedify that the entity identified in Pad t:

. ls organized for the provision of retirement, disabiliiy, or dealh benefits (or any combination thereof) to beneficiaries that are formeremployees of one or more employers in consideration for services rendered;

o Has fewer than 50 pafticipants:

o ls sponsored by one or more employers, each of which is not an investment entity or passive NFFE.

. Employee and employer contributions to.the fund (disregarding transfers of assets from other plans described in this pad, retirement andpension accounts described in an applicabrle Model 1 or Model 2 lGA, or accounts described in Regulations section 1 .1 47 1 -s(bX2XiXA)) arelimited by reference to earned income and compensation of the employee, respectively;

o Padicipants'.that are not residents o{ the country in which the fund is established or operated are not entitled to more than 20 percent ofthe fund's assets: and

' ls subject to government regulatron and provides annual information f epoüing about its beneficiaries io the relevant tax authorities in thecountry in which the fund is established or operates"

d I I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), otherihan the requirement that the plan be funded by a trust created ororganized in the United States.

" tr | certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds described

in th is part or in an appl icable Model 1 or Model 2 lGA, accounts descr ibed in Regulat ions sect ion '1 .1471-5(bX2XD(A) ( referr ing toretirement and pension accounts), or retiremeht and pension accounts described in an applicable Model 1 or Model 2 lGA,

f n I certify that the entity identified in Part l:

' ls established and sponsored by a foreign governmer)t, international organization, central bank of issue, or government of a U.S.possession (each as def ined in Regulat ions sect ion 1.1471-6) or an exempt benef ic ia l owner descr ibed in an appl icable Model 1 or Model2 IGA to provide retirement, disability, or death benefits to beneficiaries or participants that are current or former employees of the sponsor(or persons designated by such employees); or

' ls established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S.n ^ e c o a c i ^ n f a r . h 1\ -* - , , -s def ined in Regulat ions sect ion 1.1471 -6) or an exempt benef ic ia l owner descr ibed in an appl icable Model 1 or Model2 IGA to provide retirement, disability. or death benefits to beneficiaries or padicipants that are not current or former employees of suchsponsor, but are in consideration of personal services pedormed lor the sponsor.

rorm W-8|MY (ReY. 4-2a14)

Form W 8 lM\ ' (8ev . 4 '2014 j

xcI ceriify that the eniity identified in Part I:. ls a holdtng company, treasury center. or captive finance company and subsiantially all of the entity's activities are functions described inRegulations section 1.'1471 -s(eXsXi)(C) through (E);

. ls a member of a nonfinancial group described in Flegulations section 1 .1 471 -s(eXsXiXB);

. ls not a depository or custodial institution (other than for members of the entity's expanded affiliated group); and

. Does not function (or hold itself out) as an investment fund. such as a private equity fund, venture capital fund, leveraged buyout fund orany investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capitalassets tor investment purDoses.

32 Li I cedify that the entity identified in Pad l:. Was formed on (or in the case of a new line of business, the date of board resolution approving the new line of business)

(date must be less than 24 months prior to date of payment);. ls not yel operating a business and has no prior operatin! h'story or is jnvesting capital in assets with the intent to operate a new line ofbusiness other than that oi a financial institution or passi\,,e NFFF; and

. Does not function (or hold itself out) as an investment fund, such as a p'ivate equity fund. venture capital fund, leveraged buyout fund, orany investment vehicle vvhose purpose is to acquire or iuriC cen-rpanies and then hold interests in those companies as capital assets forinvestment ourooses.

tI ge"'i'L*'upt"Y33 L-] | cedify that the entity identified in Part l:

. Filed a plan of liquidation, filed a plan or reorganization. or filed for bankruptcy on the following date:

. Has not been engaged during the past 5 years in business as a financial institution or acted as a passive NFFE;

. ls either liquidating or emerging from a reorganization or bankruptcy !.Jith the intent to continue or recommence operatrons as anonfinancial entity; and

. Has provided, or wi l l provide, documentary evidence such as a bankruprcy f i l ing or other publ ic documentat ion that suppods i ts c la im i fit remains in bankruptcy or liquidation for more than three irears.-----FuEiEitT;ädäA

IFFE or NFFCheck whichever box applies:34a I lcert i fythat:

. The entity identified in Part I is a foreign corporation thr, ;s not a finan,-'iai ,nstitution; and

. The stock of such corporation is regularly traded on one or mofe established securities markets, including

L-l I cedify that:. The entity identified in Part I is a foreign corporation that is not a financial institution;. The entity identified in Pad I is a member of the same expanded attiliz'e')group as an entity the stock of which is regularly traded on anestablished securities market;r The name of the entity, the stock of which is regularly traded on an estalliished securities market, is ; and. The name of the securities market on which the stock is regularly tracied is I- -

35 L-J I certify that:. The entity identified in Fart I is an entity that is organized in a possession Lrf the United Siates;. The entity identified in Pad I:

(i) Does not accept deposits in the ordinary course of a banking cr similar business,

(ii) Does not hold, as a substantial portion of its business. financiai assets for the account of others, and

(iii) Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments withresoect to a financial account: and

. All of the owners of the entitv identified in Part I are bona fide residents of the in which the NFFE is

Active NFFEI certify that:. The entity identified in Part I is a foreign entity that is not a financial institLr'lion;. Less than 50% of such entity's gross income for the prececiing calendar year is passive income; and

. Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as aweighted average of the percentage of passive assets measured quarierly). See the instructions for the definition of passive income.

rorm W-8|MY (Fev. 4-2014)

Form W-BIMY (Rev. 4,2Q1 4). . - - . - * " *

37 I I cerlify that the entily identified in Part t:

eage 8

' ls a foreign entity that is not a financial institutic" ': lrs category i, cl.ides an entity organized in a possession of the United States thatengages {or holds itseif out as being engaged) p,,:,raiil\,tn the bJsrness of investinq, r.einvestinc. oi ti.adino in securities, padnershipinterests, commodities, notional prjncipal contracts. ,surance 91 snnuitv contracts, or any interesi in such se;urity, partnership interest,commodity,not iona|pr incipa|contract . inSurancecÜi l t ractorannui tv. .ontract) ;and

. ls using this form to rransmit withholding cert.fi-.irtes ancJ/cr oilla, documentation and has provided or will provide a withholdingstatement, as required.

3839

Na,meröfr sponsoriing entity:

thai the enti identified in Part I is a qirect , . :ürting NFFE ihat rs sponsored by the entity identified in line 38.

Under penalties of perjury' I oeclare that I have exarnrned the information nr: thrs forn anc to the irest of my knowledge and be{ief it is true. correct, and complete.Funnermore. I authorize this form to be provioed to any withhoiding ager,t that has conlrol. rece;pt. or custody of the income for which I an oroviding this form or anywithholding agent that can disburse or make payments of the amounts tör which I am providing this form

I agree that I wil l submit a new within 30 incorrect.

Sign HereI r ..,ud'grg'r;gghL; ,trat:'* i p"",

i', t {..,'. \+/j----Signature of Dare (MM-DD-YYYY)

(Fev. 4-201 4)