W-8ECI Rev October, 2021
Certificate of Foreign Person's Claim That Income Is
Effectively Connected With the Conduct of a Trade or Business in the United States

Note. Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business (see instructions).

Click on any of the following for help with this form:
IRS W-8 instructions, IRS W-8ECI instructions

Instructions:
1. Complete Part 1 below.
2. Complete Part 2 to electronically sign and date the form and add attachments.
When complete, send the completed form by clicking on the "Submit W-8" button.

W-8ECI Part I: Identification of Beneficial Owner
1. Individual/organization name:
2. Country of incorporation:
3. Name of disregarded entity:
4. Type of entity:
5. Permanent residence address:
City or town, state or province:
Country:
6. Business address in the U.S.:
City or town, state or province:
Country:United States of America
7. U.S. taxpayer ID (SSN/ITIN): - -
or EIN: -

8a. Foreign Tax Identification
Number (FTIN):

8b. Check if FTIN not legally required
9. Reference number(s):
10. Date of Birth (MM-DD-YYYY): / /   For Individuals Only

11. Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or business in the United States. Attach statement in Part II if necessary.

12. Check here to certify that: you are a dealer in securities (as defined in section 475(c)(1)); you are a transferor of an interest in a publicly traded partnership (PTP) claiming an exception from withholding under Regulations section 1.1446(f)-4(b)(6); and any gain from the transfer of the PTP interest associated with this form is effectively connected with the conduct of a trade or business within the United States without regard to section 864(c)(8).


Part II: Attachments/Certification/Signature:

Please select and attach any required documentation per instructions.
Not including these documents may cause a delay in your setup.

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Under penalties of perjury, 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. I further certify under penalties of perjury that:

- I am the beneficial owner (or I am authorized to sign for the beneficial owner) of all the payments to which this form relates,

- The amounts for which this certification is provided are effectively connected with the conduct of a trade or business in the United States,

- The income for which this form was provided is includible in my gross income (or the beneficial owner's gross income) for the taxable year, and

- The beneficial owner is not a U.S. person.

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the payments of which I am the beneficial owner or any withholding agent that can disburse or make payments of the amounts of which I am the beneficial owner.

I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

Name:
Email Address:
Verify Email Address:
Title:
Phone:
I certify that I have the capacity to sign for the person identified on line 1 of this form.
Signature below of beneficial owner (or individual authorized to sign for the beneficial owner)
Signature:
Date: 04/19/2024
Message:

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Validation Code:

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