W-8EXP Rev. July 2017
Certificate of Foreign Government or Other Foreign Organization for United States Tax Withholding and Reporting


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

Instructions:
1. Complete Part 1, 2 & 3 below.
2. Complete Part IV to electronically sign and date the form and add attachments.
When complete, send the completed form by clicking on the "Submit W-8" button.


Part I: Identification of Beneficial Owner
1. Name of organization:
2. Country of incorporation:
3. Type of entity:

4. Chapter 4 Status (FATCA status) (Must check one box only unless otherwise indicated). (See instructions for details and complete the certification below for the entity's applicable status).

Participating FFI.
Reporting Model 1 FFI.
Reporting Model 2 FFI.

Registered deemed-compliant FFI (other than a Reporting Model 1 FFI).

Nonreporting IGA FFI. Complete Part III.

Territory financial institution. Complete Part III.

International organization.

Foreign government (including a political subdivision), government of a U.S. possession, or foreign central bank of issue. Complete Part III.

Exempt retirement plan of foreign government. Complete Part III.

501(c) organization. Complete Part III.

Passive NFFE. Complete Part III.

Direct reporting NFFE.

Sponsored direct reporting NFFE. Complete Part III.

5. Permanent address:
City or town, state or province:
Country:
6. Mailing address:
City or town, state or province:
Country:
7. U.S. TIN (if required):
8a. GIIN:
8a. Foreign TIN:
9. Reference number(s):
Part II: Qualification Statement for Chapter 3 Status
Part III: For a nonreporting IGA FFI:


Part IV: Attachments/Certification/Signature: (all fields required)

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:
   - The organization for which I am signing is the beneficial owner of the income and other payments to which this form relates,
   - The beneficial owner is not a U.S. person,
   - For a beneficial owner that is a controlled entity of a foreign sovereign (other than a central bank of issue wholly owned by a foreign sovereign), the beneficial owner is not engaged in commercial activities within or outside the United States, and
   - For a beneficial owner that is a central bank of issue wholly owned by a foreign sovereign, the beneficial owner is not engaged in commercial activities within the United States.
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 on this form becomes incorrect.

Signature and name of authorized individual below certifies that I have the capacity to sign for the entity identified on line 1 of this form.

Name:
Email Address:
Verify Email Address:
Title:
Phone:
Signature:
Date: December 8, 2021
Message:

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