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AH XSL/XML Fileid: … /iw-8imy/202110/a/xml/cycle10/source (Init. & Date) _______

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Department of the Treasury
Internal Revenue Service
Instructions for Form W-8IMY

(Rev. October 2021)
Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S.
Branches for United States Tax Withholding and Reporting

Section references are to the Internal Revenue Code unless 2022. As a result, this Form W-8IMY includes chapter 3
otherwise noted. status certifications for entities acting as QSLs (applicable to
either a qualified intermediary (QI) or other entity acting as a
QSL) and clarifies (as provided in the QI agreement) when a
General Instructions QI may continue to claim status as a QSL in a case in which it
Future developments. For the latest information about is also a qualified derivatives dealer (QDD).
developments related to Form W-8IMY and its instructions, New lines 9a and 9b. Line 9b, foreign taxpayer
such as legislation enacted after they were published, go to identification number, if required, has been added for a QDD
IRS.gov/Formw8imy. to indicate its foreign taxpayer identification number (FTIN)
on this form (with line 9, GIIN (if applicable), redesignated as
What’s New
line 9a). See QDD withholding statement, later, for when a
Guidance under section 1446(f). The Tax Cuts and Jobs QDD is required to provide its FTIN on line 9b.
Act (TCJA), added section 1446(f), which generally requires Nonqualified intermediary (NQI) that provides an alter-
that if any portion of a gain on any disposition of an interest in native withholding statement. The Form W-8IMY and
a partnership would be treated under section 864(c)(8) as these instructions have been updated to allow an NQI that is
effectively connected gain, the transferee purchasing an to provide alternative withholding statements and beneficial
interest in such a partnership from a non-U.S. transferor must owner withholding certificates for payments associated with
withhold a tax equal to 10% of the amount realized on the this form to represent on the form that the information on the
disposition unless an exception to withholding applies. T.D. withholding certificates will be verified for consistency with
9926 (84 FR 76910), published on November 30, 2020, any other account information the NQI has for the beneficial
contains final regulations (section 1446(f) regulations) owners for determining the rate of withholding with respect to
relating to the withholding and reporting required under each payee (applying the standards of knowledge under
section 1446(f), which include withholding requirements that section 1441 or 1471 regulations, as applicable). See T.D.
apply to brokers effecting transfers of interests in publicly 9890 and Regulations section 1.1441-1(e)(3)(iv)(C)(3). When
traded partnerships (PTPs). The section 1446(f) regulations applicable, an NQI may make this representation on new
also revise certain requirements under section 1446(a) line 17e instead of on its withholding statement. The Form
relating to withholding and reporting on distributions made by W-8IMY and these instructions have also been updated to
PTPs, including by expanding the entities permitted to act as allow nonwithholding foreign partnerships and
nominees for PTP distributions to include certain qualified nonwithholding foreign trusts to make this representation
intermediaries and U.S. branches of foreign persons that when providing an alternative withholding statement. For
agree to act as U.S. persons. Withholding on transfers of further information, see the instructions for line 21f.
interests in PTPs and the revisions included in the section
1446(f) regulations relating to withholding on PTP Electronic signature. These instructions have been
distributions under section 1446(a) apply to transfers and updated to include additional guidance included in final
distributions that occur on or after January 1, 2023. See regulations issued under chapter 3 (T.D. 9890) concerning
Notice 2021-51, 2021-36 I.R.B. 361, for more information. the use of electronic signatures on withholding certificates.
The provisions of the section 1446(f) regulations relating to See Part XXIX Certification, later, and Regulations section
withholding and reporting on transfers of interests in 1.1441-1(e)(4)(i)(B).
partnerships that are not PTPs generally apply to transfers Section 6050Y reporting. These instructions have been
occurring after January 29, 2021. See Pub. 515 for an updated to reference the use of this form by a foreign
additional discussion of section 1446(f) withholding. The partnership, foreign simple trust, or foreign grantor trust that
Form W-8IMY and these instructions have been updated to is the seller of a life insurance contract (or interest therein) or
incorporate the use of this form by brokers and certain a recipient of a reportable death benefit for purposes of
transferors of partnership interests for purposes of certain of reporting under section 6050Y.
the requirements of the section 1446(f) regulations for
withholding on dispositions of partnership interests (in both Purpose of Form
PTPs and other partnerships) and for withholding on PTP Under chapter 3, foreign persons are generally subject to
distributions. U.S. tax at a 30% rate on income they receive from U.S.
Section 871(m) regulations and qualified securities sources that consists of interest (including certain original
lenders (QSLs). Notice 2020-2, 2020-3 I.R.B. 327, further issue discount (OID)), dividends, rents, premiums, annuities,
extended the transition relief provided in Notice 2018-72, compensation for, or in expectation of, services performed,
2018-40 I.R.B. 522, for certain provisions of the section or other fixed or determinable annual or periodical (FDAP)
871(m) regulations, generally for 2021 and 2022. Notice gains, profits, or income. This tax is imposed on the gross
2020-2 also further extended the period that a withholding amount paid and is generally collected by withholding under
agent may apply the transition rules to act as a QSL section 1441 or 1442 on that amount. A payment is
described in obsoleted Notice 2010-46, 2010-24 I.R.B. 757, considered to have been made whether it is made directly to
Part III, for substitute dividend payments made in 2021 and the beneficial owner or to another person, such as an

Nov 02, 2021 Cat. No. 25904R

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intermediary, agent, trustee, executor, or partnership, for the        Additional information. For additional information and 
benefit of the beneficial owner.                                       instructions for the withholding agent, see the Instructions for 
                                                                       the Requester of Forms W-8BEN, W-8BEN-E, W-8ECI, 
Under chapter 4, withholding agents must withhold at a                 W-8EXP, and W-8IMY.
30% rate under sections 1471 and 1472 on withholdable 
payments made to nonparticipating foreign financial                    Who Must Provide Form W-8IMY
institutions (FFIs) (including when the nonparticipating FFI is 
                                                                       Except as otherwise provided, you should provide Form 
a flow-through entity or is acting as an intermediary), certain 
                                                                       W-8IMY when receiving a reportable amount or withholdable 
other foreign entities, and certain account holders of FFIs. 
                                                                       payment on behalf of another person or as a flow-through 
For example, if a U.S. withholding agent makes a payment of 
                                                                       entity or when acting as a QDD or QSL. When receiving a 
portfolio interest described in section 871(h) to an account 
                                                                       withholdable payment, your chapter 4 status is generally 
maintained by a nonparticipating FFI, the payment will be 
                                                                       required to be included on the form unless otherwise 
subject to a 30% withholding tax under section 1471 even if 
                                                                       provided in accordance with these instructions. In some 
the nonparticipating FFI is an intermediary or flow-through 
                                                                       cases you should provide Form W-8IMY for an amount 
entity and the beneficial owner for whom the intermediary or 
                                                                       realized or a PTP distribution. Form W-8IMY must be 
flow-through is acting is a foreign individual who provides a 
                                                                       provided by the following persons.
valid Form W-8BEN.
                                                                       • A foreign person, or a foreign branch of a U.S. person, to 
Foreign persons are also subject to tax at graduated rates             establish that it is a QI that is not acting for its own account, 
on income they earn that is considered effectively connected           to represent that it has provided or will provide a withholding 
with a U.S. trade or business. If a foreign person invests in a        statement, as required, or, if applicable, to represent that it 
partnership that conducts a U.S. trade or business, the                has assumed primary withholding responsibility under 
foreign person is considered to be engaged in a U.S. trade or          chapters 3 and 4 and/or primary Form 1099 reporting and 
business. The partnership is required to withhold tax under            backup withholding responsibility.
section 1446(a) on the foreign person’s distributive share of          • A foreign person, a foreign branch of a foreign person, or a 
the partnership’s effectively connected taxable income or, in          foreign branch of a U.S. person, to establish that it is a QI 
the case of a PTP, on the amount of a distribution attributable        acting as a QDD, as permitted by the person’s QI agreement. 
to effectively connected taxable income of the PTP as                  A QDD that receives payments for which the QDD is entitled 
provided in Regulations section 1.1446-4 (excluding when a             to a reduced rate of withholding under an income tax treaty 
nominee rather than the PTP is required to withhold). For              may use its Form W-8IMY to both certify to its status as a QI 
purposes of section 1446(a), the partnership may generally             acting as a QDD and to claim treaty benefits with respect to 
accept any beneficial owner withholding certificate submitted          such payments. A QDD may also use its Form W-8IMY to 
for purposes of section 1441 or 1442, with few exceptions, to          claim an exemption from withholding that may apply based 
establish the foreign status of the partner, including a               on the QDD’s status as a foreign beneficial owner of a 
withholding certificate that is associated with a Form W-8IMY          payment.
submitted by an upper-tier foreign partnership, a foreign              • A foreign person, or a foreign branch of a U.S. person, to 
grantor trust, or a foreign intermediary. See Regulations              establish that it is a QI assuming primary withholding 
sections 1.1446-1 through 1.1446-6 to determine whether a              responsibility with respect to payments of substitute interest, 
withholding certificate submitted for purposes of section              as permitted by the QI agreement.
1441 or 1442 will be accepted for purposes of section                  • For purposes of withholding under section 1446(f), a 
1446(a).                                                               foreign person, or foreign branch of a U.S. person, to 
                                                                       establish that it is a QI that is not acting for its own account 
Withholding may also be required under the section                     and to represent that it has assumed primary withholding 
1446(f) regulations by a transferee paying the amount                  responsibility for a payment of an amount realized from the 
realized from a transfer of a partnership interest to a                sale of an interest in a PTP or has provided, or will provide, a 
transferor of the interest or, for a transfer of an interest in a      withholding statement, as required, for the amounts realized.
PTP, by a broker effecting the transfer. This withholding is           • A foreign person, or a foreign branch of a U.S. person, to 
generally required when any portion of the gain from the               establish that it is a QI not acting for its own account, to 
transfer would be treated as effectively connected gain under          represent that it has assumed primary withholding 
section 864(c)(8). The withholding required of a broker on an          responsibility for distributions from PTPs for which the QI acts 
amount realized on the transfer of a PTP interest is subject to        as a nominee or has provided, or will provide, a withholding 
certain exceptions such as when an amount realized is paid             statement, as required, for the distributions.
to a qualified intermediary assuming withholding                       • A foreign person to establish that it is an NQI that is not 
responsibility under section 1446(f) or to a U.S. branch acting        acting for its own account for chapter 3 purposes (including 
as a U.S. person for the amount realized. See Regulations              for amounts subject to withholding under section 1446(a) or 
section 1.1446(f)-4. For certain withholding exceptions, an            (f)), to certify its chapter 4 status (if required), to certify 
applicable withholding certificate is required for a transfer of a     whether it reports U.S. accounts under chapter 4 (if required), 
PTP interest, such as for an entity to represent its status as         and to indicate, if applicable, that it is using the form to 
an entity described in the preceding sentence (made on this            transmit withholding certificates and/or other documentary 
Form W-8IMY) or for a transferor to claim an exemption from            evidence (when permitted) and has provided, or will provide, 
withholding based on an income tax treaty. A withholding               a withholding statement, when required (including for 
certificate may also be required to establish the status of a          payments subject to withholding under section 1446(a) and, 
broker or partner withheld upon under section 1446(f).                 in certain cases, for section 1446(f)).
Separate withholding exceptions apply to transfers of                  • A U.S. branch that is acting as an intermediary to 
interests in partnerships other than PTPs, certain of which            represent that the income it receives is not effectively 
require the collection of a withholding certificate or other           connected with the conduct of a trade or business within the 
applicable certification. See Regulations section 1.1446(f)-2.         United States and either that it is using the form (1) to 

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evidence it is treated as a U.S. person under Regulations represent that it has provided, or will provide, a withholding
section 1.1441-1(b)(2)(iv)(A) with respect to reportable statement with respect to a modified amount realized for
amounts associated with the Form W-8IMY, or (2) to transmit purposes of withholding under section 1446(f) on the
the documentation of the persons for whom it receives a transfer.
payment of such an amount and has provided, or will • A foreign grantor trust transferring a partnership interest
provide, a withholding statement, as required, and to certify it providing, on behalf of each grantor or other owner of the
is applying the rules described in Regulations section trust under Regulations section 1.1446(f)-1(c)(2)(vii), a
1.1471-4(d)(2)(iii)(C) when receiving a withholdable withholding statement to allocate an amount realized to each
payment. grantor or owner for withholding under section 1446(f) on the
• For purposes of section 1446(f), a U.S. branch that is transfer.
acting as an intermediary, to certify that it agrees to act as a • A flow-through entity (including a foreign reverse hybrid
U.S. person with respect to amounts realized on sales of entity) transmitting withholding certificates and/or other
interests in PTPs. documentary evidence to claim treaty benefits on behalf of its
• A U.S. branch, to represent that it is treated as a U.S. owners, to certify its chapter 4 status (if required), and to
person and is acting as a nominee for distributions from certify that it has provided, or will provide, a withholding
PTPs under Regulations section 1.1446-4(b)(3) (or has statement, as required.
otherwise provided (or will provide) a withholding statement • A nonparticipating FFI acting as an intermediary or that is a
for a distribution). flow-through entity using this form to transmit a withholding
• A financial institution incorporated or organized under the statement and withholding certificates or other
laws of a U.S. territory that is acting as an intermediary or is a documentation for exempt beneficial owners described in
flow-through entity to represent that it is a financial institution Regulations section 1.1471-6 with respect to its receipt of a
(other than an investment entity that is not also a depository withholdable payment.
institution, custodial institution, or specified insurance • A QSL that is either a QI (to the extent not acting as a
company) and either that it is using the form (1) to evidence it QDD) or other entity certifying to a withholding agent that it is
is treated as a U.S. person under Regulations section acting as a QSL in Part IV of Form W-8IMY with respect to
1.1441-1(b)(2)(iv)(A) with respect to payments of income that U.S. source substitute dividends received from the
are not effectively connected with the conduct of a trade or withholding agent prior to January 1, 2023, pursuant to a
business in the United States associated with the Form securities lending transaction within the meaning of Notice
W-8IMY, or (2) to certify that it is transmitting documentation 2010-46. See also Notice 2020-2.
of the persons for whom it receives such payment and has • A foreign intermediary or flow-through entity not receiving
provided, or will provide, a withholding statement, as withholdable payments or reportable amounts that is holding
required. an account with a participating FFI or registered
• For withholding under section 1446(f), a financial deemed-compliant FFI providing this form for purposes of
institution incorporated or organized under the laws of a U.S. documenting its chapter 4 status as an account holder. No
territory that is acting as an intermediary or that is a withholding statement is required to be provided along with
flow-through entity, to certify that it is acting as a U.S. person Form W-8IMY in this case. The entity may instead provide
for amounts realized on sales of interests in PTPs. Form W-8BEN-E to document its chapter 4 status as an
• A financial institution incorporated or organized under the account holder of an FFI when it is not receiving withholdable
laws of a U.S. territory that is acting as an intermediary or that payments or reportable amounts.
is a flow-through entity, to certify that it agrees to act as a • A foreign partnership, foreign simple trust, or foreign
U.S. person and as a nominee for distributions from PTPs grantor trust that is the seller of a life insurance contract (or
under Regulations section 1.1446-4(b)(3) (or has otherwise interest therein) or a recipient of a reportable death benefit to
provided (or will provide) a withholding statement for a establish its foreign status and to associate this form with any
distribution). other applicable documentation for purposes of section
• A foreign partnership or a foreign simple or grantor trust to 6050Y or chapter 3. See Regulations sections 1.6050Y-3
establish that it is a withholding foreign partnership or and 1.6050Y-4.
withholding foreign trust for purposes of chapters 3 and 4. This form may serve to establish foreign status for
• A foreign partnership or a foreign simple or grantor trust to purposes of sections 1441, 1442, and 1446(a) or (f).
establish that it is a nonwithholding foreign partnership or However, any representations that items of income, gain,
nonwithholding foreign simple or grantor trust for reportable deduction, or loss are not effectively connected with a U.S.
amounts and withholdable payments, to certify to its trade or business will be disregarded by a partnership
chapter 4 status (if required), to represent that the income is receiving this form for purposes of section 1446(a) or (f), as
not effectively connected with a U.S. trade or business, and the partnership will undertake its own analysis.
to certify that the form is being used to transmit withholding
certificates and/or documentary evidence and that it has Do Not Use Form W-8IMY If You Are Described
provided or will provide a withholding statement as required.
• A foreign partnership or foreign grantor trust to establish Below
that it is an upper-tier foreign partnership or foreign grantor • You are the beneficial owner (other than a QDD acting in
trust for purposes of section 1446(a) and, except for a its QDD capacity or a QSL acting as a principal for substitute
partnership that is a PTP, to represent that the form is being dividend payments) of U.S. source income (other than
used to transmit withholding certificates and/or documentary income that is effectively connected with the conduct of a
evidence and that it has provided, or will provide, a trade or business within the United States ), and you need to
withholding statement, as required. establish that you are not a U.S. person, establish your
• A foreign partnership to establish that it is the transferor of chapter 4 status (if required), or claim a reduced rate of
an amount realized from the transfer of a partnership interest withholding on your own behalf under an income tax treaty (if
for purposes of section 1446(f) and, when applicable, to applicable). Instead, submit Form W-8BEN or Form
W-8BEN-E.

Instructions for Form W-8IMY (Rev. 10-2021) -3-

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• You are a hybrid entity claiming treaty benefits on your When to provide Form W-8IMY to the withholding agent.
own behalf (unless you are a QDD acting in your QDD Give Form W-8IMY to the person requesting it before income
capacity). Instead, provide Form W-8BEN-E to claim treaty is paid, credited, or allocated to your account. If you do not
benefits. However, if you are receiving a withholdable provide this form, the withholding agent may have to withhold
payment you may also be required to provide Form W-8IMY at the 30% rate (for an amount subject to withholding under
to establish your chapter 4 status (unless you are a chapter 3 or a withholdable payment under chapter 4),
disregarded entity) and the chapter 4 status of each of your backup withhold, or withhold at the applicable rate for net
partners, beneficiaries, or owners. See the Instructions for effectively connected taxable income allocable to a foreign
Form W-8BEN-E for more information about hybrid entities partner in a partnership under section 1446. Generally, a
claiming treaty benefits. separate Form W-8IMY must be submitted to each
• You are a foreign reverse hybrid entity (unless you are a withholding agent from whom you receive a payment.
QDD acting in your QDD capacity or a QSL acting as a
principal for substitute dividend payments) that is not Expiration of Form W-8IMY. Generally, a Form W-8IMY
claiming treaty benefits on behalf of your interest holders. remains valid until the status of the person whose name is on
Instead, provide Form W-8BEN-E on your own behalf. the certificate is changed in a way relevant to the certificate
• You are the beneficial owner of income that is effectively or there is a change in circumstances that makes the
connected with the conduct of a trade or business within the information on the certificate no longer correct. The indefinite
United States. Instead, provide Form W-8ECI. validity period does not extend, however, to any other
• You are a nonresident alien individual who claims withholding certificates, documentary evidence, or
exemption from withholding on compensation for withholding statements associated with the certificate. If you
independent or certain dependent personal services are a QDD, the attachment associated with your Form
performed in the United States. Instead, provide Form 8233 W-8IMY used to claim treaty benefits (if applicable) is treated
or Form W-4. as a beneficial owner withholding certificate that is not valid
• You are a disregarded entity, other than a hybrid entity that indefinitely. For the validity period of a Form W-8IMY used by
is a disregarded entity claiming treaty benefits on your own a QDD to claim an exemption from withholding that applies
behalf (see above bullet). Instead, the single owner (if a based on a QDD’s status as a foreign beneficial owner of the
foreign person) should provide the appropriate Form W-8 payment, see Regulations section 1.1441-1(e)(4)(ii)(A)(1).
based on the single owner's status. If you are a disregarded Change in circumstances. If a change in circumstances
entity that is a QDD acting in your QDD capacity, your single makes any information on the Form W-8IMY (or any
owner (whether or not a QDD) should provide Form W-8IMY documentation or withholding statement associated with the
as a QI. Form W-8IMY) you have submitted incorrect for purposes of
• You are a QI receiving payments of U.S. source income chapter 3 or chapter 4 (when relevant), you must notify the
that you beneficially own other than payments received as a withholding agent within 30 days of the change in
QDD in respect of potential section 871(m) transactions or circumstances and provide the documentation required in
underlying securities or received as a QSL acting as a Regulations section 1.1471-3(c)(6)(ii)(E)(2). You must
principal in a security lending or sale-repurchase transaction update the information associated with Form W-8IMY as
(that is, you are receiving payments that you beneficially own often as is necessary to enable the withholding agent to
that are not covered by your QI agreement). Instead, provide withhold at the appropriate rate on each payment and to
the appropriate Form W-8 based on your status for those report such income.
payments you beneficially own.
See Regulations sections 1.1441-1(e)(4)(ii)(D) for the
• You are a foreign government, international organization,
definition of a change in circumstances for purposes of
foreign central bank of issue, foreign tax-exempt
chapter 3 and Regulations section 1.1471-3(c)(6)(ii)(E) for
organization, foreign private foundation, or government of a
the definition of a change in circumstances for purposes of
U.S. possession claiming the applicability of section 115(2),
chapter 4.
501(c), 892, 895, or 1443(b), and, if required, claiming an
exemption from chapter 4 withholding. Instead, provide Form With respect to an FFI claiming a chapter 4 status
W-8EXP. However, these entities should use Form ! under an applicable IGA, a change in circumstances
W-8BEN-E instead if they are claiming treaty benefits or are CAUTION includes when the jurisdiction where the FFI is
providing the form only to claim exempt recipient status for organized or resident (or the jurisdiction where a disregarded
Form 1099 and backup withholding purposes. entity or branch of an FFI is organized, identified in Part II of
the form) was included on the list of jurisdictions treated as
Giving Form W-8IMY to the withholding agent. Do not
having an intergovernmental agreement in effect and is
send Form W-8IMY to the IRS. Instead, give it to the person
removed from that list or when the FATCA status of the
who is requesting it. Generally, this will be the person from
jurisdiction changes (for example, from Model 2 to Model 1).
whom you receive the payment, the person who credits your
The list of agreements is maintained at www.treasury.gov/
account, or a partnership that allocates income to you. If you
resource-center/tax-policy/treaties/Pages/FATCA-
are an account holder of an FFI, the FFI may request this
Archive.aspx.
form from you to document the status of your account for
chapter 4 purposes.
Definitions
You may provide a single Form W-8IMY if you have
TIP multiple branches receiving payments from the same Account. With respect to QI, including a QI acting as a
withholding agent rather than separate Forms QDD, an account is defined in section 2.01 of the QI
W-8IMY to identify each branch receiving payments Agreement.
associated with the form. In such a case, you should provide Account holder. An account holder is generally the person
a schedule that includes all required information for each listed or identified as the holder or owner of a financial
branch. See the instructions for Part II. account (other than an agent or nominee that is not an FFI).

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For example, if a partnership is listed as the holder or owner to a foreign partnership are generally the partners in the
of a financial account, then the partnership is the account partnership, provided that the partner is not itself a
holder rather than the partners of the partnership. However, partnership, foreign simple or grantor trust, nominee, or other
an account that is held by a disregarded entity is treated as agent. The beneficial owners of income paid to a foreign
held by the person owning the entity. With respect to a QI simple trust (that is, a foreign trust that is described in section
acting as a QDD, see section 2.02 of the QI Agreement for 651(a)) are generally the beneficiaries of the trust, if the
the definition of account holder. beneficiary is not itself a foreign partnership, foreign simple
or grantor trust, nominee, or other agent. The beneficial
Amount realized. For purposes of section 1446(f), an
owners of income paid to a foreign grantor trust (that is, a
amount realized on the transfer of an interest in a partnership
foreign trust to the extent that all or a portion of the income of
other than a PTP is determined under section 1001 (including
the trust is treated as owned by the grantor or another person
Regulations sections 1.1001-1 through 1.1001-5) and section
under sections 671 through 679) are the persons treated as
752 (including Regulations sections 1.752-1 through
the owners of the trust. The beneficial owner of income paid
1.752-7). See Regulations section 1.1446(f)-2(c)(2). An
to a foreign complex trust (that is, a foreign trust that is not a
amount realized on the transfer of a PTP interest is the
foreign simple trust or foreign grantor trust) is the trust itself.
amount of gross proceeds (as defined in Regulations section
1.6045-1(d)(5)) paid or credited to a partner or broker (as Generally, these beneficial owner rules apply for purposes
applicable) that is a transferor of the interest. The amount of sections 1441, 1442, and 1446(a) and (f), except that
realized on a PTP distribution is the amount of the distribution sections 1446(a) and (f) require a foreign simple trust to
reduced by the portion of the distribution that is attributable to provide a Form W-8 on its own behalf rather than on behalf of
the cumulative net income of the partnership (as determined the beneficiary of such trust.
under Regulations section 1.1446(f)-4(c)(2)(iii)). The beneficial owner of income paid to a foreign estate is
Amounts subject to withholding. Generally, an amount the estate itself.
subject to chapter 3 withholding is an amount from sources A payment to a U.S. partnership, U.S. trust, or U.S. estate
within the United States that is fixed or determinable annual is treated as a payment to a U.S. payee. A U.S. partnership,
or periodical (FDAP) income (including such an amount on a trust, or estate should provide the withholding agent with a
PTP distribution unless indicated otherwise). FDAP income is Form W-9. However, for purposes of section 1446(a), a U.S.
all income included in gross income, including interest (as grantor trust or disregarded entity shall not provide the
well as OID), dividends (including dividend equivalents), withholding agent a Form W-9 pertaining to itself. Instead,
rents, royalties, and compensation. Amounts subject to the entity must provide a Form W-8 or Form W-9 pertaining
chapter 3 withholding do not include amounts that are not to each grantor or owner, as appropriate, and in the case of a
FDAP, such as most gains from the sale of property trust, a statement identifying the portion of the trust treated as
(including market discount and option premiums), as well as owned by each such person. For purposes of section
other specific items of income described in Regulations 1446(f), the grantor or owner must provide a Form W-8 or
section 1.1441-2 (such as interest on bank deposits and Form W-9 to certify its status and the amount realized
short-term OID). allocable to the grantor or owner, which, alternatively, can be
Amounts subject to chapter 4 withholding are payments of provided by the U.S. grantor trust on behalf of a grantor or
U.S. source FDAP income that are withholdable payments as owner.
defined in Regulations section 1.1473-1(a) and to which no Broker. A person described in Regulations section
exception under Regulations section 1.1473-1(a)(4) applies 1.1446(f)-1(b)(1) when referenced in connection with a
(for example, certain nonfinancial payments are excepted transfer of a PTP interest.
from the definition of withholdable payment). The exemptions
from withholding provided for under chapter 3 are not Chapter 3. Chapter 3 of the Internal Revenue Code
applicable when determining whether withholding applies (Withholding of Tax on Nonresident Aliens and Foreign
under chapter 4. Corporations), excluding sections 1445 and 1446.
For purposes of section 1446(a), the amount subject to Chapter 3 withholding rate pool. A payment of a single
withholding is the foreign partner’s share of the partnership’s type of income, based on the categories of income reported
effectively connected taxable income. For purposes of on Form 1042-S (for example, interest or dividends), that is
section 1446(f), the amount subject to withholding is the not subject to withholding under chapter 4 but is subject to a
amount realized on the transfer of a partnership interest. single rate of withholding and is paid to foreign persons or, in
the case of a zero-percent pool, U.S. exempt recipients not
Beneficial owner. For payments other than those for which included in a separate pool of exempt recipients.
a reduced rate of, or exemption from, withholding is claimed
under an income tax treaty, the beneficial owner of income is Chapter 4. Chapter 4 of the Internal Revenue Code (Taxes
generally the person who is required under U.S. tax to Enforce Reporting on Certain Foreign Accounts).
principles to include the payment in gross income on a tax Chapter 4 contains sections 1471 through 1474.
return. A person is not a beneficial owner of income, Chapter 4 status. A person’s status as a U.S. person,
however, to the extent that person is receiving the income as specified U.S. person, foreign individual, participating FFI,
a nominee, agent, or custodian, or to the extent the person is deemed-compliant FFI, restricted distributor, exempt
a conduit whose participation in a transaction is disregarded. beneficial owner, nonparticipating FFI, territory financial
In the case of amounts paid that do not constitute income, institution, excepted Non-Financial Foreign Entity (NFFE) or
beneficial ownership is determined as if the payment were passive NFFE.
income.
Chapter 4 withholding rate pool. A pool identified on a
Foreign partnerships, foreign simple trusts, and foreign withholding statement provided by an intermediary or
grantor trusts are not the beneficial owners of income paid to flow-through entity with respect to a withholdable payment
the partnership or trust. The beneficial owners of income paid that is allocated to payees that are nonparticipating FFIs. The

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term chapter 4 withholding rate pool also includes a pool For purposes of chapter 4, exceptions are provided for
identified on an FFI withholding statement provided by a accounts such as certain tax-favored savings accounts, term
participating FFI or registered deemed-compliant FFI with life insurance contracts, accounts held by estates, escrow
respect to a withholdable payment that is allocated to a class accounts, and certain annuity contracts. See Regulations
of recalcitrant account holders as described in Regulations section 1.1471-5(b)(2). Accounts may also be excluded from
section 1.1471- 4(d)(6) (or with respect to an FFI that is a QI, the definition of financial account under an applicable IGA.
a single pool of recalcitrant account holders without the need
Financial institution. A financial institution generally
to subdivide into each class of recalcitrant account holder),
means an entity that is a depository institution, custodial
including a pool of account holders to which the escrow
institution, investment entity, or an insurance company (or
procedures for dormant accounts apply. Finally, a chapter 4
holding company of an insurance company) that issues cash
withholding rate pool also includes a pool of U.S. persons
value insurance or annuity contracts. See Regulations
included in a U.S. payee pool described in Regulations
section 1.1471-5(e).
section 1.6049-4(c)(4) provided by a participating FFI
(including a reporting Model 2 FFI), a registered Fiscally transparent entity. An entity is treated as fiscally
deemed-compliant FFI (including a reporting Model 1 FFI), or transparent with respect to an item of income to the extent
a QI. that the interest holders in the entity must, on a current basis,
take into account separately their shares of an item of income
Deemed-compliant FFI. Under section 1471(b)(2), certain
paid to the entity, whether or not distributed, and must
FFIs are deemed to comply with the regulations under determine the character of the items of income as if they
chapter 4 without the need to enter into an FFI agreement
were realized directly from the sources from which realized
with the IRS. However, certain deemed-compliant FFIs are
by the entity. For example, partnerships, common trust funds,
required to register with the IRS and obtain a GIIN. These
and simple trusts or grantor trusts are generally considered
FFIs are referred to as registered deemed-compliant FFIs.
to be fiscally transparent with respect to items of income
See Regulations section 1.1471-5(f)(1) and also an received by them.
applicable IGA for entities treated as registered
deemed-compliant FFIs. Flow-through entity. A foreign partnership (other than a
withholding foreign partnership), a foreign simple or foreign
Disclosing QI. For purposes of section 1446(a) or (f), a QI
grantor trust (other than a withholding foreign trust), or, for
that provides with its withholding statement the specific
payments for which a reduced rate of withholding is claimed
payee documentation referenced in Regulations section
under an income tax treaty, any entity to the extent the entity
1.1446(f)-4(a)(7)(iii) (for an amount realized) or Regulations
is considered to be fiscally transparent with respect to the
section 1.1446-4(e)(4) (for withholding on a PTP distribution
payment by an interest holder’s jurisdiction.
under section 1446(a)) instead of the chapter 3 withholding
rate pool information otherwise permitted to be included on Foreign financial institution (FFI). A foreign entity that is a
the withholding statement. A QI that acts as a disclosing QI financial institution.
for a payment must act as a disclosing QI for the entire Foreign person. A foreign person includes a nonresident
payment. alien individual, a foreign corporation, a foreign partnership, a
Disregarded entity. A business entity that has a single foreign trust, a foreign estate, and any other person that is
owner and is not a corporation under Regulations section not a U.S. person. It also includes a foreign branch or office
301.7701-2(b) is disregarded as an entity separate from its of a U.S. financial institution or U.S. clearing organization if
owner. A disregarded entity does not submit Form W-8IMY to the foreign branch is a qualified intermediary. Generally, a
a withholding agent or FFI. Instead, the owner of such entity payment to a U.S. branch of a foreign person is a payment to
provides the appropriate documentation (for example, a a foreign person.
Form W-8BEN-E if the owner is a foreign entity that is not a Global intermediary identification number (GIIN). The
QDD). However, if a disregarded entity receiving a identification number assigned to an entity that has
withholdable payment is an FFI outside the single owner’s registered with the IRS for chapter 4 purposes.
country of organization or has its own GIIN, see the
instructions to Part II of Form W-8IMY for when to provide the Hybrid entity. Any person (other than an individual) that is
chapter 4 status of the disregarded entity receiving the treated as fiscally transparent (rather than as a beneficial
payment. owner) under the Code but is not treated as fiscally
Certain entities that are disregarded for U.S. tax purposes transparent by a country with which the United States has an
may nevertheless be treated as treaty residents for purposes income tax treaty. Hybrid entity status is relevant for claiming
of claiming treaty benefits under an applicable tax treaty (see treaty benefits for purposes of chapter 3. A hybrid entity,
the definition of Hybrid entity, later). See Form W-8BEN-E may, however, be considered the payee for purposes of
and the accompanying instructions for more information chapter 4 (see Regulations section 1.1471-3(a) defining who
about a hybrid entity claiming treaty benefits on its own is a payee of a withholdable payment). See the special
behalf as a resident of a treaty jurisdiction. instructions for hybrid entities, earlier, under Who Must
Provide Form W-8IMY, and Regulations section 1.1471-3(d)
Financial account. A financial account includes: for the documentation requirements with respect to entities
• A depository account maintained by an FFI; receiving withholdable payments.
• A custodial account maintained by an FFI;
• Equity or debt interests (other than interests regularly Intergovernmental Agreement (IGA). A Model 1 IGA or a
traded on an established securities market) in investment Model 2 IGA. For a list of jurisdictions treated as having in
entities and certain holding companies, treasury centers, or effect a Model 1 or Model 2 IGA, go to www.treasury.gov/
financial institutions; resource-center/tax-policy/treaties/Pages/FATCA-
• Certain cash value insurance contracts; and Archive.aspx.
• Annuity contracts.

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A Model 1 IGA means an agreement between the United foregoing, a QDD may not act as a QSL for potential section
States or the Treasury Department and a foreign government 871(m) transactions, except with respect to a payment on a
or one or more agencies to implement FATCA through securities lending or sale-repurchase transaction for which
reporting by FFIs to such foreign government or agency the QI has determined that it is acting as an intermediary for
thereof, followed by automatic exchange of the reported the payment. While Notice 2010-46 was obsoleted, Notice
information with the IRS. An FFI in a Model 1 IGA jurisdiction 2020-2 permits withholding agents to apply the transition
that performs account reporting to the jurisdiction’s rules described in Notice 2010-46 for payments made in
government is referred to as a reporting Model 1 FFI. 2021 and 2022.
A Model 2 IGA means an agreement or arrangement Nonqualified intermediary. Any intermediary that is not
between the United States or the Treasury Department and a a U.S. person and that is not a qualified intermediary.
foreign government or one or more agencies to implement Modified amount realized. In the case of an amount
FATCA through reporting by FFIs directly to the IRS in realized under section 1446(f) received by a transferor that is
accordance with the requirements of an FFI agreement, a foreign partnership, the amount determined under
supplemented by the exchange of information between such Regulations section 1.1446(f)-4(c)(2)(ii) (for a transfer of a
foreign government or agency thereof and the IRS. An FFI in PTP interest) or under Regulations section 1.1446(f)-2(c)(2)
a Model 2 IGA jurisdiction that registered with the IRS to (iv) (for a transfer of an interest in a partnership other than a
obtain a GIIN and agreed to comply with the terms of an FFI PTP).
agreement with respect to a branch is treated as a
participating FFI but may be referred to as a reporting Nominee. When referenced in connection with a PTP
Model 2 FFI. distribution, a person that holds an interest in a PTP on
behalf of a foreign person and that is either a U.S. person, a
The term reporting IGA FFI refers to both reporting
QI that assumes primary withholding responsibility for a PTP
Model 1 FFIs and reporting Model 2 FFIs.
distribution, or a U.S. branch of a foreign person (or territory
Intermediary. Any person that acts as a custodian, broker, financial institution) that agrees to be treated as a U.S.
nominee, or otherwise as an agent for another person, person with respect to the distribution. See Regulations
regardless of whether that other person is the beneficial section 1.1446-4(b)(3).
owner of the amount paid, a flow-through entity, or another
Nonreporting IGA FFI. An FFI that is a resident of, or
intermediary.
located or established in, a Model 1 or Model 2 IGA
Qualified intermediary (QI). A person that is a party to a jurisdiction that meets the requirements of:
withholding agreement with the IRS (described in • A nonreporting financial institution described in a specific
Regulations section 1.1441-1(e)(5)(iii)) and is: category in Annex II of the Model 1 or Model 2 IGA;
• A foreign financial institution (other than a U.S. branch of • A registered deemed-compliant FFI described in
an FFI) that is a participating FFI (including a reporting Model Regulations section 1.1471-5(f)(1)(i)(A) through (F);
2 FFI), a registered deemed-compliant FFI (including an FFI • A certified deemed-compliant FFI described in
treated as a deemed-compliant FFI under an applicable IGA Regulations section 1.1471-5(f)(2)(i) through (v); or
subject to due diligence and reporting requirements similar to • An exempt beneficial owner described in Regulations
those applicable to a registered deemed-compliant FFI under section 1.1471-6.
Regulations section 1.1471-5(f)(1), including the requirement
to register with the IRS), or any other category of FFI Nonwithholding foreign partnership, simple trust, or
identified in the QI agreement; grantor trust. A nonwithholding foreign partnership is any
• A foreign person that is a home office or has a branch that foreign partnership other than a withholding foreign
is an eligible entity (as described in Regulations section partnership. A nonwithholding foreign simple trust is any
1.1441-1(e)(6)(ii); foreign simple trust that is not a withholding foreign trust. A
• A foreign branch or office of a U.S. financial institution or a nonwithholding foreign grantor trust is any foreign grantor
foreign branch or office of a U.S. clearing organization; or trust that is not a withholding foreign trust.
• A foreign entity not described above that the IRS accepts Participating FFI. An FFI that has agreed to comply with the
as a qualified intermediary. terms of an FFI agreement with respect to all branches of the
Qualified derivatives dealer (QDD). A QI that is an FFI, other than a branch that is a reporting Model 1 FFI or a
eligible entity that agrees to meet the requirements of U.S. branch. The term participating FFI also includes a
Regulations section 1.1441-1(e)(6)(i) and the QI agreement reporting Model 2 FFI and a QI branch of a U.S. financial
and has been approved by the IRS to so act. An eligible institution, unless such branch is a reporting Model 1 FFI.
entity is defined in Regulations section 1.1441-1(e)(6)(ii).
Payee. A payee is generally a person to whom a payment is
The home office or branch, as applicable, that is a QDD made, regardless of whether such person is the beneficial
must represent itself as a QDD on its Form W-8IMY and owner. For a payment made to a financial account, the payee
separately identify the home office or branch as a recipient is generally the holder of the financial account. However,
on a withholding statement (if necessary). Each home office under certain circumstances a person who receives a
or branch that obtains QDD status is treated as a separate payment will not be considered the payee. For purposes of
QDD. chapter 3, see Regulations section 1.1441-1(b)(2) and for
Qualified securities lender (QSL). Notice 2010-46, chapter 4, see Regulations section 1.1471-3(a)(3).
provided rules for QSLs acting with respect to payments of
substitute dividends. A QSL that is a QI should certify to its Publicly traded partnership (PTP). A PTP is an entity that
QSL status in Part III of this form, regardless of whether it is has the same meaning as in section 7704 and Regulations
acting as a principal or an agent with respect to its QSL sections 1.7704-1 through 1.7704-4 but does not include a
transactions. A QSL that is not a QI, including a QSL acting PTP treated as a corporation under that section.
as a principal with respect to QSL transactions, should certify
its QSL status in Part IV of this form. Notwithstanding the

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PTP distribution. A PTP distribution is a distribution made any foreign intermediary, foreign partnership, and U.S.
by a PTP. branches of certain foreign banks and insurance companies.
For purposes of section 1446(a), in general, the
PTP interest. A PTP interest is an interest in a PTP if the
withholding agent is the partnership conducting the trade or
interest is publicly traded on an established securities market
business in the United States. For purposes of section
or is readily tradable on a secondary market (or the
1446(a), the withholding agent for a PTP may be the
substantial equivalent thereof).
partnership or a nominee for a distribution holding an interest
Reportable amount. Solely for purposes of the statements on behalf of a foreign person. See Regulations section
required to be attached to Form W-8IMY, a reportable 1.1446-4.
amount is an amount subject to withholding under chapter 3,
Withholding foreign partnership (WP) or withholding
U.S. source deposit interest (including original issue
foreign trust (WT). A WP or WT is a foreign partnership or
discount), and U.S. source interest or original issue discount
a foreign simple or grantor trust that has entered into a
on the redemption of short-term obligations. It does not
withholding agreement with the IRS in which it agrees to
include payments on deposits with banks and other financial
assume primary withholding responsibility for purposes of
institutions that remain on deposit for 2 weeks or less or
chapter 4 and sections 1441 through 1443 for all payments
amounts received from the sale or exchange (other than a
that are made to its partners, beneficiaries, or owners, except
redemption) of a short-term obligation that is effected outside
as otherwise provided in the withholding agreement. A WP
the United States. It also does not include amounts of original
also includes a foreign reverse hybrid entity that has entered
issue discount arising from a sale and repurchase transaction
into a withholding agreement.
completed within a period of 2 weeks or less, or amounts
described in Regulations section 1.6049-5(b)(7), (10), or (11) Withholding statement. A withholding statement for a
(relating to certain obligations issued in bearer form). reportable amount provides an allocation (by income type) to
each payee (or withholding rate pool, if applicable, or other
Reverse hybrid entity. Any person (other than an
pool of payees to the extent permitted under the section 1441
individual) that is not fiscally transparent under U.S. tax law
and chapter 4 regulations) of each payment an intermediary
principles but that is fiscally transparent under the laws of a
or flow-through entity receives. For purposes of section
jurisdiction with which the United States has an income tax
1446(a), a withholding statement provided by an upper-tier
treaty.
foreign partnership (or foreign grantor trust to a lower-tier
Territory financial institution. A financial institution that is partnership or intermediary receiving the amount on behalf of
incorporated or organized under the laws of any U.S. the foreign partnership or grantor trust) provides an allocation
territory. However, an investment entity that is not also a of the effectively connected income to each partner or owner
depository institution, custodial institution, or specified in the upper-tier partnership or the trust. For purposes of
insurance company is not a territory financial institution. A section 1446(f), a withholding statement provided by an
territory financial institution acting as an intermediary or that intermediary for an amount realized on the transfer of a PTP
is a flow-through entity may agree to be treated as a U.S. interest provides an allocation of the amount realized to each
person under Regulations section 1.1441-1(b)(2)(iv)(A), for transferor of the PTP interest or to a chapter 3 or 4
purposes of withholding on a PTP distribution as a nominee withholding rate pool when permitted under Regulations
under Regulations section 1.1446-4(b)(3), or for an amount section 1.1446(f)-4(a)(7). The withholding statement
realized under section 1446(f). provided by an intermediary for a PTP distribution provides
Transfer. A sale, exchange, or other disposition of an allocation information with respect to each partner receiving
interest in a partnership, and includes a distribution from a a distribution of an amount subject to withholding under
partnership to a partner, as well as a transfer treated as a section 1446(a) or (f), with respect to each beneficial owner
sale or exchange under section 707(a)(2)(B). or payee receiving an amount subject to withholding under
chapter 3 or 4 on the distribution (such as a beneficiary of a
Transferee. Any person, foreign or domestic, that acquires partner in the PTP that is a simple trust receiving a payment
a partnership interest through a transfer, and includes a subject to chapter 3 withholding), or with respect to a
partnership that makes a distribution. chapter 3 or 4 withholding rate pool as permitted (including a
Transferor. A transferor is any person, foreign or domestic, QI not assuming withholding responsibility for the distribution,
that transfers an interest in a partnership. In the case of a but excluding an allocation to a U.S. partner or when the QI
trust, to the extent all or a portion of the income of the trust is acts as a disclosing QI). For the limitation on when a
treated as owned by the grantor or another person under nonqualified intermediary may provide a withholding
sections 671 through 679, the term transferor means the statement for an amount realized, however, see Withholding
grantor or other person. statement for amount realized or PTP distribution in Part IV,
later. Also, see Regulations section 1.1446-4(d)(1) for when
Underlying security. The term underlying security is the amounts subject to withholding on a PTP distribution
defined in Regulations section 1.871-15(a)(15). cannot be determined from a qualified notice issued by the
Withholdable payment. The term withholdable payment is PTP. For a withholding statement provided by a foreign
defined in Regulations section 1.1473-1(a). partnership to claim a modified amount realized for purposes
of section 1446(f), see the instructions for Line 21d, later.
Withholding agent. Any person, U.S. or foreign, that has
control, receipt, custody, disposal, or payment of U.S. source The withholding statement forms an integral part of the
FDAP income subject to chapter 3 or a withholdable payment withholding certificate, and the penalties of perjury statement
under chapter 4 is a withholding agent. The withholding provided on the withholding certificate shall apply to the
agent may be an individual, corporation, partnership, trust, withholding statement. The withholding statement may be
association, or any other entity, including (but not limited to) provided in any manner upon which the intermediary or the
flow-through entity and the withholding agent mutually agree,
including electronically if certain safeguards concerning

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electronic transmission are met. A withholding statement also a treaty should check the appropriate box (including
provides information required for purposes of chapter 4 if the “Withholding foreign partnership” or “Withholding foreign
intermediary or flow-through entity is receiving a withholdable trust” if the entity has entered into a withholding agreement).
payment, in which case the entity must provide an FFI A partnership or grantor trust submitting Form W-8IMY solely
withholding statement, chapter 4 withholding statement, or because it is allocated income effectively connected with a
exempt beneficial owner withholding statement (as U.S. trade or business as a partner in a partnership should
applicable). See Regulations section 1.1471-3(c)(3)(iii)(B). check the box for nonwithholding foreign partnership or
Additional information is required for a withholding statement nonwithholding foreign grantor trust and, if it is submitting or
from a QDD. See QDD withholding statement, later. will submit documentation for its partners or owners, it should
complete Part VIII.
Specific Instructions Form W-8IMY may be provided to satisfy
TIP documentation requirements for purposes of
Part I — Identification of Entity withholding on certain partnership allocations to
foreign partners under section 1446(a). Section 1446(a)
Line 1. Enter your name. By doing so, you are representing generally requires withholding when a partnership is
to the payer or withholding agent that you are not the conducting a trade or business in the United States and
beneficial owner of the amounts that will be paid to you allocates taxable income effectively connected with that
(unless you are acting as a QDD or QSL for certain payments trade or business (ECTI) to foreign persons that are partners
associated with this form or you are a QI acting with respect in the partnership. Section 1446(a) can also apply when
to payments of substitute interest, as permitted by the QI certain income is treated as effectively connected income of
agreement). If you are a disregarded entity, do not enter the the partnership and is so allocated.
business name of the disregarded entity here. Instead, enter
the legal name of the entity that owns the disregarded entity An upper-tier foreign partnership that is allocated ECTI as a
(looking through multiple disregarded entities, if applicable). partner in a lower-tier partnership (LTP) may request, if
Line 2. If you are a corporation, enter the country of certain requirements are met, the lower-tier partnership
incorporation. If you are another type of entity, enter the perform withholding under section 1446(a) on that ECTI
country under whose laws you are created, organized, or taking into account the status of the partners in the upper-tier
governed. partnership. Upper-tier PTPs are not permitted to use these
look-through rules. Generally, this is accomplished by the
Line 3. If you are a disregarded entity receiving a payment, upper-tier partnership submitting withholding certificates of
enter your name (if required). You are required to complete its partners (for example, Form W-8BEN) along with a Form
line 3 if you are a disregarded entity receiving a withholdable W-8IMY, which identifies itself as a partnership, and
payment or hold an account with an FFI requesting this form identifying the manner in which ECTI of the upper-tier
and you: partnership will be allocated to the partners. Domestic
• Have registered with the IRS and been assigned a GIIN non-PTPs that meet similar requirements may be able to
associated with the legal name of the disregarded entity; and elect to apply look-through rules, if the LTP agrees, by using
• Are a reporting Model 1 FFI or reporting Model 2 FFI. Form W-9, instead of a W-8IMY. For further information, see
If you are a disregarded entity that is a QDD, identify the Regulations section 1.1446-5. A foreign grantor trust that is
QDD by the name used by the QDD for the QI application. allocated ECTI as a partner in a partnership should provide
For instructions for identifying the names of multiple QDDs, the withholding certificates of its grantor (for example, Form
see QDD withholding statement, later. W-8BEN) along with its Form W-8IMY which identifies the
trust as a foreign grantor trust. See Regulations section
If you are not required to provide the legal name of 1.1446-1(c)(2)(ii)(E) for the rules requiring it to provide
! the disregarded entity, however, you may want to additional documentation to the partnership.
CAUTION notify the withholding agent that you are a
disregarded entity receiving a payment or maintaining an Line 5. Check the one box that applies to your chapter 4
account by indicating the name of the disregarded entity on status. You are only required to provide a chapter 4 status if
line 10. you are acting as an intermediary with respect to a
withholdable payment, you are a flow-through entity receiving
Line 4. Complete this line to establish your entity status for a withholdable payment on behalf of your owners (including a
purposes of chapter 3. Check the one box that applies. If you reverse hybrid entity providing documentation on behalf of its
are a foreign partnership receiving the payment on behalf of owners to claim treaty benefits), you are providing a
your partners, check the “Withholding foreign partnership” withholding statement associated with this form that allocates
box or the “Nonwithholding foreign partnership” box, a portion of the payment to a chapter 4 withholding rate pool
whichever is appropriate. If you are a foreign simple trust or of U.S. payees with respect to your direct account holders
foreign grantor trust receiving the payment on behalf of your (as described in Regulations section 1.6049-4(c)(4)), you are
beneficiaries or owners, check the “Withholding foreign trust” providing this form to an FFI requesting this form to
box, the “Nonwithholding foreign simple trust” box, or the document your chapter 4 status, or you are a QI (including a
“Nonwithholding foreign grantor trust” box, whichever is QDD), WP, or WT. If you are a U.S. branch that does not
appropriate. If you are a foreign partnership (or a foreign agree to be treated as a U.S. person and that does not make
trust) receiving a payment on behalf of persons other than the certification on line 19c, you should check
your partners (or beneficiaries or owners), check the nonparticipating FFI; otherwise, leave line 5 blank. By
“Qualified intermediary” box or the “Nonqualified checking a box on this line, you are representing that you
intermediary” box, whichever is appropriate. A foreign qualify for this classification.
reverse hybrid entity that is providing documentation from its
interest holders to claim a reduced rate of withholding under

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For most of the chapter 4 classifications, you are appropriate box and enter the EIN that was issued to you in
TIP required to complete additional certifications found in such capacity (your “QI-EIN,” “WP-EIN,” or “WT-EIN”). If you
Parts IX through XXVIII. Complete the appropriate are not acting in that capacity, you must use your U.S.
part of this form certifying that you meet the conditions of the taxpayer identification number (TIN), if any, that is not your
status indicated on line 5 (as defined under Regulations QI-EIN, WP-EIN, or WT-EIN.
sections 1.1471-5 or 1.1471-6). Complete the required A nonqualified intermediary, a nonwithholding foreign
portion of this form before signing and providing it to the partnership, or a nonwithholding foreign simple or grantor
withholding agent. trust is generally not required to provide a U.S. TIN.
However, an upper-tier partnership or trust that is allocated
FFIs Covered by IGAs and Related Entities ECTI (or receives a PTP distribution attributable to ECTI) as a
A reporting FFI resident in, or established under the laws of, partner in a lower-tier partnership is required to provide a
a jurisdiction covered by a Model 1 IGA should check U.S. TIN. The requirement to include a U.S. TIN in this line 8
“Reporting Model 1 FFI.” A reporting FFI resident in, or also applies to a foreign partnership or a foreign trust
established under the laws of, a jurisdiction covered by a receiving an amount realized from a transfer of an interest in
Model 2 IGA should check “Reporting Model 2 FFI.” If you a partnership conducting a trade or business in the United
are treated as a registered deemed-compliant FFI under an States. Additionally, a QSL providing this form with respect to
applicable IGA, you should check “Nonreporting IGA FFI” a U.S. source substitute dividend must provide an EIN (a
rather than “registered deemed-compliant FFI” and provide QI-EIN if the QSL is a QI).
your GIIN. See the specific instructions for Part XIX. In Line 9a. Complete line 9a if you are a participating FFI
general, if you are treated as a nonreporting IGA FFI under (including a reporting Model 2 FFI), registered
an applicable IGA, you should check “Nonreporting IGA FFI” deemed-compliant FFI (including a reporting Model 1 FFI
even if you meet the qualifications for deemed-compliant and a sponsored FFI described in Regulations section
status under the chapter 4 regulations. In such a case, you 1.1471-5(f)(1)(i)(F)), direct reporting NFFE (including a
need not also check your applicable status under the sponsored direct reporting NFFE), or trustee of a trustee
regulations but should provide your GIIN on line 9. However, documented trust that is a foreign person, you are required to
an owner documented FFI that is treated as a nonreporting enter your GIIN (with regard to your country of residence) on
IGA FFI under an applicable IGA must check line 9a. If you are a trustee of a trustee-documented trust and
“Owner-documented FFI” and complete Part XI. An FFI that you are a foreign person, you should provide the GIIN that
is related to a reporting IGA FFI and that is treated as a you received when you registered as a participating FFI or
nonparticipating FFI in its country of residence should check reporting Model 1 FFI. In addition, you must provide your
nonparticipating FFI on line 5. An FFI that is related to a GIIN on line 9a if you are a nonreporting IGA FFI that is: (1)
reporting IGA FFI and that is a participating FFI, treated as registered deemed-compliant under Annex II to an
deemed-compliant FFI, or exempt beneficial owner under the applicable Model 2 IGA, or (2) a registered
U.S. Treasury regulations, or an applicable IGA should check deemed-compliant FFI under Regulations section 1.1471-5(f)
the appropriate box depending on its chapter 4 status rather (1).
than the box for nonparticipating FFI. If you are a QI acting as a QDD, you must provide your
If you are an FFI in a jurisdiction treated as having an IGA GIIN on line 9a if you have one.
in effect, you should not check “Participating FFI” and should If you are a certified deemed-compliant FFI described in
check “Reporting Model 1 FFI” or “Reporting Model 2 FFI” as Part XIV of this form, provide the GIIN of your sponsoring
applicable. entity on line 9a.
See www.treasury.gov/resource-center/tax-policy/treaties/ If you are in the process of registering with the IRS as
Pages/FATCA-Archive.aspx for a list of jurisdictions treated TIP a participating FFI, registered deemed-compliant FFI
as having an IGA in effect. (including a sponsored FFI), reporting Model 1 FFI,
reporting Model 2 FFI, direct reporting NFFE, sponsored
Line 6. Enter the permanent address of the entity identified direct reporting NFFE, or nonreporting IGA FFI but have not
on line 1. Your permanent residence address is the address received a GIIN, you may complete line 9a by writing “applied
in the country where you claim to be a resident for purposes for.” However, the person requesting this form from you must
of that country's income tax. Do not show the address of a receive and verify your GIIN within 90 days.
financial institution (other than yourself), a post office box, or
an address used solely for mailing purposes unless such If you are a disregarded entity that completed Part I, line 3,
address is the only permanent address you use and it do not enter your GIIN on line 9a. Instead, enter it on line 13.
appears in your organizational documents (that is, your Line 9b. Complete line 9b if you are a QDD that must
registered address). If you do not have a tax residence in any provide a foreign taxpayer identification number (FTIN). For
country, the permanent residence address is where you information on this requirement (and when an FTIN is not
maintain your principal office. required), see QDD withholding statement, later.
Line 7. Enter your mailing address only if it is different from Line 10. You, or a withholding agent, may use this line to
the address you show on line 6. include any referencing information that is useful to the
Line 8. You must provide an employer identification number withholding agent in carrying out its reporting and withholding
(EIN) if you are a U.S. branch or are a territory financial obligations. For example, a withholding agent who is required
institution that certifies that it has agreed to be treated as a to associate a particular Form W-8BEN or Form W-8BEN-E
U.S. person for any payments associated with this Form with this Form W-8IMY may use line 10 for a referencing
W-8IMY. number or code that will make the association clear.
If you are acting as a QI (including a QDD), withholding
foreign partnership, or withholding foreign trust, check the

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If you are in the process of registering your branch
Part II — Disregarded Entity or
TIP with the IRS but have not received a GIIN, you may
Branch Receiving Payment complete this line by writing “applied for.” However,
Complete Part II for a disregarded entity that has its own GIIN the person requesting this form from you must receive and
and is receiving a withholdable payment or for a branch verify your GIIN within 90 days.
(including a branch that is a disregarded entity that does not
have its own GIIN) operating in a jurisdiction other than the Certification of Chapter 3 Status:
country of residence identified on line 2. For example,
assume ABC Co., which is a participating FFI resident in Parts III Through VIII
Country A, operates through a branch in Country B (which is You should only complete one part from Parts III through VIII.
a Model 1 IGA jurisdiction) and the branch is treated as a Generally, if you are acting in multiple capacities, you should
reporting Model 1 FFI under the terms of the Country B provide separate Forms W-8IMY for each capacity. For
Model 1 IGA. ABC Co. should not enter its GIIN on line 9a, example, if you are acting as a QI for one account, but an
and the Country B branch should complete this Part II by NQI for another account, you should provide one Form
identifying itself as a reporting Model 1 FFI and providing its W-8IMY in your capacity as a QI and a separate Form
GIIN on line 13. If the Country B branch receiving the W-8IMY in your capacity as an NQI.
payment is a disregarded entity, you may be required to You may, however, provide a single Form W-8IMY that
provide its legal name on line 3. covers more than one category of QI provided that you
If the disregarded entity receiving a withholdable properly identify the accounts and/or transactions, as
TIP payment has its own GIIN, Part II should be required, on a withholding statement. For example, if you are
completed regardless of whether it is in the same a QI that acts as both a QI and a QDD, you may provide a
country as the single owner identified in Part I. single Form W-8IMY with a withholding statement
designating each type of account or transaction.
If you have multiple branches/disregarded entities
receiving payments from the same withholding agent and the Part III — Qualified Intermediary
information in Part I is the same for each branch/disregarded Line 14. Check the box on line 14 if you are a QI (whether or
entity that will receive payments, you may provide (and a not you assume primary withholding responsibility) for the
withholding agent may accept) a single Form W-8IMY with a payments for which you are providing this form. By checking
separate schedule attached that includes all of the Part II the box, you are certifying to the applicable statements
information for each branch/disregarded entity rather than contained on line 14. See the QI agreement for the definition
separate Forms W-8IMY to identify each branch receiving of “account” for purposes of Part III.
payments associated with the form. You must also provide
the withholding agent with sufficient information to associate Line 15. Complete line 15 only if you are acting as a QI that
the payments with each branch/disregarded entity. is not a QDD. To the extent you are a QI acting as a QDD,
see the instructions for line 16. If you are acting in both QI
If you are a QDD home office or you are a QI and have capacities, you should complete both lines 15 and 16 to the
one or more QDD branches, do not complete Part II for any extent applicable.
branches that are acting in their QDD capacities. Instead, Line 15a. Check the box on line 15a if you have assumed
provide the relevant branch information that you would primary withholding responsibility under both chapter 3 and
otherwise provide on Part II (including the information chapter 4 with respect to the account(s) identified on a
required for chapter 4 purposes, as required) on your withholding statement attached to this form (or, if no
withholding statement. withholding statement is attached to this form, for all
Line 11. Check the one box that applies. If no box applies accounts). The representation made in this box on line 15a
to the disregarded entity, you do not need to complete Part II. may be made regardless of whether you assume primary
If you check reporting Model 1 FFI, reporting Model 2 FFI, or withholding responsibility for a PTP distribution (by checking
participating FFI, you must complete line 13. If you are a the box on line 15c) as the representation made on this
branch of a reporting IGA FFI that cannot comply with the line 15a does not apply to an amount subject to chapter 3
requirements of an applicable IGA or the regulations under withholding on a PTP distribution.
chapter 4, you must check branch treated as nonparticipating Furthermore, the box on line 15a may be checked
FFI. If you are a QI that is an NFFE and a withholding agent regardless of which boxes you check on lines 15b through
requests your chapter 4 status, you may provide a statement 15i for any accounts identified on a withholding statement.
certifying to your chapter 4 status as an NFFE. Line 15b. Check the box on line 15b if you have assumed
Line 12. Enter the address of the branch or disregarded primary withholding and reporting responsibilities under
entity. section 1446(f) for each payment of an amount realized on a
sale of a PTP interest associated with each account identified
Line 13. If you are a reporting Model 1 FFI, a reporting on a withholding statement attached to this form for receiving
Model 2 FFI, or a participating FFI, you must enter on line 13 such amounts (or, if no withholding statement is attached to
the GIIN of your branch that receives the payment. If you are this form, for all accounts).
a disregarded entity that completed Part I, line 3, of this form Line 15c. Check the box on line 15c if you have assumed
and are receiving payments associated with this form, enter primary withholding responsibility as a nominee for each
your GIIN. Do not enter your GIIN (if any) on line 9a. If you distribution by a PTP that is associated with each account
are a U.S. branch, do not enter a GIIN on line 13. identified on a withholding statement attached to this form for
receiving such distributions (or, if no withholding statement is
attached to this form, for all accounts).

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Line 15d. Check the box on line 15d if you are a QI that is participating FFI, registered deemed-compliant FFI, or a
acting as a QSL with respect to payments associated with qualified intermediary. See Regulations sections 1.1471-3(d)
each account identified on a withholding statement attached (4) and 1.1471-3(e) for more information on the requirements
to this form (or, if no withholding statement is attached to this for documenting such chapter 4 statuses.
form, for all accounts) that are U.S. source substitute
A payment that is subject to chapter 3 withholding or
dividends made in 2021 or 2022 by a party to a securities
that should be subject to chapter 4 withholding may
lending transaction (as described in Notice 2010-46) for CAUTION!
not be included in a U.S. payee pool that is described
which you are not acting as a QDD. See Notice 2020-2 and
in Regulations section 1.6049-4(c)(4)(ii).
Qualified securities lender (QSL), earlier, for the limitation on
when a QI is permitted to act as a QSL. Although, as a QI, you obtain withholding certificates or
Line 15e. Check the box on line 15e to certify that you are appropriate documentation from beneficial owners or
a QI that is assuming primary withholding responsibility under payees, as specified in your QI agreement, you do not need
chapter 3 and chapter 4 and primary Form 1099 reporting to attach the certificates or documentation to this form unless
and backup withholding responsibility with respect to all you are acting as a disclosing QI with respect to an amount
payments associated with this form that are U.S. source realized or PTP distribution. Also, to the extent you have not
interest and substitute interest payments, as permitted by assumed primary Form 1099 reporting or backup withholding
(and described in) the QI agreement. You may act as a QI responsibility and are not permitted to allocate the payment
with respect to such substitute interest payments under the to a chapter 4 withholding rate pool of U.S. payees under
QI agreement regardless of whether you are acting in a Regulations section 1.6049-4(c)(4)(iii), you must disclose the
principal or intermediary capacity with respect to payments of names of those U.S. persons for whom you receive
interest and substitute interest you receive that are reportable amounts and that are not exempt recipients (as
associated with this form and regardless of whether you act defined in Regulations section 1.6049-4(c)(1)(ii) or under
as a QDD or QSL. section 6041, 6042, 6045, or 6050N). You should make this
Line 15f. Check the box on line 15f if you have assumed disclosure by attaching to Form W-8IMY the Forms W-9 (or
primary Form 1099 reporting and backup withholding substitute forms) of persons that are U.S. non-exempt
responsibility with respect to the accounts identified in a recipients. If you do not have a Form W-9 for a non-exempt
withholding statement associated with this form or if you are U.S. payee, you must attach to Form W-8IMY any
a participating FFI or registered deemed-compliant FFI that information you do have regarding that person’s name,
meets the requirements to report only under Regulations address, and TIN for a withholding agent to report the
sections 1.6049-4(c)(4)(i) and (c)(4)(ii). For accounts for payment.
which you check this box on line 15f, you should not check
Line 16a. Check the box on line 16a to certify that each
the boxes on lines 15g through 15i.
QDD identified on the form or on the QDD withholding
If you checked boxes 15a and 15f with respect to any statement that is acting as a QDD meets the requirements to
TIP accounts, or box 15b or 15c (as applicable) and the act as a QDD in Regulations section 1.1441-1(e)(6) and
box on line 15f when this form is associated with an assumes primary withholding and reporting responsibilities
amount realized or PTP distribution, you do not have to under chapters 3, 4, and 61, and section 3406 with respect to
provide a withholding statement for any payments made to potential section 871(m) transactions and has been
those accounts. approved by the IRS to act as a QDD.
Line 15g. Check the box on line 15g if you have not A QDD must act as a QDD for all payments it
assumed primary Form 1099 reporting and backup ! receives as a principal with respect to potential
withholding responsibility with respect to the account(s) CAUTION section 871(m) transactions and underlying
identified on a withholding statement attached to this form securities, excluding any payments that are treated as
(or, if no withholding statement is attached to this form, for all effectively connected with the conduct of a trade or business
accounts). This box applies to an amount realized only if you within the United States within the meaning of section 864. A
have not checked the box on line 15b and does not apply to a QDD may not act as a QDD for any other payments it
payment made by a QSL that is described on line 15d. If you receives. To certify your foreign status for any other payment
check the box on line 15g, check the applicable of U.S. source income you beneficially own, see Who Must
certification(s) on line 15h or 15i. Provide Form W-8IMY and Do Not Use Form W-8IMY If You
Lines 15h and 15i. If you are allocating any portion of the are Described Below, earlier.
payment on a withholding statement to a chapter 4
withholding rate pool of U.S. payees in lieu of providing Line 16b. Check the box to indicate your status, including if
Forms W-9, you must certify by checking the boxes on lines you are a QDD that is a disregarded entity claiming treaty
15h and/or 15i (as applicable): benefits. If the QDD is a branch other than a disregarded
• For each account holder included in a chapter 4 entity (that is, a branch that is not a separate legal entity from
withholding rate pool of U.S. payees who holds an account its home office), check the box to indicate the status of the
that you maintain, you are permitted to provide this pool entity identified in Part I. If the Form W-8IMY is being used for
under Regulations section 1.6049-4(c)(4)(iii) (including for more than one QDD and different boxes must be checked for
payments of income other than interest for which reporting different QDDs, check all relevant boxes and include the
would be required under chapter 61 but for a coordination applicable information on the withholding statement for each
rule similar to that provided in Regulations section QDD. See QDD withholding statement, later.
1.6049-4(c)(4)(iii)); and/or Claim of treaty benefits or beneficial ownership. If you
• For a withholding rate pool of U.S. payees that includes are acting as a QDD, you may be entitled to claim treaty
account holders of another intermediary or flow-through benefits for certain payments that are subject to withholding
entity, you have obtained or will obtain documentation to that you receive in your principal capacity (for example,
establish that the intermediary or flow-through entity is a interest payments or payments of dividends beginning in

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2023). See Notice 2020-2. To make a claim for treaty specific partners receiving the payment (rather than including
benefits in such a case, you may provide your withholding any part of the payment in any chapter 3 withholding rate
agent a statement associated with your Form W-8IMY that pool) when you act as a disclosing QI for a payment of an
contains the information required in Part III of Form amount realized or PTP distribution.
W-8BEN-E, including (if applicable) a treaty claim by a hybrid For chapter 4 purposes. If you are a QI and you receive
entity that is a disregarded entity that is identified on a QDD's a withholdable payment, you must provide a withholding
withholding statement described in the instructions for Part II. statement which satisfies the requirements of an FFI
Alternatively, a Form W-8BEN-E may be used for this withholding statement or chapter 4 withholding statement (if
purpose. An entity acting as a QDD (other than a you are not an FFI) when you do not assume primary
flow-through entity or disregarded entity) for a payment of withholding responsibility under chapter 3 and chapter 4 and
U.S. source FDAP income may also use Form W-8IMY to Form 1099 reporting and backup withholding responsibility
claim status as the foreign beneficial owner of the payment for the payment.
when the entity provides its foreign TIN (when required) on If you are a QI that is an FFI you may provide an FFI
line 9b to this form). withholding statement to allocate the payment to chapter 4
If you are acting as a QDD and fiscally transparent in withholding rate pools (as applicable) or other pool of payees
permitted on an FFI withholding statement under the
! your jurisdiction of organization, do not claim treaty
CAUTION benefits as described in these instructions. Instead, chapter 4 regulations. See Regulations section 1.1471-3(c)
you must include the withholding certificates or documentary (3)(iii)(B)(2). You may also provide on the withholding
evidence of the owners claiming treaty benefits and provide statement a single pool of nonparticipating FFIs, a single pool
an allocation on the withholding statement. of recalcitrant account holders of yours or of or another
intermediary that is a participating FFI or registered
QDD branch of a U.S. person. If you are a foreign branch deemed-compliant FFI, and, if you do not assume primary
of a U.S. person that is acting as a QDD and you receive a Form 1099 and backup withholding responsibility, a
payment that otherwise would be subject to withholding chapter 4 withholding rate pool of U.S. payees. A chapter 4
except for the U.S. person’s status as a U.S. person, you withholding rate pool of U.S. payees may include:
may associate this Form W-8IMY with a Form W-9 from the • If you are a reporting Model 1 FFI, an account holder that
U.S. person. is not withheld on under chapter 3, chapter 4, or section 3406
that you report as a U.S. account pursuant to the Model 1
Withholding statement of a QI. As a QI, you must provide
IGA because the account has U.S. indicia and you have not
a withholding statement to each withholding agent from
obtained appropriate documentation to treat the account as
which you receive reportable amounts or withholdable
held by other than a specified U.S. person;
payments if you have not assumed primary withholding
responsibility under chapter 3 and chapter 4 with respect to • If you are a reporting Model 2 FFI, an account holder that
is not withheld on under chapter 3, chapter 4, or section 3406
the payment for one or more accounts (as indicated
that you report as an account holder of a non-consenting
otherwise on line 15a), or if you are receiving a reportable
U.S. account as described in the Model 2 IGA;
amount on behalf of a U.S. non-exempt recipient, you have
not assumed primary Form 1099 reporting and backup • If you are a non-U.S. payor (as described in Regulations
section 1.6049-5(c)(5)) that is a participating FFI (including a
withholding responsibility for the payment. You must also
reporting Model 2 FFI), registered deemed-compliant FFI, or
provide a withholding statement for an amount realized or a
reporting Model 1 FFI, an account holder not withheld on
PTP distribution for which you have not assumed primary
under chapter 4 or section 3406 who you report under
withholding responsibility. The withholding statement
chapter 4 or an applicable IGA (including the account
becomes an integral part of the Form W-8IMY and, therefore,
holder’s TIN).
the certification statement that you sign in Part XXIX of the
form applies to the withholding statement as well as to the Additionally, a chapter 4 withholding rate pool of U.S.
form. If you are a QDD, see also QDD withholding statement, payees may be provided in the above-described cases for a
later. payment of an amount realized for which a withholding
A QI withholding statement must also: statement is provided for purposes of section 1446(f) that
• Designate those accounts for which you act as a QI; allocates some amount of the payment to a U.S. person.
• Designate those accounts for which you are assuming See, For a payment of an amount realized, later, and
primary withholding and reporting responsibility under Example 5 and Example 6, later.
chapter 3 and chapter 4; An FFI withholding statement must also identify each
• If you receive an amount realized or a PTP distribution, intermediary or flow-through entity that is receiving a
designate those accounts for which you are assuming payment on behalf of a payee and include such entity’s
primary withholding and reporting responsibility for either chapter 4 status and GIIN (if applicable), excluding any
such amount; intermediary or flow-through entity that is an account holder
• If applicable, designate those accounts or payments for or interest holder in another QI, WP, or WT. An FFI
which you are acting as a QSL with respect to any U.S. withholding statement of a QI may combine withholding rate
source substitute dividends; and pool information provided by such an entity to the QI with
• For any account for which you are not assuming primary withholding rate pools comprised of accounts that the QI
withholding and reporting responsibility, provide information maintains.
to allocate the payment, as applicable, to chapter 3 If you are a QI that is not an FFI and that does not assume
withholding rate pools, chapter 4 withholding rate pools, or primary withholding responsibility under chapter 3 and
other pools of payees permitted under the chapter 4 chapter 4, you must provide, for a withholdable payment, a
regulations. See Regulations section 1.1471-3(c)(3)(iii)(B)(2) chapter 4 withholding statement that contains the name,
(with respect to a chapter 4 withholding rate pool). You must, address, TIN (if any), entity type (if applicable), and chapter 4
however, provide information to allocate the payment to the status of each payee, the amount allocated to each payee, a

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valid withholding certificate or other documentation sufficient allocate the amounts subject to withholding on the
to establish the payee’s chapter 4 status. However, a distribution to each U.S. partner.
chapter 4 withholding statement may include pooled Form 1099 reporting. If you do not assume primary Form
information for payees that are nonparticipating FFIs that 1099 reporting and backup withholding responsibility, you
hold accounts that you maintain or hold accounts with an must provide payee-specific information for each U.S.
intermediary or flow-through entity receiving the payment non-exempt recipient account holder (other than those U.S.
from you. You may also provide another pool of payees as payees included in a chapter 4 withholding rate pool of U.S.
permitted under the chapter 4 regulations for a chapter 4 payees (described in Regulations section 1.6049-4(c)(4)(iii))
withholding statement. See Regulations section 1.1471-3(c) or when the alternative procedure is used. The pools are
(3)(iii)(B). based on valid documentation that you obtain or, if a
For chapter 3 purposes. In the case of a reportable payment cannot be reliably associated with valid
amount that is a withholdable payment, any portion of the documentation, the applicable presumption rules.
payment for which you are acting as a QI that is not allocated Example 1. A QI that is a participating FFI receives a
to a chapter 4 withholding rate pool or a U.S. non-exempt $100 payment of U.S. source dividends on an account for
recipient (including for backup withholding purposes) must which it acts as a QI held with the withholding agent for the
be allocated to a chapter 3 withholding rate pool or pool of following recipients:
U.S. exempt recipients, if it is not required to be separately • $20 to NPFFI, a nonparticipating FFI that is an account
reported. The chapter 3 withholding rate pool may be holder of the QI;
established by any reasonable method agreed upon by you • $10 each on behalf of two recalcitrant account holders of
and the withholding agent. For example, you may agree to the QI ($20 total), each with U.S. indicia (as described in
establish a separate account for a single chapter 3 Regulations section 1.1441-7(b)(5)) associated with the
withholding rate pool or you may agree to divide a payment account;
made to a single account into portions allocable to each • $5 each on behalf of A and B, U.S. individual account
chapter 3 withholding rate pool. You must provide the holders of the QI that the QI reports as U.S. accounts
chapter 3 withholding rate pool information that is required for pursuant to its chapter 4 reporting obligations as a
the withholding agent to meet its withholding and reporting participating FFI ($10 total);
obligations. A withholding agent may request any information • $10 on behalf of C, a U.S. exempt recipient that is not a
reasonably necessary to withhold and report payments specified U.S. person and is an indirect account holder of the
correctly. QI (who beneficially owns the payment through an account
For a payment of an amount realized. In the case of a with another participating FFI);
payment of an amount realized, you must provide chapter 3 • $20 on behalf of D, a U.S. non-exempt recipient that is a
withholding rate pool information with respect to the foreign specified U.S. person who is an indirect account holder of the
transferors receiving the payment for your broker to meet its QI (that beneficially owns the payment through an account
withholding and reporting obligations (except when you act with a certified deemed-compliant FFI described in
as a disclosing QI). See Regulations section 1.1446(f)-4(a) Regulations section 1.1471-5(f)(2)); and
(7)(iii). The chapter 3 withholding rate pool information you • $10 each on behalf of two nonresident alien individuals
provide on a withholding statement may be properly adjusted who are account holders of the QI, one of whom is entitled to
to take into account the withholding required on a transferor a 15% rate of withholding under an applicable income tax
that is a foreign partnership for which you permit a modified treaty.
amount realized. With respect to U.S. transferors receiving
an amount realized, and regardless of whether you act as a The dividend payment is both a withholdable payment
disclosing QI, you must allocate the payment to each such under chapter 4 and a reportable amount under chapter 3.
transferor to the extent of the amount that may not be The QI assumes primary withholding and reporting
allocated to a chapter 4 withholding rate pool of U.S. payees responsibility under chapter 3 and chapter 4 as well as
(to the extent permitted for chapter 4 purposes). primary Form 1099 reporting and backup withholding
responsibility. As a result, the QI is not required to provide a
For a PTP distribution. In the case of a PTP distribution,
withholding statement allocating the payment to specific
you must provide to the PTP or nominee from which you
payees or withholding rate pools. The QI will provide Form
receive the distribution chapter 3 withholding rate pool
W-8IMY and check the boxes on lines 14, 15a, and 15f.
information and chapter 4 withholding rate pool information
(when permitted for chapter 4 purposes) for your foreign Example 2. The facts are the same as Example 1,
partners with respect to the amounts subject to withholding except QI is a non-U.S. payor under Regulations section
on the distribution (except when you act as a disclosing QI). 1.6049-5(c)(5) and does not assume primary Form 1099 and
For determining the amounts to include in each withholding backup withholding responsibility but reports the accounts of
rate pool, the QI must rely on the allocation of each amount A and B as U.S. accounts under Regulations section
subject to withholding on the distribution as determined by 1.1471-4(d).
the PTP or nominee that pays the distribution to the QI. When The QI must provide a withholding statement allocating
acting as a disclosing QI for a PTP distribution, you must $20 of the payment to D, $10 to C, and $10 to a chapter 4
provide with respect to each partner an allocation of the withholding rate pool of U.S. payees. The QI need not
income attributable to the distribution that is subject to allocate any portion of the payment specifically to A or B
withholding under section 1446(a) or (f) (and, for an amount because the QI is a non-U.S. payor that is permitted to
subject to chapter 3 or 4 withholding, an allocation of such include A and B in a chapter 4 withholding rate pool of U.S.
amount to each beneficial owner or payee). See Withholding payees under Regulations section 1.6049-4(c)(4)(i). For
statement, earlier, for the requirements of a withholding payments made on or after April 1, 2017, see the instructions
statement provided by an intermediary for a PTP distribution. for Part IV of this form for when a withholding statement
Regardless of whether you act as a disclosing QI, you must includes an allocation of a payment of an amount subject to
chapter 3 withholding that is made to a pool of U.S. payees.

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The QI must also provide a Form W-9 (or alternatively, name information specified in Regulations section 1.1446(f)-4(c)(2)
and TIN) for D. A Form W-9 is not required for C. The QI will (ii)(C) for QI to determine a modified amount realized of $10
provide Form W-8IMY and check the boxes on lines 14, 15a, (one-half of the $20 is allocable to partners of F who are
and 15g and 15h. nonresident alien individuals and one-half allocable to a U.S.
Example 3. The facts are the same as Example 1, except partner of F (USP)), and QI does not report F’s account as a
the QI is a U.S. payor and does not assume primary Form U.S. account for purposes of chapter 4 reporting;
1099 and backup withholding responsibility. • $10 on behalf of foreign grantor trust H, an account holder
of QI that has provided to QI the documentation from which
Because the QI is a U.S. payor, it is not permitted, under QI can associate the amount realized with G, a nonresident
Regulations section 1.6049-4(c)(4)(i) and (iii), to include A alien that is the sole grantor of the trust;
and B in a chapter 4 withholding rate pool of U.S. payees. • $10, on behalf of N, an account holder of the QI that is a
The QI must provide a withholding statement allocating $5 of nonqualified intermediary.
the payment to A, $5 of the payment to B, $10 of the payment
to C, and $20 of the payment to D along with Forms W-9 (or As QI is not acting as a disclosing QI for this payment, QI
name and TIN) for A, B, and D. The QI will provide Form may provide to its U.S. broker a withholding statement that
W-8IMY and check the boxes on lines 14 and 15a. allocates the amount realized to chapter 3 withholding rate
pools, excluding amounts allocable to a U.S. partner or to a
Example 4. The facts are the same as Example 1, chapter 4 reporting pool of U.S. payees. QI must report on
except the QI is a non-U.S. payor that does not assume the withholding statement the payment allocated as follows:
primary withholding and reporting responsibility under • To a chapter 3 withholding rate pool at a 10% rate - $70
chapter 3 and chapter 4. The QI also does not assume (for the $40 allocable to A and B, $10 allocable to F’s
primary Form 1099 and backup withholding responsibility. nonresident alien partners; $10 allocable to G, and $10
If the QI does not assume primary withholding and allocable to N);
reporting responsibility under chapter 3 and chapter 4 as well • To a chapter 4 withholding rate pool of U.S. payees - $20
as primary Form 1099 reporting and separate backup (for the total amount allocable to C and D); and
withholding responsibilities, the QI will provide an FFI • To USP, for the $10 of the $20 of amount realized by F that
withholding statement with the following pools: is allocable to USP.
• Nonparticipating FFI Pool — $20 (which is subject to The QI will complete Form W-8IMY and check the box on
chapter 4 withholding); line 14. As QI does not assume primary withholding
• Recalcitrant Account Holder Pool — $20 (which is subject responsibility under section 1446(f) for the amount realized,
to chapter 4 withholding and which is aggregated in a single QI must not check the box on line 15b but should check the
pool of recalcitrant account holders rather than each class boxes on lines 15g and 15h because it has not assumed
described in Regulations section 1.1471-4(d)(6)); Form 1099 reporting and backup withholding responsibility.
• Chapter 4 Withholding Rate Pool of U.S. Payees — $10 QI does not account for any of the account holders of N on its
(for the portion of the payment allocable to A and B); withholding statement as withholding applies to N at the 10%
• Chapter 3 30% Rate Pool — $10; rate on the payment regardless of the statuses of N’s
• Chapter 3 15% Rate Pool — $10; and account holders receiving the payment. See Regulations
• 0% Rate Pool — $10 (for the portion of the payment section 1.1446(f)-4(a)(2) for this withholding requirement.
allocable to C). See Withholding statement for amount realized or PTP
The QI will also be required to allocate $20 to a separate distribution in Part IV, later, however, for when N (as an NQI)
withholding rate pool for D because D is a U.S. non-exempt would be permitted to provide to QI allocation information
recipient who cannot be included in a chapter 4 withholding and beneficial owner withholding certificates for the account
rate pool of U.S. payees (because D’s account is maintained holders of N receiving the amount realized from the sale.
by a certified deemed-compliant FFI). The QI will provide With respect to grantor trust H, the withholding is determined
Form W-8IMY and check the boxes on lines 14, 15g, and with respect to grantor G, rather than H, as G is the transferor
15h. of the PTP interest. With respect to foreign partnership F, the
Example 5. A QI that is foreign corporation and a withholding statement includes the $10 allocable to F’s
Participating FFI does not assume primary withholding and foreign partners in a chapter 3 withholding rate pool at the
reporting responsibility for a payment of $100 from a U.S. 10% rate as these partners did not claim any exception to
broker that is an amount realized from the sale of a PTP withholding based on an income tax treaty. With respect to
interest. The QI also does not assume primary Form 1099 USP, QI discloses the identity of USP on the withholding
reporting and backup withholding responsibility for any of its statement because it does not assume primary Form 1099
accounts. The QI holds the PTP interest in an account with a reporting and backup withholding responsibility and does not
U.S. broker and does not act as a disclosing QI for the report the account of USP for purposes of QI’s chapter 4
payment of the amount realized. The QI determines that the requirements as a participating FFI. QI must also provide the
amount realized from the sale is allocable to the following documentation permitted for section 1446(f) purposes to
transferors of the interest in the PTP on whose behalf the QI support USP’s non-foreign status. With respect to C and D,
held the interest: however, as QI reports their accounts under QI’s
• $20 each on behalf of A and B, two nonresident alien requirements as a participating FFI, QI may report the
individuals who are account holders of the QI; amount realized allocable to C and D in a chapter 4
• $10 each on behalf of C and D, two U.S. individual withholding rate pool of U.S. payees.
account holders of the QI that the QI reports as U.S. Example 6. The facts are the same as Example 5, except
accounts pursuant to its chapter 4 reporting obligations as a the QI acts as a disclosing QI for the payment of the amount
participating FFI; realized. Unlike Example 5, because the QI is a disclosing
• $20 on behalf of F, a foreign partnership and account QI, it may not allocate any portion of the payment to a
holder of the QI that has provided the certification and other chapter 3 withholding rate pool on the withholding statement

Instructions for Form W-8IMY (Rev. 10-2021) -15-

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provided to the U.S. broker. QI must instead allocate the The amount allocable to these two pools under the
payment of the amount realized to each account holder that ! alternative procedure excludes amounts allocated to
is a transferor of the PTP interest, excluding any transferors CAUTION the chapter 4 withholding rate pool of U.S. payees.
that are includible in a chapter 4 withholding rate pool of U.S.
payees. See Regulations section 1.1446(f)-4(a)(7)(iii). Thus, Updating the statement. Your withholding statement must
with respect to QI’s account holders that are foreign be updated as often as is necessary to allow the withholding
transferors, QI must allocate $20 of the amount realized each agent to withhold at the appropriate rate on each payment
to A and B and must associate a valid Form W-8BEN for and to correctly report the income to the IRS. The updated
each of them with the withholding statement. With respect to information becomes an integral part of Form W-8IMY.
foreign partnership F, QI must identify F as the transferor of QDD withholding statement. Similar to a QI withholding
the interest (with a valid Form W-8IMY from F completed in statement, a QDD withholding statement becomes an
accordance with Part VIII , later), must indicate on its integral part of a QDD's Form W-8IMY. In addition to the
withholding statement that QI has determined a modified information required on a withholding statement (if any) you
amount realized of $10 from the $20 of the amount realized provide in your QI capacity, generally a QDD withholding
allocable to F, and must allocate the amount realized statement should (as applicable) for each QDD (identifying
between each of the partners of F based on the certification the QDD by name used for the QI application):
and withholding statement provided by F for this payment in • Designate the accounts for which the QDD is receiving
accordance with Regulations section 1.1446(f)-4(c)(2)(ii)(C). payments with respect to potential section 871(m)
QI must include on the withholding statement the amount transactions or underlying securities as a QDD;
allocable to USP for the reasons noted in Example 5, earlier, • Designate the accounts for which the QDD is receiving
(with the documentation permitted to support USP’s payments with respect to potential section 871(m)
non-foreign status) that F should have provided to QI with its transactions as a QDD (and that are not underlying
withholding statement. With respect to foreign grantor trust securities) for which withholding is not required;
H, QI must allocate the $10 received on behalf of H to G (as • Designate the accounts for which the QDD is receiving
G is the transferor), and must associate with the withholding payments with respect to underlying securities as a QDD for
statement a valid Form W-8IMY from H (completed in which withholding is required; and
accordance with Part VIII, later), a valid Form W-8BEN from • Identify the home office or branch that is treated as the
G, and information provided by H regarding the amount owner for U.S. income tax purposes.
realized allocable to G. With respect to nonqualified
intermediary N, QI must allocate the $10 received on behalf If you are acting as a QDD that meets the conditions
of N to N and associate this amount with the withholding described below, you must provide on line 9b, your foreign
statement and a valid Form W-8IMY from N. See Withholding taxpayer identification number (FTIN) issued by the
statement for amount realized or PTP distribution in Part IV, jurisdiction in which you are tax resident identified on line 6,
later, however, for when N would also be permitted to provide unless you were not issued an FTIN (including if the
to QI allocation information and beneficial owner withholding jurisdiction does not issue FTINs). If you do not provide your
certificates for the account holders of N receiving the amount FTIN, you must provide on your QDD withholding statement
realized from the sale. As indicated in Example 5, earlier, QI a reasonable explanation of why you have not been issued
may include C and D in a chapter 4 withholding rate pool of an FTIN. For this purpose, such an explanation includes a
U.S. payees with respect to the amount allocable to them (an statement that you are not legally required to obtain an FTIN
allowance that applies even when a QI acts as a disclosing in your jurisdiction of tax residence. Do not write “not
QI for an amount realized). applicable.” If you are acting as a QDD, you are required to
Alternative procedure for reportable amounts paid to provide your FTIN or an explanation of why you have not
U.S. non-exempt recipients (and for chapter 4). If been issued an FTIN if:
approved by the withholding agent, you can establish: • You are providing this Form W-8IMY to document yourself
• A single pool (not subject to backup withholding) for all as an account holder (as defined in Regulations section
U.S. non-exempt recipient account holders for whom you 1.1471-5(a)(3)) with respect to a financial account (as
have provided Forms W-9 or are includible in a chapter 4 defined in Regulations section 1.1471-5(b)) that you hold at a
withholding rate pool of U.S. payees prior to the withholding U.S. office of a financial institution (including a U.S. branch of
agent making any payments. Alternatively, you may include an FFI);
such U.S. non-exempt recipients in a zero rate withholding • You receive U.S. source income reportable on a Form
pool that includes U.S. exempt recipients and foreign 1042-S associated with this form; and
persons exempt from non-resident alien withholding provided • This form is treated as a beneficial owner withholding
all the conditions of the alternative procedure are met; and certificate under Regulations section 1.1441-1(e)(2)(i).
• A separate pool for all U.S. non-exempt recipient account If you are a QDD using its Form W-8IMY to make a claim
holders subject to backup withholding for whom you have not for treaty benefits, see Claim of treaty benefits or beneficial
provided Forms W-9 prior to the withholding agent making ownership, earlier, for the information required for the claim
any payments. (including for a hybrid entity that is a disregarded entity).

If you elect the alternative procedure, you must provide Part IV — Nonqualified Intermediary
the allocation information required by your QI withholding
agreement to the withholding agent no later than January 15 Line 17a. If you are providing Form W-8IMY as a
of the year following the year in which the payments are paid. nonqualified intermediary (NQI), you must check the box on
Failure to provide this information may result in penalties line 17a. By checking this box, you are certifying to all of the
under sections 6721 and 6722 and termination of your statements on line 17a.
withholding agreement with the IRS. Line 17b. Check the box on line 17b if you are using this
form to transmit withholding certificates or other

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documentation along with a withholding statement that For chapter 4 purposes. If you are an NQI that is a
satisfies the requirements of chapters 3 and 4 (including for participating FFI or registered deemed-compliant FFI and
purposes of section 1446(a) and including if you are you receive a withholdable payment, you must provide a
providing pooled information for purposes of chapter 61 withholding statement which satisfies the requirements of an
under the alternative procedure for U.S. non-exempt FFI withholding statement or chapter 4 withholding
recipients, or chapter 4 withholding rate pools (as applicable) statement.
for a withholdable payment). An FFI withholding statement may allocate the payment to
If you are required to provide a chapter 4 status on chapter 4 reporting rate pools (as appropriate), including a
TIP line 5 and are acting as an intermediary for a chapter 4 withholding rate pool for nonparticipating FFIs,
withholdable payment, you must provide your recalcitrant account holders (in each class of account holders
chapter 4 status on line 5 or as otherwise permitted in these described in Regulations section 1.1471-4(d)(6)(i)), or other
instructions to avoid withholding at the chapter 4 rate of 30% pool of payees permitted on an FFI withholding statement
being applied to any withholdable payment you receive from under the chapter 3 or 4 regulations (see Regulations
the withholding agent regardless of whether you check the sections 1.1471-3(c)(3)(iii)(B) and 1.1441-1(e)(3)(iv)(C)),
box on line 17b (except for documentation provided with and, for a participating FFI (including a reporting Model 2 FFI)
respect to exempt beneficial owners). or a registered deemed-compliant FFI (including a reporting
Model 1 FFI), U.S. payees. However, if you are an NQI, you
Line 17c. Check the box on line box 17c to certify that you may allocate a portion of a reportable amount (regardless of
are permitted under Regulations section 1.6049-4(c)(4) to whether the payment is a withholdable payment) to a
provide a chapter 4 withholding rate pool of U.S. payees to chapter 4 withholding rate pool of U.S. payees when you
which a payment is allocated on a withholding statement satisfy the requirements to provide such a pool (including the
associated with the Form W-8IMY. This checkbox does not requirement to certify to your status as a participating FFI
apply to a PTP distribution. You may check this box with (including a reporting Model 2 FFI) or registered
respect to U.S. source substitute dividends you receive as a deemed-compliant FFI (including a reporting Model 1 FFI)).
QSL regardless of whether you act as an intermediary or The withholding statement must also identify each
principal for those amounts. See the instructions to line 8 for intermediary or flow-through entity that is receiving a
a QSL's requirement to provide a U.S. TIN. payment (excluding any intermediary or flow-through entity
that is an account holder or interest holder in a QI, WP, or
Line 17d. Check the box on line 17d to certify that you are WT), each such entity’s chapter 4 status and GIIN (if
acting as a QSL with respect to the accounts identified on applicable), and the chapter 4 withholding rate pools
this line or in a withholding statement associated with this associated with each such entity receiving the payment.
form with respect to a payment that is a U.S. source
substitute dividend. You may check this box with respect to A chapter 4 withholding statement must contain the name,
U.S. source substitute dividends you receive as a QSL address, TIN (if any), entity type, chapter 4 status of each
regardless of whether you act as an intermediary or principal payee, the amount allocated to each payee, and a valid
for those amounts. See the instructions for line 8 for a QSL's withholding certificate or other documentation sufficient to
requirement to provide a U.S. TIN. establish each payee’s chapter 4 status. However, a
chapter 4 withholding statement may instead include pooled
If you are acting on behalf of another NQI or on behalf of a information for payees that are nonparticipating FFIs or
foreign partnership or foreign trust that is not a withholding another pool of payees as permitted under the chapter 4
foreign partnership or a withholding foreign trust, you must regulations for a chapter 4 withholding statement. The
attach to your Form W-8IMY the Form W-8IMY of the other withholding statement must also identify each intermediary or
NQI, foreign partnership, or foreign trust together with the flow-through entity that is receiving a payment (excluding any
withholding certificates and other documentation attached to intermediary or flow-through entity that is an account holder
that Form W-8IMY that are required for both chapter 3 and or interest holder in a QI, WP, or WT), each such entity’s
chapter 4 purposes. chapter 4 status and GIIN (if applicable), and the chapter 4
If you are an NQI receiving an amount realized from withholding rate pools associated with each such entity
! the transfer of a PTP interest, however, the receiving the payment.
CAUTION preceding paragraph and the representation made
A payment that is subject to chapter 3 withholding or
on line 17b applies only to the extent indicated in Withholding ! that should be subject to chapter 4 withholding
statement for amount realized or PTP distribution, later. CAUTION should not be included in a U.S. payee pool that is
described in Regulations section 1.6049-4(c)(4)(ii). Instead,
Withholding statement of an NQI. If you are an NQI, you
an allocation of a payment of an amount subject to chapter 3
must provide a withholding statement and appropriate
withholding to a withholding rate pool of U.S. payees must
documentation to obtain reduced rates of withholding under
identify the payees as described in Regulations section
chapter 3 and section 3406 for your customers receiving
1.1471-3(c)(3)(iii)(B)(2).
reportable amounts and to avoid certain reporting
responsibilities. However, see the paragraph later describing For chapter 3 and chapter 61 purposes. For chapter 3
an NQI’s withholding statement for chapter 4 purposes for and chapter 61 purposes, in the case of a reportable amount
when an NQI may provide a chapter 4 withholding rate pool that is also a withholdable payment, the withholding
of U.S. payees instead of documentation for those payees. statement should allocate only the portion of the payment
The withholding statement must be provided prior to a that was not allocated to a chapter 4 withholding rate pool or
payment and becomes an integral part of the Form W-8IMY a pool described in Regulations section 1.1441-1(e)(3)(iv)(C)
and, therefore, the certification statement that you sign in or to a payee identified on the withholding statement to whom
Part XXIX of the form applies to the withholding statement as withholding was applied under chapter 4. The withholding
well as to the form. statement must generally include the following information.

Instructions for Form W-8IMY (Rev. 10-2021) -17-

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• Include the name, address, U.S. TIN (if any), chapter 4        payment and the information for the broker to allocate the 
status (for a foreign person receiving a withholdable            amount realized to each transferor; and
payment), and the type of documentation (documentary             •    The NQI receives from the broker paying the amount 
evidence, Form W-9, or type of Form W-8) for every person        realized a written representation that the broker is acting as 
for whom documentation has been received and state               an agent of the PTP with respect to the statement described 
whether that person is a U.S. exempt recipient, a U.S.           in Regulations section 1.6031(c)-1T(a) or otherwise 
non-exempt recipient, or a foreign person. The statement         designates the broker as its agent for providing the statement 
must indicate whether a foreign person is a beneficial owner     to the PTP (or the PTP's agent).
or an intermediary, flow-through entity, U.S. branch, or 
                                                                         The allowance for an NQI to provide a withholding 
territory financial institution and the type of recipient, based 
                                                                         statement and transferor documentation applies 
on the recipient codes shown on Form 1042-S.                     CAUTION!
                                                                         despite that an NQI may not obtain reduced 
• Allocate each payment by income type to every payee for 
                                                                 withholding on an amount realized it receives from the 
whom documentation has been provided. The type of income 
                                                                 transfer of a PTP interest.
is based on the income codes reported on Form 1042-S (or, 
if applicable, the income categories for Form 1099). If a             Alternative procedure for NQIs receiving reportable 
payee receives income through another NQI, flow-through          amounts (and for chapter 4).    To use the alternative 
entity, or U.S. branch acting as an intermediary, the            procedure you must inform the withholding agent on your 
withholding certificate must also state the name, address,       withholding statement that you are using the procedure, and 
U.S. TIN (if known), and, for a withholdable payment, the        the withholding agent must agree to the procedure.
chapter 4 status (if required) and GIIN (if applicable) of the        Under this procedure, you must provide a withholding 
other NQI or U.S. branch from which the payee directly           agent with all the information required on the withholding 
receives the payment or the flow-through entity in which the     statement and all payee documentation, except the specific 
payee has a direct ownership interest. If another NQI,           allocation information for each payee, prior to the payment of 
flow-through entity, or U.S. branch fails to allocate a          a reportable amount. In addition, you must provide the 
payment, you must provide, for that payment, the name of         withholding agent with withholding rate pool information. The 
the NQI, flow-through entity, or U.S. branch that failed to      withholding statement must assign each payee that is not 
allocate the payment.                                            subject to withholding under chapter 4 to a chapter 3 
• If a payee is identified as a foreign person, specify the rate withholding rate pool prior to the payment of a reportable 
of withholding under chapter 3 to which the payee is subject,    amount. The withholding rate pool may be established by any 
the payee’s country of residence and, if a reduced rate of       reasonable method agreed upon by you and the withholding 
withholding is claimed, the basis for that reduced rate (for     agent. For example, you may agree to establish a separate 
example, treaty benefit, portfolio interest, or exemption under  account for a single withholding rate pool, or you may agree 
section 501(c)(3), 892, or 895). The statement must also         to divide a payment made to a single account into portions 
include the U.S. or foreign TIN (if required) and, if the        allocable to each withholding rate pool. You must determine 
beneficial owner is not an individual and is claiming treaty     withholding rate pools based on valid documentation or, to 
benefits, state whether the limitation on benefits and section   the extent a payment cannot be reliably associated with valid 
894 statements have been provided by the beneficial owner.       documentation, the applicable presumption rules.
You must inform the withholding agent as to which payments 
those statements relate.                                              You must provide the withholding agent with sufficient 
• Include any other information the withholding agent            information to allocate the income in each withholding rate 
requests in order to fulfill its withholding and reporting       pool to each payee (including U.S. exempt recipients) within 
obligations under chapters 3 and 4 of the Code and/or Form       the pool no later than January 31 of the year following the 
1099 reporting and backup withholding responsibility.            year of payment. If you fail to provide allocation information, if 
                                                                 required, by January 31 for any withholding rate pool, you 
  Withholding statement for amount realized or PTP 
                                                                 may not use this procedure for any payment made after that 
distribution. In the case of a PTP distribution, an NQI may 
                                                                 date for all withholding rate pools. You may remedy your 
provide a withholding statement and appropriate 
                                                                 failure to provide allocation information by providing the 
documentation for each of its account holders receiving the 
                                                                 information to the withholding agent no later than February 
distribution to allocate to its account holders the amounts 
                                                                 14.
subject to withholding on the distribution under chapters 3 
and 4 (or under section 1446(a)). See Withholding statement,          In the case of a reportable amount that is also a 
earlier, for additional requirements of a withholding statement  withholdable payment, you may include amounts allocable to 
provided by an intermediary for a PTP distribution.              a chapter 4 withholding rate pool (other than a chapter 4 
                                                                 withholding rate pool of U.S. payees) and payees subject to 
  In the case of an amount realized (including on a PTP 
                                                                 chapter 4 withholding for whom you will provide 
distribution), however, an NQI may provide a withholding 
                                                                 payee-specific information in a 30-percent rate pool together 
statement and appropriate documentation on the transferors 
                                                                 with payees subject to chapter 3 withholding at the 
of the PTP interest only when:
                                                                 30-percent rate and may not otherwise apply these 
• The broker paying the amount realized to the NQI agrees 
                                                                 provisions for payments made to U.S. non-exempt recipients 
to report (or ensures another broker will report) under section 
                                                                 (regardless of whether the payment is a withholdable 
1461 (and, if required, under section 6045) with respect to 
                                                                 payment). For the amount of the payment allocable to a 
the amount realized allocated each of the account holders 
                                                                 chapter 4 withholding rate pool of U.S. payees, you may 
that are the transferors of the PTP interest (and provide NQI 
                                                                 include such an amount in the withholding rate pool that is 
a copy of each Form 1042-S issued due to this reporting);
                                                                 exempt from withholding (you can include such payees in an 
• The NQI provides to the broker the statement described in 
                                                                 exempt pool regardless of whether the payment is a 
Regulations section 1.6031(c)-1T(a)(1) with respect to each 
                                                                 withholdable payment). You must identify prior to the 
NQI account holder that is a partner required to be issued a 
                                                                 payment each chapter 4 withholding rate pool to be allocated 
statement under section 6031(b) for the calendar year of the 

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a portion of the payment and must also allocate by January documentation for persons for whom you are receiving a
31 the portion of the payment to each such pool in addition to payment (as required for chapter 3, chapter 61, and section
allocating the payment to each other payee as described in 3406 purposes, and, in the case of a withholdable payment,
the preceding paragraph. See Regulations section for chapter 4 withholding and reporting purposes). You must
1.1441-1(e)(3)(iv)(D) for further information on alternative also certify that you have provided or will provide a
procedures for an NQI. withholding statement (as required) with the information
Alternative withholding statement. If a withholding required on an NQI withholding statement.
agent agrees, instead of providing a withholding statement If this form is being provided for purposes of the entity’s
that contains all of the information described previously, you holding of an interest in a PTP, check the box on line 18d to
may provide an alternative withholding statement for a certify that you have agreed to be treated as a U.S. person
payment of a reportable amount. You may only use an under Regulations section 1.1446(f)-4(a)(2)(i)(B) with respect
alternative withholding statement if you are providing the to an amount realized from a sale of a PTP interest. You may
withholding agent with withholding certificates (and not provide a withholding statement when you do not act as a
documentary evidence) from the beneficial owners of the U.S. person for an amount realized under the same
payment. The alternative withholding statement is not conditions that apply to an NQI receiving an amount realized.
required to include information that is already on the See Withholding statement for amount realized or PTP
withholding certificates (including name, address, TIN, distribution in Part IV, earlier. Check the box on line 18e to
chapter 4 status, and GIIN), and you are not required to certify that you have agreed to be treated as a U.S. person
provide the rate of withholding applicable to each beneficial (as described in Regulations section 1.1441-1(b)(2)(iv)) and
owner, so long as the withholding agent can determine the as a nominee under Regulations section 1.1446-4(b)(3) with
appropriate rate based on the withholding certificates. Just respect to distributions made by PTPs. If you check either the
as for a nonqualified intermediary withholding statement, the box on line 18d or 18e, you must provide an EIN on line 8. If
alternative withholding statement must provide information you receive PTP distributions for which you do not act as a
for allocating the payment to each payee and must include nominee under Regulations section 1.1446-4(b)(3), check
any other information the withholding agent needs to fulfill its the box on line 18f instead of the box on line 18e. You should
withholding and reporting obligations. provide a withholding statement to allocate the amounts
Line 17e. As part of providing any alternative withholding subject to withholding on a distribution and provide the
statements that are associated with your Form W-8IMY, you appropriate account holder documentation, taking into
may make the representation indicated on line 17e. If you account the limitation on an NQI providing this
check the box line 17e, you are not required to represent on documentation for an amount realized (to the extent
each alternative withholding statement that the information applicable). See Withholding statement, earlier, for the
on the withholding certificates provided with the alternative requirements of a withholding statement provided by an
withholding statement is not inconsistent with any other intermediary for a PTP distribution.
account information you have for the beneficial owners for
determining the appropriate rate of withholding. See A territory entity that is a flow-through entity but is not
Regulations section 1.1441-1(e)(3)(iv)(C)(3) for further ! a territory financial institution may not complete this
information on the representation otherwise required on each CAUTION Part V to agree to be treated as a U.S. person.
alternative withholding statement. Instead, complete Part IV or Part VIII, as appropriate.

Part V — Territory Financial Part VI — Certain U.S. Branches
Institution Line 19. Check the box on line 19a to certify that you are a
U.S. branch receiving payments of income that are
Line 18. Check the box on line 18a to certify that you are a reportable amounts or withholdable payments not effectively
financial institution (other than an investment entity that is not connected with the conduct of a trade or business in the
also a depository institution, custodial institution, or specified United States, payments of PTP distributions, or payments of
insurance company) incorporated or organized under the amounts realized.
laws of a territory of the United States.
You must also check either the box on line 19b or 19c if
You must also check either the box on line 18b or 18c, the you are receiving payments of reportable amounts or
box on line 18d, and either the box line on 18e or 18f (each withholdable payments associated with this form. Check the
box as applicable based on the types of payments received). box on line 19b to certify that you are a U.S. branch of a
Check the box on line 18b to certify that you have agreed to foreign bank or insurance company described in this
be treated as a U.S. person for purposes of both chapter 3 certification that has agreed with the withholding agent to be
and chapter 4 with respect to payments of reportable treated as a U.S. person under Regulations section
amounts and withholdable payments associated with this 1.1441-1(b)(2)(iv) with respect to such payments associated
Form W-8IMY. In this case, you will be responsible for with this Form W-8IMY. In such case, you will be responsible
chapter 3 withholding and reporting, backup withholding for chapter 3 withholding and reporting and chapter 4
under section 3406, and chapter 4 withholding and reporting withholding and reporting for any such payments you make
for any payments you make to persons for whom you are to persons for whom you are receiving a withholdable
receiving a reportable amount or withholdable payment. If payment (including any of your branches treated as NPFFIs).
you check the box on line 18b, you must provide an EIN on In addition, you will be treated as a U.S. payor for chapter 61
line 8. purposes by checking the box on line 19b (including for
Check the box on line 18c to certify that you are a territory backup withholding under section 3406). You must provide
financial institution that has not agreed to be treated as a your EIN on line 8. You do not need to provide a chapter 4
U.S. person for reportable amounts and withholdable status on line 5 or a GIIN on line 9.
payments associated with this form. You must certify that you
are transmitting withholding certificates or other

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Check the box on line 19c to certify that you are a U.S. or any other amount subject to withholding on a PTP
branch that does not have an agreement with the withholding distribution. If you are also receiving payments from the same
agent to be treated as a U.S. person under Regulations withholding agent for persons other than your partners,
section 1.1441-1(b)(2)(iv). You must certify that you are beneficiaries, or owners, you must provide a separate Form
transmitting withholding certificates or other documentation W-8IMY for those payments. If you are receiving a
for persons for whom you are receiving the payment of a withholdable payment, you must provide your chapter 4
reportable amount or withholdable payment. You must also status on line 5 and provide your GIIN (if applicable).
certify that you have provided or will provide a withholding
statement (as required) with the information required on an Part VIII — Nonwithholding Foreign
NQI withholding statement. Also, check the box on line 19c to Partnership, Simple Trust, or Grantor
certify that, when you are receiving a withholdable payment
associated with this form, you are applying the rules Trust
described in Regulations section 1.1471-4(d)(2)(iii)(C). You
must also provide your EIN on line 8 but do not need to Line 21a. Check the box on line 21a if you are a foreign
include a chapter 4 status in Part I, line 5, or a GIIN on line 9. partnership or a foreign simple or grantor trust that is not a
If you are unable to make this certification, you cannot fill out WP or WT, and is providing this form for payments that are
this part but instead must check the box on line 5 indicating not effectively connected, or are not treated as effectively
you are a nonparticipating FFI. connected, with the conduct of a trade or business in the
United States.
If this form is being provided for purposes of the entity’s
holding of an interest in a PTP, check the box on line 19d to Line 21b. Check the box on line 21b if you are a foreign
certify that you are a U.S. branch described in Regulations partnership or foreign grantor trust providing this form for
section 1.1446(f)-4(a)(2)(i)(B) that is acting as a U.S. person purposes of section 1446(a). See Foreign partnerships and
with respect to an amount realized from the sale of a PTP trusts providing Form W-8IMY for purposes of section
interest. You may provide a withholding statement when you 1446(a), later. If you are a foreign partnership (other than a
do not act as a U.S. person for an amount realized under the WP) or grantor trust receiving payments of both the amounts
same conditions that apply to an NQI receiving an amount described on line 21a and for purposes of section 1446(a),
realized. See Withholding statement for amount realized or you should check both boxes. By checking either box, you
PTP distribution in Part IV, earlier. Check the box on line 19e are certifying to the applicable statements on the form.
to certify that you are a U.S. branch described in Regulations
section 1.1441-1(b)(2)(iv) that is acting as a nominee with Note. If you are receiving income that is effectively
respect to distributions by PTPs under Regulations section connected with the conduct of a trade or business in the
1.1446-4(b)(3). You must provide your EIN on line 8 but do United States, provide Form W-8ECI (instead of Form
not need to provide a chapter 4 status on line 5 or a GIIN on W-8IMY), when you are permitted to use that form to claim an
line 9 when you check either the box on line 19d or 19e. If exemption from withholding. If you are not receiving the
you are a U.S. branch receiving PTP distributions associated income on behalf of your partners, beneficiaries, or owners,
with the form and are not acting as a nominee for the do not complete Part VIII. If you are a hybrid entity claiming
distributions under Regulations section 1.1446-4(b)(3), you treaty benefits, provide Form W-8BEN-E. However, if you are
should check the box on line 19f instead of the box on receiving a withholdable payment you may also be required
line 19e. You should provide a withholding statement to to provide this Form W-8IMY and provide your chapter 4
allocate the amounts subject to withholding on a distribution status and the chapter 4 status of each of your owners. See
and provide the appropriate account holder documentation, the Instructions for Form W-8BEN-E for more information
taking into account the limitation on an NQI providing this about hybrid entities claiming treaty benefits.
documentation for an amount realized (to the extent If you are receiving a withholdable payment, you must
applicable). See Withholding statement, earlier, for the provide a chapter 4 status on line 5 and provide your GIIN (if
requirements of a withholding statement provided by an applicable) and the information required for the withholding
intermediary for a PTP distribution. agent to report under section 1472 (to the extent required).
Withholding statement of nonwithholding foreign part-
Part VII — Withholding Foreign
nership or nonwithholding foreign trust for purposes of
Partnership (WP) or Withholding chapters 3 and 4. You must provide the withholding agent
with a withholding statement to obtain reduced rates of
Foreign Trust (WT) withholding and relief from certain reporting obligations. The
Line 20. Check the box on line 20 if you are a WP or a WT withholding statement must provide the same information as
and you are receiving the payment on behalf of your required for an NQI withholding statement, including the
partners, beneficiaries, or owners. information required with respect to an NQI, foreign
partnership, or foreign trust (other than a WP or WT) for
If you are acting as a WP or WT, you must assume
which you receive a payment. The withholding statement
primary withholding and reporting responsibility under
becomes an integral part of the Form W-8IMY. If you are an
chapter 3 and chapter 4 for all payments that are made to
FFI and allocate any portion of the payment to a chapter 4
you for your partners, beneficiaries, or owners. Therefore,
withholding rate pool of U.S. payees with respect to accounts
you are not required to provide information to the withholding
that you maintain, you must meet the requirements of
agent regarding each partner’s, beneficiary’s, or owner’s
Regulations section 1.6049-4(c)(4)(iii) and certify to your
distributive share of the payment and the information for the
status in Part I, line 5, as a participating FFI, registered
withholding agent to report under section 1472 (if otherwise
deemed-compliant FFI, reporting Model 1 FFI, or reporting
required). You are not, however, permitted to assume
Model 2 FFI. By providing a withholding statement making
primary withholding and reporting responsibility for payments
such an allocation with this form, you certify that you meet the
subject to withholding under section 1445, 1446(a), 1446(f),

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requirements outlined for an NQI withholding statement                       If you are providing this Form W-8IMY solely for 
described earlier.                                                    TIP    purposes of section 1446(a) or (f), you are not 
                                                                             required to provide a chapter 4 status because items 
Foreign partnerships and trusts providing Form W-8IMY 
                                                                      of effectively connected income are not withholdable 
for purposes of section 1446(a). In general, a partnership 
                                                                      payments. However, if you do not provide a chapter 4 status 
is required to withhold under section 1446(a) on effectively 
                                                                      and subsequently receive a withholdable payment, you will 
connected taxable income (ECTI) allocable to a foreign 
                                                                      also be required to provide a Form W-8IMY to provide your 
partner (or in the case of a PTP distribution, to the extent the 
                                                                      chapter 4 status or the lower-tier partnership or broker 
distribution is attributable to ECTI, unless withholding is 
                                                                      making the payment to you may have to withhold on the 
required by a nominee). A foreign upper-tier partnership 
                                                                      payment. You may provide your chapter 4 status on this form 
(UTP) that is a partner in a lower-tier partnership (LTP) 
                                                                      even if you are not required to do so.
should provide the LTP with a Form W-8IMY and, for a 
partnership other than a PTP, documentation sufficient for            Line 21f. To the extent that the entity identified in Part 1 of 
the LTP (or nominee for the amounts) to determine the status          this form is providing an alternative withholding statement 
of the indirect partner to whom the ECTI is allocable (looking        described in Regulations section 1.1441-1(e)(3)(iv)(C)(3), 
through additional foreign UTPs, if applicable) and to                you may check the box on this line to make the 
determine such partner’s share of the lower-tier partnership’s        representation included on this line instead of making the 
ECTI.                                                                 representation on each alternative withholding statement. 
Also, for purposes of section 1446(a), a foreign grantor              See Alternative withholding statement, earlier.
trust that is a partner in a partnership should provide Form 
W-8IMY to the partnership along with documentation and                Certification of Chapter 4 Status: 
information concerning the grantor or other owner sufficient 
for the partnership to reliably associate the portion of the          Parts IX Through XXVIII
trust’s allocable share of ECTI with the grantor or other             You should complete only one part certifying to your 
owner.                                                                chapter 4 status (if required). Identify which part (if any) you 
                                                                      should complete by reference to the box you checked on 
Check the box on line 21b to certify that you are a foreign 
                                                                      line 5.
partnership or grantor trust providing this Form W-8IMY to a 
lower-tier partnership for purposes of section 1446(a).               Part IX — Nonparticipating FFI With 
Lines 21c and 21d. Check the box on line 21c if you are a 
                                                                      Exempt Beneficial Owners
foreign partnership that is a transferor of an interest in a 
partnership receiving an amount realized from the transfer. If               You are not required to complete this part unless you 
you check the box on line 21c and are providing a                     TIP    are a nonparticipating FFI providing documentation 
withholding statement for a modified amount realized on the                  on behalf of an exempt beneficial owner.
transfer, also check the box on line 21d. The withholding 
statement for a modified amount realized must show the                Line 22. Check the box on line 22 to certify that you are 
allocation of the gain from the transfer to each of the partners      transmitting withholding certificates or other documentation 
for which a lower rate of withholding is being requested, and         for exempt beneficial owners for chapter 4 purposes on 
you must provide withholding certificates for each of the             whose behalf you are receiving a payment that is a 
partners to avoid the requirement that the transferee (or your        withholdable payment. See Regulations section 1.1471-6. 
broker for a transfer of a PTP interest) treat a partner as a         You must also certify that you have provided or will provide a 
presumed foreign partner.                                             withholding statement (as required) allocating a portion of the 
                                                                      payment to the exempt beneficial owners as required under 
        For a modified amount realized, you may not use a 
                                                                      Regulations section 1.1471-3(d)(8)(ii). The withholding 
!       withholding statement that you provided to your               statement must include the name, address, TIN (if any), 
CAUTION transferee or broker that only allocates a reportable 
                                                                      entity type, and chapter 4 status of each exempt beneficial 
amount or withholdable payment to your partners. You must 
                                                                      owner on behalf of which you are receiving the payment, the 
provide a withholding statement that allocates the gain from 
                                                                      amount of the payment allocable to each exempt beneficial 
the transfer of the PTP interest. Once you have provided that 
                                                                      owner, a valid withholding certificate or other documentation 
withholding statement, you may provide it for a subsequent 
                                                                      sufficient to establish the chapter 4 status of each exempt 
amount realized provided that the gain allocations have not 
                                                                      beneficial owner under the requirements of chapter 4, and 
changed. You may instead provide a withholding statement 
                                                                      any other information the withholding agent reasonably 
that indicates both that it may be used for all reportable 
                                                                      requests in order to fulfill its obligations under chapter 4. 
amounts, withholdable payments and gains on transfers 
                                                                      Additionally, the withholding statement must provide all 
allocable to your partners and that you will update the 
                                                                      information required for purposes of chapter 3 with respect to 
withholding statement for a change to any of these 
                                                                      each exempt beneficial owner if the payment is an amount 
allocations.
                                                                      subject to chapter 3 withholding. The withholding statement 
Line 21e. Check the box on line 21e if you are a foreign              must allocate the remainder of the payment that is not 
grantor trust providing the form on behalf of each grantor or         allocated to an exempt beneficial owner to you.
owner of the trust under Regulations section 1.1446(f)-1(c)(2)
                                                                      Part X — Sponsored FFI
(vii) that is transmitting withholding certificates and providing 
a withholding statement to allocate an amount realized to             Line 23a. If you are a sponsored FFI described in 
each grantor or other owner in the trust for purposes of              Regulations section 1.1471-5(f)(1)(i)(F), on line 23a, enter 
section 1446(f).                                                      the name of the sponsoring entity that has agreed to fulfill 
                                                                      your chapter 4 due diligence, reporting, and withholding 

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obligations on your behalf. You must provide your GIIN on
Part XV — Certified
line 9.
Lines 23b and 23c. You must check the applicable box on Deemed-Compliant Limited Life Debt
line 23b or 23c to certify that you are either an investment Investment Entity
entity or controlled foreign corporation (within the meaning of
section 957(a)) and satisfy the other relevant requirements Line 28. You must check the box on line 28 to certify that
for this classification. you satisfy the requirements for certified deemed-compliant
limited life debt investment entity status.
Part XI — Owner-Documented FFI
Part XVI — Certain Investment
An owner-documented FFI should only complete
Entities that Do Not Maintain
! Form W-8IMY if it is a flow-through entity receiving
CAUTION income allocable to its partners, owners, or
Financial Accounts
beneficiaries. An owner-documented FFI is not permitted to
act as an intermediary with respect to a withholdable Line 29. You must check the box on line 29 to certify that
payment. you meet all of the requirements for certified
deemed-compliant status as an investment entity that does
Line 24a. You must check the box on line 24a to certify that not maintain financial accounts.
you satisfy the requirements for owner-documented FFI
status and are providing this form to a U.S. financial Part XVII — Restricted Distributor
institution, a participating FFI, or a reporting Model 1 FFI that Line 30a. You must check the box on line 30a to certify that
has agreed to act as a designated withholding agent with you satisfy the requirements of restricted distributor status.
respect to you (see Regulations section 1.1471-5(f)(3)).
Lines 30b and 30c. You must also check either the box on
Lines 24b and 24c. You must also check either the box on line 30b or 30c, as appropriate, to certify that your distribution
line 24b or 24c. Check the box on line 24b to certify that you agreement meets the requirements of this classification.
have provided or will provide the documentation set forth in
the certifications, including the owner reporting statement Part XVIII — Foreign Central Bank of
described on this line 24b. Check the box on line 24c to
certify that you have provided or will provide an auditor’s Issue
letter (in lieu of the information required by line 24b) that
Line 31. You must check the box on line 31 to certify that
satisfies the requirements described on this line.
you are a foreign central bank of issue acting as an
Part XII — Certified intermediary and are an entity defined in Regulations section
1.1471-6 that is treated as the beneficial owner of the
Deemed-Compliant Nonregistering payment for chapter 4 purposes (applying the rule in
Regulations section 1.1471-6(d)(4)). You cannot be treated
Local Bank as an intermediary for purposes of this Part XVIII if you are
Line 25. You must check the box on line 25 to certify that receiving the payment in connection with a commercial
you satisfy all of the requirements for certified activity described in Regulations section 1.1471-6(h)(1) or
deemed-compliant nonregistering local bank status. are not receiving payments subject to chapter 3 withholding.

Part XIII — Certified Part XIX — Nonreporting IGA FFI
Deemed-Compliant FFI with Only Line 32. Check the box on line 32 to indicate that you are
treated as a nonreporting IGA FFI. You must identify the IGA
Low-Value Accounts by entering the name of the jurisdiction that has the
Line 26. You must check the box on line 26 to certify that applicable IGA in effect with the United States and indicate
you satisfy all of the requirements for certified whether it is a Model 1 or a Model 2 IGA. You must also
deemed-compliant FFI with only low-value account status. provide the withholding agent with the specific category of
entity described in Annex II of the IGA applicable to your
Part XIV — Certified status. In providing the specific category of FFI described in
Annex II, you should use the language from Annex II that best
Deemed-Compliant Sponsored, and most specifically describes your status in the IGA. For
Closely Held Investment Vehicle example, indicate “investment entity wholly owned by exempt
beneficial owners” rather than “exempt beneficial owner.” If
Line 27a. On line 27a, enter the name of the sponsoring you are a nonreporting IGA FFI claiming a deemed-compliant
entity that has agreed to fulfill your chapter 4 due diligence, status under the regulations, you must instead indicate on
reporting, and withholding obligations on your behalf. You this line which section of the regulations you qualify under.
must also enter the GIIN of your sponsoring entity on line 9. If you are a nonreporting financial institution under an
Line 27b. You must check the box on line 27b to certify that applicable IGA because you qualify as an
you satisfy the requirements for certified deemed-compliant owner-documented FFI under the regulations, do not check
classification as a sponsored closely held investment vehicle. “Nonreporting IGA FFI.” Instead you must check
“Owner-documented FFI” and complete Part XI rather than
this Part XIX.
See instructions for line 9 for when a GIIN is required for a
nonreporting IGA FFI (including a trustee of a
trustee-documented trust that is a foreign person).

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status. See Regulations section 1.1472-1(c)(1)(iii) for the
Part XX — Exempt Retirement Plans
definition of an excepted territory NFFE.
Line 33. You must check the appropriate box on line 33a, b,
c, d, e, or f to certify that you satisfy the requirements of Part XXVI — Active NFFE
exempt retirement plan status. Line 39. You must check the box on line 39 to certify that
If you are not a flow-through entity or acting as an you satisfy the requirements of active NFFE status.
CAUTION chapter 3 purposes, do not complete Form W-8IMY.
! intermediary with respect to the payment for Part XXVII — Passive NFFE
If you are the beneficial owner of the payment and are Line 40. If you are a passive NFFE, you must check the box
claiming an exemption under sections 115(2), 892, or 895 as on line 40 to certify that you are not a financial institution
well as exempt beneficial owner status under Regulations (other than an investment entity organized in a possession of
section 1.1471-6 you should provide Form W-8EXP. If you the United States). You must also certify that you have
are receiving payments which do not qualify for a statutory provided a withholding statement associated with Form
exemption from tax but for which you are claiming benefits W-8IMY to the extent you are required to provide a
under an applicable income tax treaty, provide Form withholding statement.
W-8BEN-E.
Note. If you would be a passive NFFE but for the fact that
Part XXI — Excepted Nonfinancial you are managed by certain types of financial institutions
(see Regulations section 1.1471-5(e)(4)(i)(B)), you should
Group Entity not complete Part XXVII as you would be considered a
Line 34. You must check the box on line 34 to certify that financial institution and not a passive NFFE.
you satisfy the requirements of excepted nonfinancial group
entity status. Part XXVIII— Sponsored Direct
Reporting NFFE
Part XXII — Excepted Nonfinancial
Lines 41 and 42. If you are a sponsored direct reporting
Start-Up Company NFFE, you must check the box on line 42 to certify that you
Line 35. You must check the box on line 35 to certify that are not a financial institution and that you satisfy all relevant
you satisfy the requirements of excepted nonfinancial requirements for this classification. Enter the name of the
start-up company status. You must also provide the date you sponsoring entity on line 41.
were formed or your board passed a resolution (or equivalent
measure) approving a new line of business (which cannot be Part XXIX — Certification
that of a financial institution or passive NFFE). Form W-8IMY must be signed and dated by a person
authorized to sign a declaration under penalties of perjury on
Part XXIII — Excepted Nonfinancial behalf of the person whose name is on the form. By signing
Form W-8IMY the authorized representative, officer, or agent
Entity in Liquidation or Bankruptcy also agrees to provide a new form within 30 days following a
Line 36. You must check the box on line 36 to certify that change in circumstances (unless no future payments will be
you satisfy the requirements of excepted nonfinancial entity made to the intermediary or flow-through entity by the
in liquidation or bankruptcy status. You must also provide the withholding agent and the requestor does not need an
date that you filed a plan of liquidation, plan of reorganization, updated form for chapter 4 purposes).
or bankruptcy petition.
A withholding agent may allow you to provide this form
Part XXIV — Publicly Traded NFFE or with an electronic signature. The electronic signature must
indicate that the form was electronically signed by a person
NFFE Affiliate of a Publicly Traded authorized to do so (for example, with a time and date stamp
and a statement that the form has been electronically
Corporation signed). Simply typing your name into the signature line is not
Lines 37a and 37b. If you are a publicly traded NFFE, you an electronic signature. A withholding agent may also rely on
must check the box on line 37a to certify that you are not a an electronically signed withholding certificate if you provide
financial institution and provide the name of a securities any additional information or documentation requested by
exchange on which your stock is publicly traded. If you are an the withholding agent to support that the form was signed by
NFFE that is a member of the same expanded affiliated you or other person authorized to do so. See Regulations
group (as described in Regulations section 1.1471-5(i)) as a section 1.1441-1(e)(4)(i)(B).
publicly traded U.S. or foreign entity, you must check the box
on line 37b to certify that you are an NFFE affiliate of a Special Instructions
publicly traded corporation, provide the name of the publicly
traded entity, and identify the securities market on which the Entities Providing Certifications Under an
stock of the publicly traded entity is traded. See Regulations Applicable IGA (Do Not Complete Line 5)
section 1.1472-1(c)(1)(i) to determine if an entity is publicly An FFI in an IGA jurisdiction with which you have an account
traded. may provide you with a chapter 4 status certification other
than as shown in Parts IX through XXVIII in order to satisfy its
Part XXV — Excepted Territory NFFE due diligence requirements under the applicable IGA. In such
Line 38. You must check the box on line 38 to certify that a case, you may attach the alternative certification to this
you satisfy the requirements for excepted territory NFFE Form W-8IMY in lieu of completing a certification otherwise
required in Parts IX through XXVIII provided that you (a)

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determine that the certification accurately reflects your status (if, for example, new regulations provide for an additional
for chapter 4 purposes or under an applicable IGA; and (b) status and this form has not been updated) then you may
the withholding agent provides a written statement to you that provide an attachment certifying that you qualify for the
it has provided the certification to meet its due diligence applicable status described in a particular Regulations
requirements as a participating FFI or registered section. Include a citation to the applicable provision in the
deemed-compliant FFI under an applicable IGA. For Regulations. Any such attached certification becomes an
example, Entity A organized in Country A holds an account integral part of this Form W-8IMY and is subject to the
with an FFI in Country B. Country B has a Model 1 IGA in penalties of perjury statement and other certifications made
effect. The FFI in Country B may ask Entity A to provide a in Part XXIX.
chapter 4 status certification based on the terms of the
Country B IGA in order to fulfill its due diligence and Paperwork Reduction Act Notice. We ask for the
documentation requirements under the Country B IGA. information on this form to carry out the Internal Revenue
You may also provide with this form an applicable IGA laws of the United States. You are required to provide the
certification if you are determining your chapter 4 status information. We need it to ensure that you are complying with
under the definitions provided in an applicable IGA and your these laws and to allow us to figure and collect the right
certification identifies the jurisdiction that is treated as having amount of tax.
an IGA in effect and describes your status as an NFFE or FFI
You are not required to provide the information requested
in accordance with the applicable IGA. However, if you
on a form that is subject to the Paperwork Reduction Act
determine your status under an applicable IGA as an NFFE,
unless the form displays a valid OMB control number. Books
you must still determine if you are an excepted NFFE under
or records relating to a form or its instructions must be
the regulations in order to complete this form unless you are
retained as long as their contents may become material in
provided an alternative certification by an FFI described in
the administration of any Internal Revenue law. Generally,
the preceding paragraph that covers your certification as an
tax returns and return information are confidential, as
NFFE (such as “active NFFE”) as defined in an applicable
required by section 6103.
IGA. Additionally, you are required to comply with the
conditions of your status under the law of the IGA jurisdiction The time needed to complete and file this form will vary
if you are determining your status under that IGA. If you depending on individual circumstances. The estimated
cannot provide the certifications in Parts IX through XXVIII, burden for business taxpayers filing this form is approved
do not check a box on line 5. However, if you determine your under OMB control number 1545-0123. The estimated
status under the definitions of the IGA and can certify to a burden for all other taxpayers who file this form is shown
chapter 4 status included on this form, you do not need to below. The estimated average time is: Recordkeeping,15
provide the certifications described in this paragraph unless hrs., 04 mins.; Learning about the law or the form, 6 hrs.,
required by the FFI to whom you are providing this form. 31 mins.; Preparing the form, 8 hrs.; Sending 16 mins.
Any certifications provided under an applicable IGA
remain subject to the penalties of perjury statement and other If you have comments concerning the accuracy of these
certifications made in Part XXIX. time estimates or suggestions for making this form simpler,
we would be happy to hear from you. You can send us
Entities Providing Alternate or Additional comments from IRS.gov/FormComments. You can write to
Certifications Under Regulations the Internal Revenue Service, Tax Forms and Publications,
1111 Constitution Ave. NW, IR-6526, Washington, DC
If you qualify for a status that is not shown on of this form, you
20224. Do not send Form W-8IMY to this office. Instead, give
may attach applicable certifications for such status from any
it to your withholding agent.
other Form W-8 on which the relevant certifications appear. If
the applicable certifications do not appear on any Form W-8

-24- Instructions for Form W-8IMY (Rev. 10-2021)

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