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Notice of Expatriation and Waiver of Treaty Benefits
(November 2009) OMB No. 1545-2138
Form W-8CE �Section references are to the Internal Revenue Code.
Department of the Treasury �Give this form to the payer. Do not send to the IRS.
Internal Revenue Service
Name of owner U.S. taxpayer identification number

Permanent address Expatriation date

City, province or state, postal code, and country

Current mailing address, if different from permanent address. Include apt. or suite no., or P.O. box if mail is not delivered to street address.

Please print or type City, town or post office, state, and ZIP code. If you have a foreign address, enter city, province or state, postal code, and country.

Under penalties of perjury, I certify that I am a covered expatriate (as defined in the instructions below). Furthermore, I authorize
this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial
owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.

Account Number
Name of payer
(or other identifying information)
For the payer above, check the box below if you had any of the following items on the day
before your expatriation date (see instructions).

1.Eligible Deferred Compensation Item. Checking this box notifies the payer that you are
irrevocably waiving any right to claim any reduction in withholding for such eligible deferred
compensation item under any treaty with the United States (see instructions)

2.Ineligible Deferred Compensation Item

3.Specified Tax Deferred Account

4.Nongrantor Trust. Checking this box notifies the payer that you will be treated as having waived any
right to claim any reduction in withholding on any distribution from this trust under any treaty with the
United States (see instructions)

Checking this box notifies the payer that you are electing to be treated as having received the value of your interest in the trust on
the day before your expatriation date and that you will be subject to withholding under section 877A until the payer receives (a) a
copy of the letter ruling issued by the IRS stating the value of your interest in the trust and (b) your certification that you have paid
any tax due on the receipt of the value of your interest in the trust (see instructions).

� Signature Date

obligations for the preceding 5 years or Long-Term Resident. For expatriation
General Instructions have not submitted evidence of such purposes, a long-term resident is any
compliance. individual who was a lawful permanent
Purpose resident of the United States in at least 8
Exceptions. Statements (1) and (2) above
out of the last 15 tax years ending with the
Use Form W-8CE to notify the payer that do not apply if: tax year of expatriation.
you are a covered expatriate individual
�
subject to special tax rules. You became a U.S. citizen and a citizen Expatriation date. Your expatriation date is
of another country at birth and, as of your
Covered Expatriate the date you relinquished U.S. citizenship or
expatriation date, continue to be a citizen the date on which you ceased to be a lawful
of, and taxed as a resident of, such other
You are a covered expatriate if you are an permanent U.S. resident.
expatriate to whom any of the following country, and you were a U.S. resident for
applied on your expatriation date. not more than 10 tax years during the Who Must File
15-year period ending with the tax year in
1) Your average annual net income tax for which you expatriated, or Covered expatriates are required to give
the 5-year period ending the year before Form W-8CE to the payer if they had any of
your expatriation date is more than � You relinquished U.S. citizenship beforethe items identified in Boxes 1 through 4 on
$145,000 (for 2009 and 2010). This amount the age of 18 ⁄1 2 and were a U.S. resident the day before their expatriation date. In
is indexed for inflation. For years after 2010, for not more than 10 tax years before your addition, all expatriates must file Form 8854
see the Instructions for Form 8854 for the expatriation date. with the Internal Revenue Service.
adjusted amount. Expatriate. An expatriate is a U.S. citizen Deferred compensation items. Deferred
2) Your net worth is $2 million or more. who relinquished citizenship or a long-term compensation items include any interest in
3) You have not certified under penalties resident who ceased to be a lawful a plan or arrangement described in section
permanent resident. 219(g)(5), any interest in a foreign pension
of perjury that you met all federal tax
For Paperwork Reduction Act Notice, see page 2. Cat. No. 51945M plan or similar retirementForm arrangementW-8CE(11-2009)

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Form W-8CE (11-2009) Page 2

or program, any item of deferred Check Box 4 if you were the beneficiary 60 days of receipt of this form with the
compensation, and any property, or right to of a nongrantor trust on the day before information needed to calculate the value
property, that the individual is entitled toyour expatriation date. Checking this box of his interest in the trust as of the day
receive in connection with the performance provides notice to the trustee that you are before the expatriation date. This
of services to the extent not previously a covered expatriate who, unless the box information includes the following.
taken into account under section 83 or in below this line is checked, is deemed to � A copy of the trust deed document.
accordance with section 83. have waived any right to claim any � A list of assets held by the trust on the
Eligible deferred compensation item reduction in withholding on any distribution day before the expatriation date and
(Box 1). A deferred compensation item is an from this trust under any treaty with the the values of such assets.
eligible deferred compensation item if the United States. � Relevant information about the
following three conditions are met. Election to be treated as receiving interests of the other beneficiaries.
1. The payer is either a U.S. person or a value of interest in the trust. You can � Dates of birth of all persons who
foreign person electing to be treated as a elect to pay tax currently on the value of constitute measuring lives for any
U.S. person under an agreement with the your interest in the trust if you first obtain a distributions.
IRS. (Separate guidance will be issued letter ruling from the IRS stating the value � Policies used by trustees in making
providing procedures to make this election.)of your interest in the trust as of the day
2. You notify the payer of your status as a before your expatriation date. Make the discretionary distributions (if any) that
covered expatriate. election on Form 8854. Attach the may constitute an ascertainable
valuation letter ruling to Form 8854 and file standard.
3. You make an irrevocable waiver on Form 8854 with your Form 1040 or Form � Any other relevant information.
Form 8854 of any right to claim any 1040NR. An election is not valid unless If you do not provide such documents
reduction of withholding on this item under your income tax return is filed by the due and information to the covered expatriate,
any treaty with the United States. date plus extensions. then the election is not valid and you must
Check Box 1 if you have an eligible withhold 30% on any taxable distributions
deferred compensation item. Checking this When To File from the trust.
box provides notice to the payer that you File Form W-8CE on the earlier of (a) the If the covered expatriate makes the
are a covered expatriate who is waiving day before the first distribution on or after election, you must withhold 30% on any
benefits under any treaty with the United the expatriation date or (b) thirty (30) days taxable distribution from the trust until you
States for the eligible deferred after the expatriation date for each receive (a) a copy of the valuation letter
compensation item. specified tax deferred account, item of ruling issued by the IRS and (b) the
Ineligible deferred compensation item deferred compensation, or interest in a covered expatriate’s certification under
(Box 2). A deferred compensation item is an nongrantor trust. penalties of perjury that he has paid any
ineligible deferred compensation item if the tax due on the value of the trust that he is
three conditions listed above are not met. Where To File treated as receiving.
Check Box 2 if you have an ineligible Give Form W-8CE to each payer of the Paperwork Reduction Act Notice. We ask
deferred compensation item. Checking this income described above. Keep a copy for for the information on this form to carry out
box provides notice to the payer that you your own records. the Internal Revenue laws of the United
are a covered expatriate who is to be States. You are required to provide the
treated as receiving an amount equal to Instructions for Payer information. We need it to ensure that you
the present value of your accrued benefit As a result of receiving notification of are complying with these laws and to allow
on the day before your expatriation date. us to figure and collect the right amount of
expatriation on Form W-8CE, you may
Specified tax deferred account (Box 3). have a requirement to withhold tax under tax.
Specified tax deferred accounts include section 877A or to report information to the The time needed to complete and file this
individual retirement plans (as defined in IRS. form will vary depending on individual
section 7701(a)(37)) other than circumstances. The estimated average time
Eligible deferred compensation.
arrangements described in subsection (k) You
or (p) of section 408, qualified tuition must withhold 30% on any taxable is: Recordkeeping, 3 hr., 35 min.; Learning
programs (as defined in section 529), payment to the covered expatriate. about the law or the form, 1 hr., 00 min.;
Preparing and sending the form, 1 hr., 6
Coverdell education savings accounts (as Ineligible deferred compensation. You min.
defined in section 530), health savings must advise the covered expatriate within
accounts (as defined in section 223), and 60 days of receipt of this form of the If you have comments concerning the
Archer MSAs (as defined in section 220). present value of the individual’s accrued accuracy of these time estimates or
Check Box 3 if you have a specified tax benefit in the deferred compensation item suggestions for making this form simpler,
deferred account. Checking this box on the day before the expatriation date. we would be happy to hear from you. You
can email us at *taxforms@irs.gov. (The
provides notice to the payer that you are a Specified tax deferred account. You asterisk must be included in the address.)
covered expatriate who is to be treated as must advise the covered expatriate within Enter “Forms Comment” on the subject
receiving a distribution of your entire 60 days of receipt of this form of the line. Or you can write to Internal Revenue
interest in the account on the day before individual’s entire interest in the account Service, Tax Products Coordinating
your expatriation date. on the day before the expatriation date. Committee, SE:W:CAR:MP:T:T:SP, 1111
Nongrantor trust (Box 4). A nongrantor Nongrantor trust. If the covered expatriate Constitution Ave. NW, IR-6526,
trust is the portion of any trust (U.S. or elects to be treated as receiving the value Washington, DC 20224. Do not send Form
foreign) that you are not considered of his interest in the nongrantor trust on W-8CE to this address. Instead, give it to
(immediately before your expatriation date) the day before his expatriation date, you the payer.
to own under the grantor trust rules (see must provide the covered expatriate within
sections 671 through 679). The withholding
rules of section 877A apply to a nongrantor
trust only if you were a beneficiary on the
day before your expatriation date.

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