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Form W-8BEN-E                               Certificate of Status of Beneficial Owner for  
(Rev. October 2021)               United States Tax Withholding and Reporting (Entities)                                              OMB No. 1545-1621
                            ▶ For use by entities. Individuals must use Form W-8BEN.  ▶Section references are to the Internal Revenue Code.
                                       
Department of the Treasury             ▶ Go to www.irs.gov/FormW8BENE for instructions      and the latest information.           
Internal Revenue Service                 ▶ Give this form to the withholding agent or payer. Do not send to the IRS.
Do NOT use this form for:                                                                                                               Instead use Form: 
• U.S. entity or U.S. citizen or resident . .  .   . . .       .    . . .       . . .  . .     . .  .     . .    .   .  .   . .    .  . .                               . . . .  W-9
• A foreign individual   .  . .   . .    .  .  .   . . .       .    . . .       . . .  . .     . .  .     . .    .   .  .   W-8BEN (Individual) or Form 8233
• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the United States                      
(unless claiming treaty benefits) . .    .  .  .   . . .       .    . . .       . . .  . .     . .  .     . .    .   .  .   . .    .  . .                               . . .  W-8ECI
• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions)  .                          .  W-8IMY
• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or 
government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming the applicability of section(s) 115(2), 
501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions for other exceptions)  .   .    .   .  .   . .    .  .  W-8ECI or W-8EXP
• Any person acting as an intermediary (including a qualified intermediary acting as a qualified derivatives dealer)  .     . .    .  . .                               . . .  W-8IMY
Part I        Identification of Beneficial Owner 
1      Name of organization that is the beneficial owner                                            2   Country of incorporation or organization 

3      Name of disregarded entity receiving the payment (if applicable, see instructions)

4      Chapter 3 Status (entity type) (Must check one box only):                Corporation                          Partnership
           Simple trust                     Tax-exempt organization             Complex trust                        Foreign Government - Controlled Entity
           Central Bank of Issue            Private foundation                  Estate                               Foreign Government - Integral Part
           Grantor trust                    Disregarded entity                  International organization
       If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty claim? If “Yes,” complete Part III.   Yes No
5      Chapter 4 Status (FATCA status) (See instructions for details and complete the  certification below for the entity's applicable status.)
           Nonparticipating FFI (including an FFI related to a Reporting IGA           Nonreporting IGA FFI. Complete Part XII.
           FFI other than a deemed-compliant FFI, participating FFI, or                Foreign government, government of a U.S. possession, or foreign 
           exempt beneficial owner).                                                   central bank of issue. Complete Part XIII.  
           Participating FFI.                                                          International organization. Complete Part XIV.
           Reporting Model 1 FFI.                                                      Exempt retirement plans. Complete Part XV.
           Reporting Model 2 FFI.                                                      Entity wholly owned by exempt beneficial owners. Complete Part XVI.
           Registered deemed-compliant FFI (other than a reporting Model 1             Territory financial institution. Complete Part XVII.
           FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII).           Excepted nonfinancial group entity. Complete Part XVIII.
           See instructions.                                                           Excepted nonfinancial start-up company. Complete Part XIX.
           Sponsored FFI. Complete Part IV.                                            Excepted nonfinancial entity in liquidation or bankruptcy. 
           Certified deemed-compliant nonregistering local bank. Complete              Complete Part XX.
           Part V.                                                                     501(c) organization. Complete Part XXI.
           Certified deemed-compliant FFI with only low-value accounts.                Nonprofit organization. Complete Part XXII.
           Complete Part VI.                                                           Publicly traded NFFE or NFFE affiliate of a publicly traded 
           Certified deemed-compliant sponsored, closely held investment               corporation. Complete Part XXIII.
           vehicle. Complete Part VII.                                                 Excepted territory NFFE. Complete Part XXIV.
           Certified deemed-compliant limited life debt investment entity.             Active NFFE. Complete Part XXV.
           Complete Part VIII.                                                         Passive NFFE. Complete Part XXVI.
           Certain investment entities that do not maintain financial accounts.        Excepted inter-affiliate FFI. Complete Part XXVII.
           Complete Part IX.                                                           Direct reporting NFFE. 
           Owner-documented FFI. Complete Part X.                                      Sponsored direct reporting NFFE. Complete Part XXVIII. 
           Restricted distributor. Complete Part XI.                                   Account that is not a financial account.
6      Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address).

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

7      Mailing address (if different from above) 

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

For Paperwork Reduction Act Notice, see separate instructions.                         Cat. No. 59689N                        Form W-8BEN-E (Rev. 10-2021) 



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Form W-8BEN-E (Rev. 10-2021)                                                                                                                    Page 2 
Part I              Identification of Beneficial Owner (continued)
8     U.S. taxpayer identification number (TIN), if required

9a    GIIN                                   b   Foreign TIN                        c       Check if FTIN not legally required. . .       . . . ▶

10    Reference number(s) (see instructions) 

Note: Please complete remainder of the form including signing the form in Part XXX. 

Part II             Disregarded Entity or Branch Receiving Payment. (Complete only if a disregarded entity with a GIIN or a 
                    branch of an FFI in a country other than the FFI’s country of residence. See instructions.)
11    Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment 
         Branch treated as nonparticipating FFI.            Reporting Model 1 FFI.                                U.S. Branch.
         Participating FFI.                                 Reporting Model 2 FFI.
12     Address of disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a 
      registered address). 

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

             Country

13    GIIN (if any)

Part III            Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only.)
14    I certify that (check all that apply):
a        The beneficial owner is a resident of                                                        within the meaning of the income tax   
         treaty between the United States and that country. 
b        The  beneficial  owner  derives  the  item  (or  items)  of  income  for  which  the  treaty  benefits  are  claimed,  and,  if  applicable,  meets  the 
         requirements of the treaty provision dealing with limitation on benefits. The following are types of limitation on benefits provisions that may 
         be included in an applicable tax treaty (check only one; see instructions):
         Government                                         Company that meets the ownership and base erosion test
         Tax-exempt pension trust or pension fund           Company that meets the derivative benefits test
         Other tax-exempt organization                      Company with an item of income that meets active trade or business test
         Publicly traded corporation                        Favorable discretionary determination by the U.S. competent authority received
         Subsidiary of a publicly traded corporation        No LOB article in treaty
                                                            Other (specify Article and paragraph): 
c        The beneficial owner is claiming treaty benefits for U.S. source dividends received from a foreign corporation or interest from a U.S. trade 
         or business of a foreign corporation and meets qualified resident status (see instructions). 
15    Special rates and conditions (if applicable—see instructions): 
      The beneficial owner is claiming the provisions of Article and paragraph
      of the treaty identified on line 14a above to claim a              % rate of withholding on (specify type of income): 
      Explain the additional conditions in the Article the beneficial owner meets to be eligible for the rate of withholding: 

Part IV             Sponsored FFI 
16    Name of sponsoring entity:
17    Check whichever box applies.
         I certify that the entity identified in Part I: 
      • Is an investment entity; 
      • Is not a QI, WP (except to the extent permitted in the withholding foreign partnership agreement), or WT; and 
      • Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity. 
         I certify that the entity identified in Part I: 
      • Is a controlled foreign corporation as defined in section 957(a);
      • Is not a QI, WP, or WT;  
      • Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this entity; and 
      • Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all 
      account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not limited 
      to, customer identification information, customer documentation, account balance, and all payments made to account holders or payees.
                                                                                                                  Form W-8BEN-E (Rev. 10-2021) 



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Form W-8BEN-E (Rev. 10-2021)                                                                                                                      Page 3 
Part V    Certified Deemed-Compliant Nonregistering Local Bank 
18        I certify that the FFI identified in Part I:
      • Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country of 
      incorporation or organization; 
      • Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to such 
      bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than 5% 
      interest in such credit union or cooperative credit organization;
      • Does not solicit account holders outside its country of organization;
      • Has no fixed place of business outside such country (for this purpose, a fixed place of business does not include a location that is not 
      advertised to the public and from which the FFI performs solely administrative support functions);
      • Has no more than $175 million in assets on its balance sheet and, if it is a member of an expanded affiliated group, the group has no more 
      than $500 million in total assets on its consolidated or combined balance sheets; and
      • Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institution that 
      is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements set forth in this part. 
Part VI   Certified Deemed-Compliant FFI with Only Low-Value Accounts 
19        I certify that the FFI identified in Part I:
      •  Is  not  engaged  primarily  in  the  business  of  investing,  reinvesting,  or  trading  in  securities,  partnership  interests,  commodities,  notional 
      principal  contracts,  insurance  or  annuity  contracts,  or  any  interest  (including  a  futures  or  forward  contract  or  option)  in  such  security, 
      partnership interest, commodity, notional principal contract, insurance contract or annuity contract; 
      • No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of 
      $50,000 (as determined after applying applicable account aggregation rules); and
      •  Neither  the  FFI  nor  the  entire  expanded  affiliated  group,  if  any,  of  the  FFI,  have  more  than  $50  million  in  assets  on  its  consolidated  or 
      combined balance sheet as of the end of its most recent accounting year.
Part VII  Certified Deemed-Compliant Sponsored, Closely Held Investment Vehicle
20    Name of sponsoring entity:
21        I certify that the entity identified in Part I:
      • Is an FFI solely because it is an investment entity described in Regulations section 1.1471-5(e)(4); 
      • Is not a  QI, WP, or WT; 
      • Will have all of its due diligence, withholding, and reporting responsibilities (determined as if the FFI were a participating FFI) fulfilled by the 
      sponsoring entity identified on line 20; and
      • 20 or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial institutions, 
      participating  FFIs,  registered  deemed-compliant  FFIs,  and  certified  deemed-compliant  FFIs  and  equity  interests  owned  by  an  entity  if  that 
      entity owns 100% of the equity interests in the FFI and is itself a sponsored FFI). 
Part VIII Certified Deemed-Compliant Limited Life Debt Investment Entity
22        I certify that the entity identified in Part I:
      • Was in existence as of January 17, 2013;
      • Issued all classes of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and
      • Is certified deemed-compliant because it satisfies the requirements to be treated as a limited life debt investment entity (such as the 
      restrictions with respect to its assets and other requirements under Regulations section 1.1471-5(f)(2)(iv)). 
Part IX   Certain Investment Entities that Do Not Maintain Financial Accounts
23        I certify that the entity identified in Part I:
      • Is a financial institution solely because it is an investment entity described in Regulations section 1.1471-5(e)(4)(i)(A), and
      • Does not maintain financial accounts.
Part X    Owner-Documented FFI 
Note: This status only applies if the U.S. financial institution, participating FFI, or reporting Model 1 FFI to which this form is given has agreed that it will 
treat the FFI as an owner-documented FFI (see instructions for eligibility requirements). In addition, the FFI must make the certifications below.
24a       (All owner-documented FFIs check here) I certify that the FFI identified in Part I:  
      • Does not act as an intermediary;
      • Does not accept deposits in the ordinary course of a banking or similar business;
      • Does not hold, as a substantial portion of its business, financial assets for the account of others; 
      • Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to 
      a financial account;
      •  Is  not  owned  by  or  in  an  expanded  affiliated  group  with  an  entity  that  accepts  deposits  in  the  ordinary  course  of  a  banking  or  similar 
      business, holds, as a substantial portion of its business, financial assets for the account of others, or is an insurance company (or the holding 
      company of an insurance company) that issues or is obligated to make payments with respect to a financial account; 
      • Does not maintain a financial account for any nonparticipating FFI; and
      •  Does  not  have  any  specified  U.S.  persons  that  own  an  equity  interest  or  debt  interest  (other  than  a  debt  interest  that  is  not  a  financial 
      account or that has a balance or value not exceeding $50,000) in the FFI other than those identified on the FFI owner reporting statement.
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Form W-8BEN-E (Rev. 10-2021)                                                                                                                         Page 4 
Part X        Owner-Documented FFI (continued)
Check box 24b or 24c, whichever applies.
b       I certify that the FFI identified in Part I:
    • Has provided, or will provide, an FFI owner reporting statement that contains:
        (i)   The name, address, TIN (if any), chapter 4 status, and type of documentation provided (if required) of every individual and specified 
              U.S. person that owns a direct or indirect equity interest in the owner-documented FFI (looking through all entities other than specified 
              U.S. persons); 
        (ii)  The name, address, TIN (if any), and chapter 4 status of every individual and specified U.S. person that owns a debt interest in the 
              owner-documented FFI (including any indirect debt interest, which includes debt interests in any entity that directly or indirectly owns 
              the payee or any direct or indirect equity interest in a debt holder of the payee) that constitutes a financial account in excess of 
              $50,000 (disregarding all such debt interests owned by participating FFIs, registered deemed-compliant FFIs, certified deemed-
              compliant FFIs, excepted NFFEs, exempt beneficial owners, or U.S. persons other than specified U.S. persons); and 
        (iii) Any additional information the withholding agent requests in order to fulfill its obligations with respect to the entity. 
    •  Has  provided,  or  will  provide,  valid  documentation  meeting  the  requirements  of  Regulations  section  1.1471-3(d)(6)(iii)  for  each  person 
    identified in the FFI owner reporting statement.
c       I certify that the FFI identified in Part I has provided, or will provide, an auditor's letter, signed within 4 years of the date of payment,
        from an independent accounting firm or legal representative with a location in the United States stating that the firm or representative has 
        reviewed the FFI’s documentation with respect to all of its owners and debt holders identified in Regulations section 1.1471-3(d)(6)(iv)(A)(2), 
        and that the FFI meets all the requirements to be an owner-documented FFI. The FFI identified in Part I has also provided, or will provide, 
        an FFI owner reporting statement of its owners that are specified U.S. persons and  Form(s) W-9, with applicable waivers.

Check box 24d if applicable (optional, see instructions).
d       I certify that the entity identified on line 1 is a trust that does not have any contingent beneficiaries or designated classes with unidentified 
        beneficiaries.
Part XI       Restricted Distributor 
25a     (All restricted distributors check here) I certify that the entity identified in Part I:
    • Operates as a distributor with respect to debt or equity interests of the restricted fund with respect to which this form is furnished;
    • Provides investment services to at least 30 customers unrelated to each other and less than half of its customers are related to each other; 
    • Is required to perform AML due diligence procedures under the anti-money laundering laws of its country of organization (which is an FATF-
    compliant jurisdiction);
    • Operates solely in its country of incorporation or organization, has no fixed place of business outside of that country, and has the same 
    country of incorporation or organization as all members of its affiliated group, if any;
    • Does not solicit customers outside its country of incorporation or organization;
    • Has no more than $175 million in total assets under management and no more than $7 million in gross revenue on its income statement for 
    the most recent accounting year;
    • Is not a member of an expanded affiliated group that has more than $500 million in total assets under management or more than $20 million 
    in gross revenue for its most recent accounting year on a combined or consolidated income statement; and
    • Does not distribute any debt or securities of the restricted fund to specified U.S. persons, passive NFFEs with one or more substantial U.S. 
    owners, or nonparticipating FFIs.
Check box 25b or 25c, whichever applies.
I further certify that with respect to all sales of debt or equity interests in the restricted fund with respect to which this form is furnished that are made 
after December 31, 2011, the entity identified in Part I:
b       Has been bound by a distribution agreement that contained a general prohibition on the sale of debt or securities to U.S. entities and U.S. 
        resident individuals and is currently bound by a distribution agreement that contains a prohibition of the sale of debt or securities to any 
        specified U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.
c       Is currently bound by a distribution agreement that contains a prohibition on the sale of debt or securities to any specified U.S. person, 
        passive  NFFE  with  one  or  more  substantial  U.S.  owners,  or  nonparticipating  FFI  and,  for  all  sales  made  prior  to  the  time  that  such  a 
        restriction was included in its distribution agreement, has reviewed all accounts related to such sales in accordance with the procedures 
        identified in Regulations section 1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any, or caused the restricted 
        fund to transfer the securities to a distributor that is a participating FFI or reporting Model 1 FFI securities which were sold to specified U.S. 
        persons, passive NFFEs with one or more substantial U.S. owners, or nonparticipating FFIs.

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Form W-8BEN-E (Rev. 10-2021)                                                                                                                                   Page 5 
Part XII       Nonreporting IGA FFI
26    I certify that the entity identified in Part I: 
    • Meets the requirements to be considered a nonreporting financial institution pursuant to an applicable IGA between the United States and 
                                                                               .  The applicable IGA is a  Model 1 IGA or a Model 2 IGA; and
    is treated as a                                                            under the provisions of the applicable IGA or Treasury regulations 
    (if applicable, see instructions); 
    • If you are a trustee documented trust or a sponsored entity, provide the name of the trustee or sponsor                                                       .
    The trustee is: U.S.     Foreign

Part XIII      Foreign Government, Government of a U.S. Possession, or Foreign Central Bank of Issue 
27    I certify that the entity identified in Part I is the beneficial owner of the payment, and is not engaged in commercial financial activities of a 
      type  engaged  in  by  an  insurance  company,  custodial  institution,  or  depository  institution  with  respect  to  the  payments,  accounts,  or 
      obligations for which this form is submitted (except as permitted in Regulations section 1.1471-6(h)(2)). 
Part XIV       International Organization
Check box 28a or 28b, whichever applies.
28a   I certify that the entity identified in Part I is an international organization described in section 7701(a)(18).
b        I certify that the entity identified in Part I:
    • Is comprised primarily of foreign governments; 
    • Is recognized as an intergovernmental or supranational organization under a foreign law similar to the International Organizations Immunities 
    Act or that has in effect a headquarters agreement with a foreign government;  
    • The benefit of the entity’s income does not inure to any private person; and
    • Is the beneficial owner of the payment and is not engaged in commercial financial activities of a type engaged in by an insurance company, 
    custodial institution, or depository institution with respect to the payments, accounts, or obligations for which this form is submitted (except as 
    permitted in Regulations section 1.1471-6(h)(2)).  
Part XV        Exempt Retirement Plans
Check box 29a, b, c, d, e, or f, whichever applies.
29a   I certify that the entity identified in Part I:
    • Is established in a country with which the United States has an income tax treaty in force (see Part III if claiming treaty benefits); 
    • Is operated principally to administer or provide pension or retirement benefits; and 
    • Is entitled to treaty benefits on income that the fund derives from U.S. sources (or would be entitled to benefits if it derived any such income) 
    as a resident of the other country which satisfies any applicable limitation on benefits requirement.  
b     I certify that the entity identified in Part I:
    •  Is  organized  for  the  provision  of  retirement,  disability,  or  death  benefits  (or  any  combination  thereof)  to  beneficiaries  that  are  former 
    employees of one or more employers in consideration for services rendered; 
    • No single beneficiary has a right to more than 5% of the FFI’s assets; 
    • Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the 
    country in which the fund is established or operated; and  
         (i)   Is generally exempt from tax on investment income under the laws of the country in which it is established or operates due to its status 
               as a retirement or pension plan; 
         (ii)  Receives at least 50% of its total contributions from sponsoring employers (disregarding transfers of assets from other plans described 
               in this part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, other retirement funds described in 
               an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A)); 
         (iii) Either does not permit or penalizes distributions or withdrawals made before the occurrence of specified events related to retirement, 
               disability, or death (except rollover distributions to accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to retirement 
               and pension accounts), to retirement and pension accounts described in an applicable Model 1 or Model 2 IGA, or to other retirement 
               funds described in this part or in an applicable Model 1 or Model 2 IGA); or 
         (iv)  Limits contributions by employees to the fund by reference to earned income of the employee or may not exceed $50,000 annually. 
c     I certify that the entity identified in Part I:
    •  Is  organized  for  the  provision  of  retirement,  disability,  or  death  benefits  (or  any  combination  thereof)  to  beneficiaries  that  are  former 
    employees of one or more employers in consideration for services rendered; 
    • Has fewer than 50 participants;
    • Is sponsored by one or more employers each of which is not an investment entity or passive NFFE;
    • Employee and employer contributions to the fund (disregarding transfers of assets from other plans described in this part, retirement and 
    pension accounts described in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A)) are 
    limited by reference to earned income and compensation of the employee, respectively;  
    •  Participants that are not residents of the country in which the fund is established or operated are not entitled to more than 20% of the fund’s assets; and 
    • Is subject to government regulation and provides annual information reporting about its beneficiaries to the relevant tax authorities in the 
    country in which the fund is established or operates. 
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Form W-8BEN-E (Rev. 10-2021)                                                                                                               Page 6 
Part XV    Exempt Retirement Plans (continued)
d  I certify that the entity identified in Part I is formed pursuant to a pension plan that would meet the requirements of section 401(a), other 
   than the requirement that the plan be funded by a trust created or organized in the United States. 
e  I certify that the entity identified in Part I is established exclusively to earn income for the benefit of one or more retirement funds
   described in this part or in an applicable Model 1 or Model 2 IGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A) (referring to 
   retirement and pension accounts), or retirement and pension accounts described in an applicable Model 1 or Model 2 IGA.
f  I certify that the entity identified in Part I:
   • Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession 
   (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide 
   retirement,  disability,  or  death  benefits  to  beneficiaries  or  participants  that  are  current  or  former  employees  of  the  sponsor  (or  persons 
   designated by such employees); or 
   • Is established and sponsored by a foreign government, international organization, central bank of issue, or government of a U.S. possession 
   (each as defined in Regulations section 1.1471-6) or an exempt beneficial owner described in an applicable Model 1 or Model 2 IGA to provide 
   retirement, disability, or death benefits to beneficiaries or participants that are not current or former employees of such sponsor, but are in 
   consideration of personal services performed for the sponsor. 
Part XVI   Entity Wholly Owned by Exempt Beneficial Owners 
30        I certify that the entity identified in Part I:  
   • Is an FFI solely because it is an investment entity; 
   • Each direct holder of an equity interest in the investment entity is an exempt beneficial owner described in Regulations section 1.1471-6 or in 
   an applicable Model 1 or Model 2 IGA; 
   • Each direct holder of a debt interest in the investment entity is either a depository institution (with respect to a loan made to such entity) or an 
   exempt beneficial owner described in Regulations section 1.1471-6 or an applicable Model 1 or Model 2 IGA.  
   • Has provided an owner reporting statement that contains the name, address, TIN (if any), chapter 4 status, and a description of the type of 
   documentation provided to the withholding agent for every person that owns a debt interest constituting a financial account or direct equity 
   interest in the entity; and 
   • Has provided documentation establishing that every owner of the entity is an entity described in Regulations section 1.1471-6(b), (c), (d), (e), 
   (f) and/or (g) without regard to whether such owners are beneficial owners. 
Part XVII  Territory Financial Institution 
31        I certify that the entity identified in Part I is a financial institution (other than an investment entity) that is incorporated or organized under
        the laws of a possession of the United States.  
Part XVIII Excepted Nonfinancial Group Entity
32        I certify that the entity identified in Part I:
   • Is a holding company, treasury center, or captive finance company and substantially all of the entity’s activities are functions described in 
   Regulations section 1.1471-5(e)(5)(i)(C) through (E);
   • Is a member of a nonfinancial group described in Regulations section 1.1471-5(e)(5)(i)(B);
   • Is not a depository or custodial institution (other than for members of the entity’s expanded affiliated group); and  
   • Does not function (or hold itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund, or any 
   investment vehicle with an investment strategy to acquire or fund companies and then hold interests in those companies as capital assets for 
   investment purposes.  
Part XIX   Excepted Nonfinancial Start-Up Company 
33        I certify that the entity identified in Part I:
   • Was formed on (or, in the case of a new line of business, the date of board resolution approving the new line of business)
   (date must be less than 24 months prior to date of payment); 
   • Is not yet operating a business and has no prior operating history or is investing capital in assets with the intent to operate a new line of 
   business other than that of a financial institution or passive NFFE; 
   • Is investing capital into assets with the intent to operate a business other than that of a financial institution; and 
   •  Does  not  function  (or  hold  itself  out)  as  an  investment  fund,  such  as  a  private  equity  fund,  venture  capital  fund,  leveraged  buyout  fund,  or  any 
   investment vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes. 
Part XX    Excepted Nonfinancial Entity in Liquidation or Bankruptcy 
34        I certify that the entity identified in Part I:
   • Filed a plan of liquidation, filed a plan of reorganization, or filed for bankruptcy on                                                                 ;
   • During the past 5 years has not been engaged in business as a financial institution or acted as a passive NFFE; 
   • Is either liquidating or emerging from a reorganization or bankruptcy with the intent to continue or recommence operations as a nonfinancial 
   entity; and 
   • Has, or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in 
   bankruptcy or liquidation for more than 3 years. 
                                                                                                                        Form W-8BEN-E (Rev. 10-2021) 



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Form W-8BEN-E (Rev. 10-2021)                                                                                                                       Page 7 
Part XXI    501(c) Organization
35       I certify that the entity identified in Part I is a 501(c) organization that:
    • Has been issued a determination letter from the IRS that is currently in effect concluding that the payee is a section 501(c) organization that is 
    dated                    ; or
    • Has provided a copy of an opinion from U.S. counsel certifying that the payee is a section 501(c) organization (without regard to whether the 
    payee is a foreign private foundation). 

Part XXII   Nonprofit Organization 
36       I certify that the entity identified in Part I is a nonprofit organization that meets the following requirements. 
    • The entity is established and maintained in its country of residence exclusively for religious, charitable, scientific, artistic, cultural or educational purposes; 
    • The entity is exempt from income tax in its country of residence; 
    • The entity has no shareholders or members who have a proprietary or beneficial interest in its income or assets; 
    • Neither the applicable laws of the entity’s country of residence nor the entity’s formation documents permit any income or assets of the entity 
    to be distributed to, or applied for the benefit of, a private person or noncharitable entity other than pursuant to the conduct of the entity’s 
    charitable activities or as payment of reasonable compensation for services rendered or payment representing the fair market value of property 
    which the entity has purchased; and 
    • The applicable laws of the entity’s country of residence or the entity’s formation documents require that, upon the entity’s liquidation or 
    dissolution, all of its assets be distributed to an entity that is a foreign government, an integral part of a foreign government, a controlled entity 
    of  a  foreign  government,  or  another  organization  that  is  described  in  this  part  or  escheats  to  the  government  of  the  entity’s  country  of 
    residence or any political subdivision thereof. 

Part XXIII  Publicly Traded NFFE or NFFE Affiliate of a Publicly Traded Corporation 
Check box 37a or 37b, whichever applies.
37a      I certify that:
    • The entity identified in Part I is a foreign corporation that is not a financial institution; and 
    • The stock of such corporation is regularly traded on one or more established securities markets, including 
    (name one securities exchange upon which the stock is regularly traded). 
b        I certify that:
    • The entity identified in Part I is a foreign corporation that is not a financial institution; 
    • The entity identified in Part I is a member of the same expanded affiliated group as an entity the stock of which is regularly traded on an 
    established securities market; 
    • The name of the entity, the stock of which is regularly traded on an established securities market, is                                       ; and
    • The name of the securities market on which the stock is regularly traded is                                                                              .

Part XXIV   Excepted Territory NFFE 
38       I certify that:
    • The entity identified in Part I is an entity that is organized in a possession of the United States; 
    • The entity identified in Part I:
      (i)   Does not accept deposits in the ordinary course of a banking or similar business;
      (ii)  Does not hold, as a substantial portion of its business, financial assets for the account of others; or
      (iii) Is not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with 
            respect to a financial account; and
    • All of the owners of the entity identified in Part I are bona fide residents of the possession in which the NFFE is organized or incorporated. 

Part XXV    Active NFFE 
39       I certify that:
    • The entity identified in Part I is a foreign entity that is not a financial institution;  
    • Less than 50% of such entity’s gross income for the preceding calendar year is passive income; and 
    • Less than 50% of the assets held by such entity are assets that produce or are held for the production of passive income (calculated as a 
    weighted average of the percentage of passive assets measured quarterly) (see instructions for the definition of passive income). 

Part XXVI   Passive NFFE 
40a      I certify that the entity identified in Part I is a foreign entity that is not a financial institution (other than an investment entity organized in a
      possession of the United States) and is not certifying its status as a publicly traded NFFE (or affiliate), excepted territory NFFE, active 
      NFFE, direct reporting NFFE, or sponsored direct reporting NFFE.
Check box 40b or 40c, whichever applies.
b        I further certify that the entity identified in Part I has no substantial U.S. owners (or, if applicable, no controlling U.S. persons); or
c        I further certify that the entity identified in Part I has provided the name, address, and TIN of each substantial U.S. owner (or, if applicable,
      controlling U.S. person) of the NFFE in Part XXIX.
                                                                                                                           Form W-8BEN-E (Rev. 10-2021) 



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Form W-8BEN-E (Rev. 10-2021)                                                                                                                                   Page 8 
Part XXVII   Excepted Inter-Affiliate FFI 
41   I certify that the entity identified in Part I: 
   • Is a member of an expanded affiliated group; 
   • Does not maintain financial accounts (other than accounts maintained for members of its expanded affiliated group);
   • Does not make withholdable payments to any person other than to members of its expanded affiliated group;
   • Does not hold an account (other than depository accounts in the country in which the entity is operating to pay for expenses) with or receive 
   payments from any withholding agent other than a member of its expanded affiliated group; and
   • Has not agreed to report under Regulations section 1.1471-4(d)(2)(ii)(C) or otherwise act as an agent for chapter 4 purposes on behalf of any financial 
   institution, including a member of its expanded affiliated group.
Part XXVIII  Sponsored Direct Reporting NFFE (see instructions for when this is permitted) 
42 Name of sponsoring entity: 
43   I certify that the entity identified in Part I is a direct reporting NFFE that is sponsored by the entity identified on line 42.
Part XXIX    Substantial U.S. Owners of Passive NFFE
As required by Part XXVI, provide the name, address, and TIN of each substantial U.S. owner of the NFFE. Please see the instructions for a definition of 
substantial U.S. owner. If providing the form to an FFI treated as a reporting Model 1 FFI or reporting Model 2 FFI, an NFFE may also use this part for 
reporting its controlling U.S. persons under an applicable IGA.
             Name                                                                  Address                                                  TIN

Part XXX     Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further 
certify under penalties of perjury that: 
   • The entity identified on line 1 of this form is the beneficial owner of all the income or proceeds to which this form relates, is using this form to certify its status for 
   chapter 4 purposes, or is submitting this form for purposes of section 6050W or 6050Y;
   • The entity identified on line 1 of this form is not a U.S. person;
   • This form relates to: (a) income not effectively connected with the conduct of a trade or business in the United States, (b) income effectively connected with the 
   conduct of a trade or business in the United States but is not subject to tax under an income tax treaty, (c) the partner’s share of a partnership’s effectively 
   connected taxable income, or (d) the partner’s amount realized from the transfer of a partnership interest subject to withholding under section 1446(f); and
   • For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which the entity on line 1 is the beneficial 
owner or any withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner. 
I agree that I will submit a new form within 30 days if any certification on this form becomes incorrect.
I certify that I have the capacity to sign for the entity identified on line 1 of this form.  
            ▲
Sign Here 
                   Signature of individual authorized to sign for beneficial owner                       Print Name                         Date (MM-DD-YYYY) 

                                                                                                                                       Form W-8BEN-E (Rev. 10-2021) 






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