Certificate of Foreign Person's Claim That Income Is 
Form  W-8ECI                    Effectively Connected With the Conduct of a Trade or 
(Rev. July 2017)                                  Business in the United States                                                                       OMB No. 1545-1621
                                           ▶ Section references are to the Internal Revenue Code.  
Department of the Treasury        ▶Go to www.irs.gov/FormW8ECI for instructions and the latest information.   
Internal Revenue Service          ▶ Give this form to the withholding agent or payer. Do not send to the IRS. 
Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively  
connected with a U.S. trade or business. See instructions. 
Do not use this form for:                                                                                                                             Instead, use Form: 
•  A beneficial owner solely claiming foreign status or treaty benefits  .        . . . .     . .           . . . . . . .      . . .                W-8BEN or W-8BEN-E 
•  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 the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b)                        . . . .     W-8EXP 
Note: These entities should use Form W-8ECI if they received effectively connected income and are not eligible to claim an exemption for chapter 3 
or 4 purposes on Form W-8EXP. 
•  A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively connected with the 
conduct of a trade or business in the United States)  .          . .          . . . . . .     . .           . . . . . . .      . . .                W-8BEN-E or W-8IMY 
•  A person acting as an intermediary .  .   . .  .            . . .          . . . . . .     . .           . . . . . . .      . . .                . . . .     W-8IMY 
Note: See instructions for additional exceptions. 
Part I           Identification of Beneficial Owner (see instructions) 
1     Name of individual or organization that is the beneficial owner                                             2 Country of incorporation or organization 

3     Name of disregarded entity receiving the payments (if applicable)

4     Type of entity (check the appropriate box):                                             Individual                           Corporation 
           Partnership                     Simple trust                                       Complex trust                        Estate 
           Government                      Grantor trust                                      Central bank of issue                Tax-exempt organization 
           Private foundation              International organization 
5     Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

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

6     Business address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. 

      City or town, state, and ZIP code 

7     U.S. taxpayer identification number (required—see instructions)                                       8 Foreign tax identifying number
           SSN or ITIN      EIN 
9     Reference number(s) (see instructions)                                  10 Date of birth (MM-DD-YYYY) 

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

Part II          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: 
                 •  I am the beneficial owner (or I am authorized to sign for the beneficial owner) of all the payments to which this form relates, 
                 •  The amounts for which this certification is provided are effectively connected with the conduct of a trade or business in the United States,
                 •  The income for which this form was provided is includible in my gross income (or the beneficial owner’s gross income) for the taxable year, and 
                 •  The beneficial owner is not a U.S. person. 
Sign             Furthermore,  I  authorize  this  form  to  be  provided  to  any  withholding  agent  that  has  control,  receipt,  or  custody  of  the  payments  of  which  I  am  the 
Here             beneficial owner or any withholding agent that can disburse or make payments of the amounts of which I am the beneficial owner.  
                 I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

                  Signature of beneficial owner (or individual authorized to sign for the beneficial owner)         Print name                        Date (MM-DD-YYYY)
                  I certify that I have the capacity to sign for the person identified on line 1 of this form.
For Paperwork Reduction Act Notice, see separate instructions.                                Cat. No. 25045D                      Form  W-8ECI  (Rev. 7-2017)