W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (PDF), opens a new window

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Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (Rev. October 2021) OMB No. 1545-1621 ▶ For use by individuals. Entities must use Form W-8BEN-E. Go to www.irs.gov/FormW8BEN for instructions and the latest information. ▶ Give this form to the withholding agent or payer. Do not send to the IRS. ▶ Department of the Treasury Internal Revenue Service Do NOT use this form if: • You are NOT an individual Instead, use Form: . . . . . . . . . . . . . . . . • You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . W-8BEN-E . . . . . . . . . . . . . . . . . . • You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the United States (other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . • You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-9 . W-8ECI 8233 or W-4 . . W-8IMY Note: If you are resident in a FATCA partner jurisdiction (that is, a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence. Part I Identification of Beneficial Owner (see instructions) 1 Name of individual who is the beneficial owner 2 3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address. Country of citizenship City or town, state or province. Include postal code where appropriate. 4 Country Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country 5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6a Foreign tax identifying number (see instructions) 6b Check if FTIN not legally required . 7 Reference number(s) (see instructions) 8 Part II 9 10 . . . . . . . . . . Date of birth (MM-DD-YYYY) (see instructions) Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country.