Countries and Languages
| Countries | Languages |
|---|---|
| USA | English |
Extracted Fields
Asterisk (*) indicates a required field or field group. Values cannot be empty.
Form Information
| Field | Description |
|---|---|
| Form | Fixed string W-8BEN, if applicable. |
Individual Information
| Field | Description |
|---|---|
| Name* | The name of the individual. |
| Citizenship | The country of citizenship. |
| Date of Birth | The individual’s date of birth. |
Address Information
Permanent Residence Address
| Field | Description |
|---|---|
| Address | The permanent residence address of the individual. |
| City and State or Province | The permanent residence address of the individual. |
| Country | The permanent residence address of the individual. |
Mailing Address
| Field | Description |
|---|---|
| Address | The address to which correspondence should be sent. |
| City and State or Province | The address to which correspondence should be sent. |
| Country | The address to which correspondence should be sent. |
Tax Identification
| Field | Description |
|---|---|
| SSN or ITIN | The individual’s Social Security Number (SSN) or Individual Taxpayer Identification Number (TIN). |
| Foreign Tax ID | The foreign Tax Identifying Number (Foreign TIN). |
| FTIN Not Legally Required | Specifies that FTIN is not legally required. |
| Reference Number | Any useful referencing information. |
Tax Treaty Information
| Field | Description |
|---|---|
| Resident of | The country where the beneficial owner is resident for income tax treaty purposes. |
Special Rates and Conditions
| Field | Description |
|---|---|
| Article and Paragraph | Special rates and conditions for individuals who are claiming treaty benefits. |
| Rate | Special rates and conditions for individuals who are claiming treaty benefits. |
| Income | Special rates and conditions for individuals who are claiming treaty benefits. |
| Additional Conditions | Special rates and conditions for individuals who are claiming treaty benefits. |
Certification
| Field | Description |
|---|---|
| Capacity to Sign | Specifies that an authorized representative or agent have the capacity to sign for the person identified on the Name of Individual field. |
| Date | The date of signing. |
| Printed Name | The printed name of the individual. |
Key Fields
- Name
- Date
