Countries and Languages
| Countries | Languages |
|---|---|
| USA | English |
| French | |
| German | |
| German (New Spelling) |
Extracted Fields
Asterisk (*) indicates a required field or field group. Values cannot be empty.
Basic Information
| Field | Description |
|---|---|
| Form | Fixed string W-8BEN-E, if applicable. |
| Box 1 - Name of Beneficial Owner* | The name of the organization that is the beneficial owner. |
| Box 2 - Country of Incorporation or Organization | The country of the incorporation or organization. |
| Box 3 - Entity Receiving the Payments | The name of the disregarded entity receiving the payment. |
Chapter 3 Status
| Field | Description |
|---|---|
| Box 4 - Chapter 3 Status Entity Type | Determines the classification of the legal entity based on U.S. tax principles. |
- Simple Trust
- Central Bank of Issue
- Grantor Trust
- Tax-Exempt Organization
- Private Foundation
- Disregarded Entity
- Corporation
- Complex Trust
- Estate
- International Organization
- Partnership
- Foreign Government - Controlled Entity
- Foreign Government - Integral Part
| Field | Description |
|---|---|
| Box 4 - Hybrid Entity | Specifies whether the entity specified in the Box 1 - Name of Beneficial Owner field is a hybrid entity claiming tax treaty benefits. Possible values: Yes, No |
Chapter 4 Status (FATCA)
| Field | Description |
|---|---|
| Box 5 - Chapter 4 Status FATCA Status | Specifies the Foreign Account Tax Compliance Act (FATCA) status of the entity. |
- Nonparticipating FFI
- Participating FFI
- Reporting Model 1 FFI
- Reporting Model 2 FFI
- Registered Deemed-Compliant FFI
- Sponsored FFI
- Certified Deemed-Compliant Nonregistering Local Bank
- Certified Deemed-Compliant FFI with Only Low-Value Accounts
- Certified Deemed-Compliant Sponsored Closely Held Investment Vehicle
- Certified Deemed-Compliant Limited Life Debt Investment Entity
- Certain Investment Entities That Do Not Maintain Financial Accounts
- Owner-Documented FFI
- Restricted Distributor
- Nonreporting IGA FFI
- Foreign Government or Government of US Possession or Foreign Central Bank of Issue
- International Organization
- Exempt Retirement Plans
- Entity Wholly Owned By Exempt Beneficial Owners
- Territory Financial Institution
- Excepted Nonfinancial Group Entity
- Excepted Nonfinancial Start-Up Company
- Excepted Nonfinancial Entity In Liquidation or Bankruptcy
- 501(c) Organization
- Nonprofit Organization
- Publicly Traded NFFE or NFFE Affiliate of Publicly Traded Corporation
- Excepted Territory NFFE
- Active NFFE
- Passive NFFE
- Excepted Inter-Affiliate FFI
- Direct Reporting NFFE
- Sponsored Direct Reporting NFFE
- Account That Is Not A Financial Account
Address Information
Permanent Residence Address
| Field | Description |
|---|---|
| Box 6 - Permanent Residence Address | The permanent residence address of the entity. |
| Address | Street address |
| City and State or Province | City and state/province |
| Country | Country |
Mailing Address
| Field | Description |
|---|---|
| Box 7 - Mailing Address | The address to which correspondence should be sent. |
| Address | Street address |
| City and State or Province | City and state/province |
| Country | Country |
Tax Identification
| Field | Description |
|---|---|
| Box 8 - US Taxpayer Identification Number | The U.S. taxpayer identification number. |
| Box 9a - GIIN | The Global Intermediary Identification Number (GIIN) of the entity. |
| Box 9b - Foreign TIN | The Foreign Tax Identification Number (Foreign TIN) of the entity. |
| Box 9c - FTIN Not Legally Required | Specifies that FTIN is not legally required. |
| Box 10 - Reference Number | Any useful referencing information. |
Disregarded Entity or Branch Information
| Field | Description |
|---|---|
| Box 11 - Chapter 4 Status FATCA Status of Disregarded Entity or Branch | Specifies the Foreign Account Tax Compliance Act (FATCA) status of the disregarded entity with a GIIN or the branch that is an FFI located in a country other than the country identified in the Box 2 - Country of Incorporation or Organization field. |
- Branch Treated As Nonparticipating FFI
- Participating FFI
- Reporting Model 1 FFI
- Reporting Model 2 FFI
- US Branch
Address of Disregarded Entity or Branch
| Field | Description |
|---|---|
| Box 12 - Address of Disregarded Entity or Branch | The address of the disregarded entity or branch. |
| Address | Street address |
| City and State or Province | City and state/province |
| Country | Country |
| Field | Description |
|---|---|
| Box 13 - GIIN of Disregarded Entity | The Global Intermediary Identification Number (GIIN) of the disregarded entity or branch. |
Treaty Benefits
| Field | Description |
|---|---|
| Box 14a | Specifies that the entity specified in the Box 1 - Name of Beneficial Owner field is making a claim for reduced withholding under a treaty on certain payments of U.S. source income. |
| Box 14a - Resident of | The country for which the beneficial owner is claiming treaty benefits. |
| Box 14b | Specifies that the entity derives the items of income for which treaty benefits are claimed and meets any applicable limitation on benefits provisions. |
Limitation on Benefits Types
| Field | Description |
|---|---|
| Box 14b - Limitation Type | Specifies the types of limitation on benefits provisions that may be included in an applicable tax treaty. |
- Government
- Tax-Exempt Pension Trust or Pension Fund
- Other Tax-Exempt Organization
- Publicly Traded Corporation
- Subsidiary of a Publicly Traded Corporation
- Company That Meets the Ownership and Base Erosion Test
- Company That Meets the Derivative Benefits Test
- Company With an Item of Income That Meets Active Trade or Business Test
- Favorable Discretionary Determination by the US Competent Authority Received
- No LOB Article in Treaty
- Other
| Field | Description |
|---|---|
| Box 14b - Other | Specifies that the type of limitation on benefits is not listed above. |
| Box 14c | Specifies the type of limitation on benefits. |
Special Rates and Conditions
| Field | Description |
|---|---|
| Box 15 - Special Rates and Conditions | Specifies that the beneficial owner is claiming treaty benefits. |
| Article and Paragraph | Treaty article and paragraph |
| Rate | Rate claimed |
| Income | Type of income |
| Additional Conditions | Any additional conditions |
Certification Boxes
The following fields are specific certifications relating to the status marked in Box 5 - Chapter 4 Status FATCA Status:| Field | Description |
|---|---|
| Box 16 - Name of Sponsoring Entity | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 17 - Investment Entity | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 18 through Box 25c | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
Box 26 - IGA FFI Information
| Field | Description |
|---|---|
| Box 26 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 26 - Name of Jurisdiction | Jurisdiction name for IGA FFI |
| Box 26 - IGA Model | Model 1 IGA or Model 2 IGA |
| Box 26 - Category of FFI | Category of Foreign Financial Institution |
| Box 26 - Name of Trustee or Sponsor | Name of trustee or sponsor |
| Box 26 - US or Foreign Trustee | US Trustee or Foreign Trustee |
Additional Certification Boxes
| Field | Description |
|---|---|
| Box 27 through Box 32 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 33 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 33 - Date | Date for Box 33 certification |
| Box 34 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 34 - Date | Date for Box 34 certification |
| Box 35 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 35 - Date | Date for Box 35 certification |
| Box 36 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
Box 37 - Publicly Traded Entity Information
| Field | Description |
|---|---|
| Box 37a | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 37a - Securities Exchange | Securities exchange information |
| Box 37b | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 37b - Name of Entity | Name of entity |
| Box 37b - Name of Securities Market | Name of securities market |
Final Certification Boxes
| Field | Description |
|---|---|
| Box 38 through Box 41 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 42 - Name of Sponsoring Entity | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
| Box 43 | Specific certifications relating to the status that is marked on the Box 5 - Chapter 4 Status FATCA Status field. |
Substantial US Owners and Signature
| Field | Description |
|---|---|
| Substantial US Owners of Passive NFFE | The name, address and TIN of each substantial U.S. owner of the NFFE. |
| Capacity to Sign | Specifies that an authorized representative or agent have the capacity to sign for the person identified on the Name of Beneficial Owner field. |
| Printed Name | The printed name of the beneficial owner. |
| Date | The date of signing. |
Key Fields
- Box1 - Name of Beneficial Owner
- Date
