Form W-8CE Notice of Expatriation and Waiver of Treaty Benefis

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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-8CE, PAGE 1 of 2
MARGINS: TOP 13mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 216mm (81⁄ 2 ") 3 279mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

W-8CE

Form
(January 2009)
Department of the Treasury
Internal Revenue Service

Date

Signature

O.K. to print
Revised proofs
requested

Notice of Expatriation and Waiver of Treaty Benefits

Name of owner

Please print or type

Action

Permanent address

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Provide to payor. Do not send to IRS.

U.S. taxpayer identification number

City, province or state, postal code, and country

Current mailing address, if different from permanent address (Include apt. or suite no., or P.O. box if mail is not delivered to street address.)

City, town or post office, state, and ZIP code (If foreign address, enter city, province or state, postal code, and country.)

Under penalties of perjury I certify that I am a covered expatriate (as defined in the instructions below). Furthermore, I authorize
this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial
owner or any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
Account Number (or other
identifying information)

Check the box below if you have any of the following items.

1. Eligible Deferred Compensation. Checking this box certifies that I will waive treaty benefits on a Form
8854 to be filed with my U.S. income tax return by the due date of that return. (See instructions.)
2. Ineligible Deferred Compensation
3. Specified Tax Deferred Account
4. Nongrantor Trust. Unless the box below is also checked, checking this box certifies that I will waive
treaty benefits on a Form 8854 that I will file with my U.S. income tax return by the due date of that
return. (See instructions.)

I hereby elect to be treated as receiving the full present value of my interest in the trust and, therefore, I am not
waiving any right to treaty benefits.

©

Signature

General Instructions
Purpose
Use Form W-8CE to notify the payor that
you are a covered expatriate individual
subject to certain U.S. withholding taxes.

Covered Expatriate
You are a covered expatriate if you are an
expatriate to whom any of the following
applied on your expatriation date.
1) Your average annual net income tax
for the 5-year period ending the year
before your expatriation date is more
than $139,000 (for 2008). This amount is
indexed for inflation. For years after 2008,
see the instructions for Form 8854 for the
adjusted amount.
2) Your net worth is $2,000,000 or
more.
3) You have not certified under penalty
of perjury that you met all U.S. federal tax
obligations for the preceding 5 years or
have not submitted evidence of such
compliance.
Exceptions. Statements (1) and (2)
above do not apply if:

Date

● You became a U.S. citizen and a
citizen of another country at birth, and,
as of your expatriation date, continue to
be a citizen of, and taxed as a resident
of, such other country, and you were a
U.S. resident for not more than 10 tax
years during the 15 year period ending
with the tax year in which you
expatriated, or
● You relinquished U.S. citizenship
before the age of 18 1⁄ 2 and were a U.S.
resident for not more than 10 tax years
before your expatriation date.
Expatriate. An expatriate is a U.S.
citizen who relinquished citizenship or a
long-term resident who ceased to be a
lawful permanent resident.
Long-Term Resident. For expatriation
purposes a long-term resident is any
individual who was a lawful permanent
resident of the United States in at least
8 out of the last 15 taxable years ending
with the tax year of expatriation.
Expatriation date. Your expatriation
date is the date you relinquished U.S.
citizenship or the date on which you
ceased to be a lawful permanent U.S.
resident.
Cat. No. 51945M

Who Must File
Covered expatriates are required to file
Form W-8CE if they have any of the
following items of income or assets.
Deferred compensation items.
Deferred compensation items include
any interest in a plan or arrangement
described in section 219(g)(5), any
interest in a foreign pension plan or
similar retirement arrangement or
program, any item of deferred
compensation, and any property, or right
to property that the individual is entitled
to receive in connection with the
performance of services to the extent
not previously taken into account under
section 83 or in accordance with section
83.
Eligible deferred compensation (Box
1). Deferred compensation is eligible
deferred compensation if the following
three conditions are met.
1. The payor is either a United States
person or a foreign person electing to be
treated as a U.S. person.

Form

W-8CE

(1-2009)

7
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM W-8CE, PAGE 2 of 2
MARGINS: TOP 13 mm (1⁄ 2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216 mm (81⁄ 2 ") 3 279 mm (11")
PERFORATE: (NONE)
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form W-8CE (1-2009)

2. You notify the payor of your status
as a covered expatriate.
3. You make an irrevocable waiver of
any right to claim reduction of
withholding on this item under any treaty
with the United States.
Check Box 1 if you have eligible
deferred compensation. Checking this
box provides notice to the payor that
you are a covered expatriate who is
waiving benefits under any treaty with
the United States with respect to the
eligible deferred compensation.
Ineligible deferred compensation
(Box 2). This is deferred compensation
that is not eligible deferred
compensation.
Check Box 2 if you have ineligible
deferred compensation. Checking this
box provides notice to the payor that
you are a covered expatriate who is to
be treated as receiving an amount equal
to the present value of your accrued
benefit on the day before your
expatriation date.
Specified tax deferred account (Box
3). Specified tax deferred accounts
include individual retirement plans (as
defined in section 7701(a)(37)) other than
arrangements described in subsection
(k) or (p) of section 408, qualified tuition
programs (as defined in section 529),
Coverdell education savings accounts
(as defined in section 530), health
savings accounts (as defined in section
223), and Archer MSAs (as defined in
section 220).

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Check Box 3 if you have a specified
tax deferred account. Checking this box
provides notice to the payor that you are
a covered expatriate who is to be
treated as receiving a distribution of your
entire interest in the account on the day
before your expatriation date.

When To File

Nongrantor trust (Box 4). A nongrantor
trust is the portion of any trust (U.S. or
foreign) that you are not considered
(immediately before your expatriation
date) to own. The withholding rules of
section 877A apply to a nongrantor trust
only if you were a beneficiary on the day
before your expatriation date.

Where To File

Check Box 4 if you are a beneficiary
of a nongrantor trust or were the
beneficiary of a nongrantor trust on the
day before your expatriation date.
Checking this box provides notice to the
trustee that you are a covered expatriate
who, unless the box below this line is
checked, is deemed to have waived
benefits under any treaty with the United
States with respect to future
distributions from the trust.

As a result of receiving notification of
expatriation on Form W-8CE, you may
have a requirement to withhold tax or to
report information to IRS.

If you do not elect to be treated as
receiving the full present value of your
interest in the trust and pay tax currently
on that interest, you cannot claim a
reduction in withholding on this item
under any treaty with the United States.
Election to be treated as receiving
distribution. You can elect to pay tax
currently on the present value of your
interest in the trust, as of the day before
your expatriation date, and enter into a
closing agreement with the IRS.

File Form W-8CE within thirty (30) days
of expatriation for each specified tax
deferred account, item of deferred
compensation, or interest in a
nongrantor trust.

File Form W-8CE with each payor of the
income for which you have certified
above. Keep a copy for your own
records.

Instructions for Payor

Ineligible deferred compensation. You
must advise the covered expatriate
within 60 days of receipt of this form of
the present value of the individual’s
substantially vested accrued benefit in
the deferred compensation item on the
day before the expatriation date.
Specified tax deferred account. You
must advise the covered expatriate
within 60 days of receipt of this form of
the individual’s entire interest the
account on the day before the
expatriation date.
Nongrantor trusts. If the covered
expatriate elects to be treated as
receiving the full present value of his or
her interest in the nongrantor trust, you
must, within 60 days of receipt of Form
W-8CE, provide a written statement to
the covered expatriate setting forth the
present value of his or her interest in the
trust on the date before his or her
expatriation date.