U. S. Business Income Tax Return

Instructions for Form W-8IMY
(Rev. September 2016)

Department of the Treasury
Internal Revenue Service

Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S.
Branches for United States Tax Withholding and Reporting
Section references are to the Internal Revenue Code unless
otherwise noted.

General Instructions
Future developments. For the latest information about
developments related to Form W-8IMY and its instructions,
such as legislation enacted after they were published, go to
www.irs.gov/formw8imy.

What’s New
Nonreporting IGA FFIs. The instructions for how a
nonreporting IGA FFI should certify to its chapter 4 status on
this form have been revised to coordinate qualification for
such status under the IGA with the chapter 4 regulations. An
FFI that meets the requirements of both a nonreporting IGA
FFI under an IGA and a deemed-compliant FFI status under
the regulations should certify as a nonreporting IGA FFI,
unless such entity meets the requirements for
owner-documented FFI status for payments associated with
this form, in which case it should certify on line 5 to that
status under the regulations and complete Part XI of the form.
Qualified derivatives dealers (QDDs). In September
2015, temporary and final regulations were published
concerning nonresident alien individuals and foreign
corporations that hold certain financial products providing for
payments that are contingent upon or determined by
reference to U.S. source dividend payments. These
regulations create a special category of qualified
intermediary, a qualified derivatives dealer or QDD. QDD
status is relevant on or after January 1, 2017. This form has
been updated to include the relevant certifications made by a
QI acting as a QDD and must be used by QDDs for payments
made on or after January 1, 2017. See Definitions, later, for
more information regarding QDDs.
Qualified intermediary (QI) not assuming primary withholding responsibility. Line 14e on Form W-8IMY has
been changed, in response to comments, to provide more
specific certifications for a QI that does not assume primary
withholding responsibility. As a result, a QI that does not
assume primary Form 1099 reporting and backup
withholding responsibility should check box 14e but should
only check box 14e(i) if it has U.S. non-exempt recipient
account holders. These instructions have been updated to
reflect this change to the form.

Purpose of Form

Under chapter 3, foreign persons are generally subject to
U.S. tax at a 30% rate on income they receive from U.S.
sources that consists of interest (including certain original
issue discount (OID)), dividends, rents, premiums, annuities,
compensation for, or in expectation of, services performed,
or other fixed or determinable annual or periodical (FDAP)
gains, profits, or income. This tax is imposed on the gross
amount paid and is generally collected by withholding under
section 1441 or 1442 on that amount. A payment is
considered to have been made whether it is made directly to
Sep 27, 2016

the beneficial owner or to another person, such as an
intermediary, agent, trustee, executor, or partnership, for the
benefit of the beneficial owner.
Under chapter 4, withholding agents must withhold at a
30% rate under sections 1471 and 1472 on withholdable
payments made to nonparticipating FFIs (including when the
nonparticipating FFI is a flow-through entity or is acting as an
intermediary), certain other foreign entities, and certain
account holders of FFIs. For example, if a U.S. withholding
agent makes a payment of portfolio interest described in
section 871(h) to an account maintained by a
nonparticipating FFI, the payment will be subject to a 30%
withholding tax under section 1471 even if the
nonparticipating FFI is an intermediary or flow-through entity
and the beneficial owner for whom the intermediary or
flow-through is acting is a foreign individual who provides a
valid Form W-8BEN.
Foreign persons are also subject to tax at graduated rates
on income they earn that is considered effectively connected
with a U.S. trade or business. If a foreign person invests in a
partnership that conducts a U.S. trade or business, the
foreign person is considered to be engaged in a U.S. trade or
business. The partnership is required to withhold tax under
section 1446 on the foreign person’s distributive share of the
partnership’s effectively connected taxable income. The
partnership may generally accept any form submitted for
purposes of section 1441 or 1442, with few exceptions, to
establish the foreign status of the partner. See Regulations
sections 1.1446-1 through 1.1446-6 to determine whether
the form submitted for purposes of section 1441 or 1442 will
be accepted for purposes of section 1446.
For purposes of section 1446, Form W-8IMY may
only be submitted by an upper-tier foreign
CAUTION partnership or a foreign grantor trust, both of which
must furnish additional documentation for their owners.

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Additional information. For additional information and
instructions for the withholding agent, see the Instructions for
the Requester of Forms W-8BEN, W-8BEN-E, W-8ECI,
W-8EXP, and W-8IMY.

Who Must File

Except as otherwise provided, you should provide Form
W-8IMY when receiving a reportable amount or withholdable
payment (see Definitions, later) on behalf of another person
or as a flow-through entity. When receiving a withholdable
payment, your chapter 4 status is also required to be
included on the form unless otherwise provided in
accordance with these instructions. Form W-8IMY must be
provided by the following persons.
A foreign person, or a foreign branch of a U.S. person, to
establish that it is a qualified intermediary that is not acting for
its own account, to represent that it has provided or will
provide a withholding statement, as required, or, if
applicable, to represent that it has assumed primary
withholding responsibility under chapters 3 and 4 of the Code

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documentation for exempt beneficial owners described in
Regulations section 1.1471-6.
A qualified securities lender (QSL) certifying to a
withholding agent that it is acting as a QSL with respect to
U.S. source substitute dividends received from the
withholding agent pursuant to a securities lending transaction
(as described in Notice 2010-46). See Definitions, later, for
when QSL status is applicable.
A foreign intermediary or flow-through entity not receiving
withholdable payments or reportable amounts that is holding
an account with a participating FFI or registered
deemed-compliant FFI providing this form for purposes of
documenting the chapter 4 status of the account holder.
However, no withholding statement is required to be
provided along with Form W-8IMY if it is being provided by
the foreign intermediary or flow-through entity solely to
document such an account when no withholdable payments
or reportable amounts are made to the account. Also note
that the entity may instead provide Form W-8BEN-E when it
is not receiving withholdable payments or reportable
amounts to document its chapter 4 status as an account
holder of an FFI requesting this form.

(excluding section 1446) and/or primary Form 1099 reporting
and backup withholding responsibility.
A foreign person, or a foreign branch of a U.S. person, to
establish that it is a qualified intermediary acting as a QDD or
assuming primary withholding responsibility with respect to
payments of substitute interest, as permitted by the QI
agreement.
A foreign person to establish that it is a nonqualified
intermediary that is not acting for its own account, to certify
its chapter 4 status (if required), to certify whether it reports
U.S. accounts under chapter 4 (if required), and to indicate, if
applicable, that it is using the form to transmit withholding
certificates and/or other documentary evidence and has
provided, or will provide, a withholding statement, as
required. A U.S. person cannot be a nonqualified
intermediary.
A U.S. branch that is acting as an intermediary to
represent that the income it receives is not effectively
connected with the conduct of a trade or business within the
United States and either that it is using the form (a) to
evidence it is treated as a U.S. person under Regulations
section 1.1441-1(b)(2)(iv)(A) with respect to any payments
associated with the Form W-8IMY, or (b) to certify to its
chapter 4 status and to transmit the documentation of the
persons for whom it receives a payment and has provided, or
will provide, a withholding statement, as required.
A financial institution incorporated or organized under the
laws of a U.S. territory that is acting as an intermediary or is a
flow-through entity to represent that it is a financial institution
(other than an investment entity that is not also a depository
institution, custodial institution, or specified insurance
company) and either that it is using the form (a) to evidence it
is treated as a U.S. person under Regulations section
1.1441-1(b)(2)(iv)(A) with respect to any payments
associated with the Form W-8IMY, or (b) to certify that it is
transmitting documentation of the persons for whom it
receives a payment and has provided, or will provide, a
withholding statement, as required.
A foreign partnership or a foreign simple or grantor trust to
establish that it is a withholding foreign partnership or
withholding foreign trust under the regulations for sections
1441 and 1442 and to certify its chapter 4 status (if required).
A foreign partnership or a foreign simple or grantor trust to
establish that it is a nonwithholding foreign partnership or
nonwithholding foreign simple or grantor trust for purposes of
sections 1441 and 1442, to certify to its chapter 4 status (if
required), and to represent that the income is not effectively
connected with a U.S. trade or business, that the form is
being used to transmit withholding certificates and/or
documentary evidence, and that it has provided or will
provide a withholding statement as required.
A foreign partnership or foreign grantor trust to establish
that it is an upper-tier foreign partnership or foreign grantor
trust for purposes of section 1446 and to represent that the
form is being used to transmit withholding certificates and/or
documentary evidence and that it has provided, or will
provide, a withholding statement, as required.
A flow-through entity (including a foreign reverse hybrid
entity) transmitting withholding certificates and/or other
documentary evidence to claim treaty benefits on behalf of its
owners, to certify its chapter 4 status (if required), and to
certify that it has provided, or will provide, a withholding
statement, as required.
A nonparticipating FFI acting as an intermediary or that is a
flow-through entity using this form to transmit a withholding
statement and withholding certificates or other

This form may serve to establish foreign status for
purposes of sections 1441, 1442, and 1446. However, any
representations that items of income, gain, deduction, or loss
are not effectively connected with a U.S. trade or business
will be disregarded by a partnership receiving this form for
purposes of section 1446 as the partnership will undertake its
own analysis.
Do not use Form W-8IMY if you are described below.
You are the beneficial owner of U.S. source income (other
than income that is effectively connected with the conduct of
a trade or business within the United States) and you need to
establish that you are not a U.S. person, establish your
chapter 4 status (if required), or claim a reduced rate of
withholding on your own behalf under an income tax treaty (if
applicable). Instead, submit Form W-8BEN, Certificate of
Status of Beneficial Owner for United States Tax Withholding
and Reporting (Individuals), or Form W-8BEN-E, Certificate
of Foreign Status of Beneficial Owner for United States Tax
Withholding and Reporting (Entities).
You are a hybrid entity claiming treaty benefits on your
own behalf. Instead, provide Form W-8BEN-E to claim treaty
benefits. However, if you are receiving a withholdable
payment you may also be required to provide this Form
W-8IMY to establish your chapter 4 status (unless you are a
disregarded entity) and the chapter 4 status of each of your
partners, beneficiaries, or owners. See the instructions for
Form W-8BEN-E for more information about hybrid entities
claiming treaty benefits.
You are a reverse hybrid entity that is not claiming treaty
benefits on behalf of your interest holders. Instead, provide
Form W-8BEN-E on your own behalf.
You are the beneficial owner of income that is effectively
connected with the conduct of a trade or business within the
United States. Instead, provide Form W-8ECI, Certificate of
Foreign Person’s Claim That Income Is Effectively
Connected With the Conduct of a Trade or Business in the
United States.
You are a nonresident alien individual who claims
exemption from withholding on compensation for
independent or certain dependent personal services
performed in the United States. Instead, provide Form 8233,
Exemption From Withholding on Compensation for
Independent (and Certain Dependent) Personal Services of a
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Instructions for Form W-8IMY (Rev. 9-2016)

Nonresident Alien Individual, or Form W-4, Employee’s
Withholding Allowance Certificate.
You are a disregarded entity (a business entity that has a
single owner and is not a corporation under Regulations
section 301.7701-2(b) is disregarded as an entity separate
from its owner). Instead, the single owner (if a foreign person)
should provide the appropriate Form W-8 based on the
single owner's status.
You are 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 115(2),
501(c), 892, 895, or 1443(b), and, if required, claiming an
exemption from chapter 4 withholding. Instead, provide Form
W-8EXP, Certificate of Foreign Government or Other Foreign
Organization for United States Tax Withholding and
Reporting. However, these entities should use Form
W-8BEN-E instead if they are claiming treaty benefits or are
providing the form only to claim exempt recipient status for
Form 1099 and backup withholding purposes.

With respect to an FFI claiming a chapter 4 status
under an applicable IGA, a change in circumstances
CAUTION includes when the jurisdiction where the FFI is
organized or resident (or the jurisdiction where a disregarded
entity or branch of an FFI is organized, identified in Part II of
the form) was included on the list of jurisdictions treated as
having an intergovernmental agreement in effect and is
removed from that list or when the FATCA status of the
jurisdiction changes (e.g., from Model 2 to Model 1). The list
of agreements is maintained at www.treasury.gov/resourcecenter/tax-policy/treaties/Pages/FATCA-Archive.aspx.

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Definitions
Account holder. An account holder is generally the person
listed or identified as the holder or owner of a financial
account (other than an agent or nominee that is not an FFI).
For example, if a partnership is listed as the holder or owner
of a financial account, then the partnership is the account
holder, rather than the partners of the partnership. However,
an account that is held by a disregarded entity is treated as
held by the person owning the entity.

Giving Form W-8IMY to the withholding agent. Do not
send Form W-8IMY to the IRS. Instead, give it to the person
who is requesting it. Generally, this person will be the one
from whom you receive the payment, who credits your
account, or a partnership that allocates income to you. If you
are an account holder of an FFI, the FFI may also request this
form from you to document the status of your account for
chapter 4 purposes.

Expiration of Form W-8IMY. Generally, a Form W-8IMY
remains valid until the status of the person whose name is on
the certificate is changed in a way relevant to the certificate
or there is a change in circumstances that makes the
information on the certificate no longer correct. The indefinite
validity period does not extend, however, to any other
withholding certificates, documentary evidence, or
withholding statements associated with the certificate.

Amounts subject to withholding. Generally, an amount
subject to chapter 3 withholding is an amount from sources
within the United States that is fixed or determinable annual
or periodical (FDAP) income. FDAP income is all income
included in gross income, including interest (as well as OID),
dividends, rents, royalties, and compensation. Amounts
subject to chapter 3 withholding do not include amounts that
are not FDAP, such as most gains from the sale of property
(including market discount and option premiums), as well as
other specific items of income described in Regulations
section 1.1441-2 (such as interest on bank deposits and
short-term OID).
Withholding under chapter 4 applies to payments of U.S.
source FDAP income that are withholdable payments as
defined in Regulations section 1.1473-1(a) to which an
exception does not apply under chapter 4. The exemptions
from withholding provided for under chapter 3 are not
applicable when determining whether withholding applies
under chapter 4. For exceptions applicable to the definition of
a withholdable payment, see Regulations section
1.1473-1(a)(4) (exempting, for example, certain nonfinancial
payments).
For purposes of section 1446, the amount subject to
withholding is the foreign partner’s share of the partnership’s
effectively connected taxable income.

Change in circumstances. If a change in circumstances
makes any information on the Form W-8IMY (or any
documentation or a withholding statement associated with
the Form W-8IMY) you have submitted incorrect for purposes
of chapter 3 or chapter 4 (when relevant), you must notify the
withholding agent within 30 days of the change in
circumstances, and provide the documentation required in
Regulations section 1.1471-3(c)(6)(ii)(E)(2). You must
update the information associated with Form W-8IMY as
often as is necessary to enable the withholding agent to
withhold at the appropriate rate on each payment and to
report such income.
See Regulations sections 1.1441-1(e)(4)(ii)(D) for the
definition of a change in circumstances for purposes of
chapter 3. See Regulations section 1.1471-3(c)(6)(ii)(E) for
the definition of a change in circumstances for purposes of
chapter 4.

Beneficial owner. For payments other than those for which
a reduced rate of, or exemption from, withholding is claimed
under an income tax treaty, the beneficial owner of income is
generally the person who is required under U.S. tax
principles to include the payment in gross income on a tax
return. A person is not a beneficial owner of income,
however, to the extent that person is receiving the income as
a nominee, agent, or custodian, or to the extent the person is
a conduit whose participation in a transaction is disregarded.
In the case of amounts paid that do not constitute income,
beneficial ownership is determined as if the payment were
income.
Foreign partnerships, foreign simple trusts, and foreign
grantor trusts are not the beneficial owners of income paid to
the partnership or trust. The beneficial owners of income paid
to a foreign partnership are generally the partners in the
partnership, provided that the partner is not itself a

When to provide Form W-8IMY to the withholding agent.
Give Form W-8IMY to the person requesting it before income
is paid to you, credited, or allocated to your account. If you
do not provide this form, the withholding agent may have to
withhold at the 30% rate (for a payment subject to
withholding under chapter 3 or a withholdable payment under
chapter 4), backup withhold, or withhold at the applicable
rate for net effectively connected taxable income allocable to
a foreign partner in a partnership under section 1446.
Generally, a separate Form W-8IMY must be submitted to
each withholding agent from whom you receive a payment.

Instructions for Form W-8IMY (Rev. 9-2016)

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partnership, foreign simple or grantor trust, nominee, or other
agent. The beneficial owners of income paid to a foreign
simple trust (that is, a foreign trust that is described in section
651(a)) are generally the beneficiaries of the trust, if the
beneficiary is not itself a foreign partnership, foreign simple
or grantor trust, nominee, or other agent. The beneficial
owners of income paid to a foreign grantor trust (that is, a
foreign trust to the extent that all or a portion of the income of
the trust is treated as owned by the grantor or another person
under sections 671 through 679) are the persons treated as
the owners of the trust. The beneficial owner of income paid
to a foreign complex trust (that is, a foreign trust that is not a
foreign simple trust or foreign grantor trust) is the trust itself.
The beneficial owner of income paid to a foreign estate is
the estate itself.

accounts apply). Finally, a chapter 4 withholding rate pool
also includes a pool of U.S. persons included in a U.S. payee
pool described in Regulations section 1.6049-4(c)(4)
provided by a participating FFI (including a reporting Model 2
FFI), a registered deemed-compliant FFI (including a
reporting Model 1 FFI), or a QI.

Note. A payment to a U.S. partnership, U.S. trust, or U.S.
estate is treated as a payment to a U.S. payee that is not
subject to 30% withholding for purposes of chapter 3 and
chapter 4. A U.S. partnership, trust, or estate should provide
the withholding agent with a Form W-9. For purposes of
section 1446, a U.S. grantor trust or disregarded entity shall
not provide the withholding agent a Form W-9 in its own right.
Rather, the grantor or other owner shall provide the
withholding agent the appropriate form.

Disregarded entity. A business entity that has a single
owner and is not a corporation under Regulations section
301.7701-2(b) is disregarded as an entity separate from its
owner. A disregarded entity does not submit this Form
W-8IMY to a withholding agent or FFI. Instead, the owner of
such entity provides the appropriate documentation (for
example, a Form W-8BEN-E if the owner is a foreign entity).
See Regulations section 1.1446-1 and section 1.1471-3(a)(3)
(v), respectively. However, if a disregarded entity receiving a
withholdable payment is an FFI outside the single owner’s
country of organization or has its own GIIN, the owner will be
required to complete Part II of Form W-8IMY to document the
chapter 4 status of the disregarded entity receiving the
payment except as otherwise provided in these instructions.
Certain entities that are disregarded for U.S. tax purposes
may nevertheless be treated as a treaty resident for
purposes of claiming treaty benefits under an applicable tax
treaty (see the definition of hybrid entity, later). See Form
W-8BEN-E and the accompanying instructions for more
information about a hybrid entity claiming treaty benefits on
its own behalf as a resident of a treaty jurisdiction.

Deemed-compliant FFI. Under section 1471(b)(2), certain
FFIs are deemed to comply with the regulations under
chapter 4 without the need to enter into an FFI agreement
with the IRS. However, certain deemed-compliant FFIs are
required to register with the IRS and obtain a GIIN. These
FFIs are referred to as registered deemed-compliant FFIs.
See Regulations section 1.1471-5(f)(1) and also an
applicable IGA for entities treated as registered
deemed-compliant FFIs.

Chapter 3. Chapter 3 means chapter 3 of the Internal
Revenue Code (Withholding of Tax on Nonresident Aliens
and Foreign Corporations). Chapter 3 contains sections 1441
through 1464.
Chapter 3 withholding rate pool. A chapter 3 withholding
rate pool is a payment of a single type of income, based on
the categories of income reported on Form 1042-S (for
example, interest or dividends), that is not subject to
withholding under chapter 4 but is subject to a single rate of
withholding for chapter 3 purposes and is paid to foreign
persons or, in the case of a zero-percent pool, U.S. exempt
recipients not included in a separate pool of exempt
recipients. See the instructions for the withholding statement
of a QI, later.

Financial account. A financial account includes:
A depository account maintained by an FFI;
A custodial account maintained by an FFI;
Equity or debt interests (other than interests regularly
traded on an established securities market) in investment
entities and certain holding companies, treasury centers, or
financial institutions as defined in Regulations section
1.1471-5(e);
Certain cash value insurance contracts; and
Annuity contracts.
For purposes of chapter 4, exceptions are provided for
accounts such as certain tax-favored savings accounts, term
life insurance contracts, accounts held by estates, escrow
accounts, and certain annuity contracts. See Regulations
section 1.1471-5(b)(2). Accounts may also be excluded from
the definition of financial account under an applicable IGA.

Chapter 4. Chapter 4 means chapter 4 of the Internal
Revenue Code (Taxes to Enforce Reporting on Certain
Foreign Accounts). Chapter 4 contains sections 1471
through 1474.
Chapter 4 status. The term chapter 4 status means a
person’s status as a U.S. person, specified U.S. person,
foreign individual, participating FFI, deemed-compliant FFI,
restricted distributor, exempt beneficial owner,
nonparticipating FFI, territory financial institution, excepted
NFFE, or passive NFFE. See Regulations section
1.1471-1(b) for the definitions of these terms.
Chapter 4 withholding rate pool. The term chapter 4
withholding rate pool means a pool identified on a
withholding statement (see the description for a withholding
statement of a QI and an NQI, later) provided by an
intermediary or flow-through entity with respect to a
withholdable payment that is allocated to payees that are
nonparticipating FFIs. The term chapter 4 withholding rate
pool also includes a pool identified on an FFI withholding
statement provided by a participating FFI or registered
deemed-compliant FFI with respect to a withholdable
payment that is allocated to a class of recalcitrant account
holders subject to withholding under chapter 4 as described
in Regulations section 1.1471- 4(d)(6)(i) (including a pool of
account holders to which the escrow procedures for dormant

Financial institution. A financial institution generally
means an entity that is a depository institution, custodial
institution, investment entity, or an insurance company (or
holding company of an insurance company) that issues cash
value insurance or annuity contracts. See Regulations
section 1.1471-5(e).
Fiscally transparent entity. An entity is treated as fiscally
transparent with respect to an item of income to the extent
that the interest holders in the entity must, on a current basis,
take into account separately their shares of an item of income
paid to the entity, whether or not distributed, and must
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Instructions for Form W-8IMY (Rev. 9-2016)

a GIIN and agreed to comply with the terms of an FFI
agreement is treated as a participating FFI, but may be
referred to as a reporting Model 2 FFI. The term reporting
IGA FFI refers to both reporting Model 1 FFIs, and
reporting Model 2 FFIs.

determine the character of the items of income as if they
were realized directly from the sources from which realized
by the entity. For example, partnerships, common trust funds,
and simple trusts or grantor trusts are generally considered
to be fiscally transparent with respect to items of income
received by them.

Intermediary. An intermediary is any person that acts as a
custodian, broker, nominee, or otherwise as an agent for
another person, regardless of whether that other person is
the beneficial owner of the amount paid, a flow-through
entity, or another intermediary.
Qualified intermediary (QI). A QI is a person that is a
party to a withholding agreement with the IRS (described in
Regulations section 1.1441-1(e)(5)(iii)) and is:
A foreign financial institution (other than a U.S. branch of
an FFI) that is a participating FFI, registered
deemed-compliant FFI (including an FFI treated as a
registered deemed-compliant FFI under an applicable Model
2 IGA), or FFI treated as a deemed-compliant FFI under an
applicable Model 1 IGA subject to due diligence and
reporting requirements similar to those applicable to a
registered deemed-compliant FFI under Regulations section
1.1471-5(f)(1), including the requirement to register with the
IRS;
An exempt beneficial owner that is a central bank of issue
that meets the requirements of and agrees to be treated as a
participating FFI (including a reporting Model 2 FFI) or a
registered deemed-compliant FFI (including a reporting
Model 1 FFI) with respect to any account that it maintains
and that is held in connection with a commercial financial
activity described in Regulations section 1.1471-6(h) and for
which it receives a withholdable payment;
An eligible entity (as defined in Regulations section
1.1441-1(e)(6)(ii), without regard to the requirement that the
eligible entity be a qualified intermediary);
A foreign branch or office of a U.S. financial institution or a
foreign branch or office of a U.S. clearing organization;
A foreign corporation for purposes of presenting claims of
benefits under an income tax treaty on behalf of its
shareholders to the extent permitted to act as such by the
IRS; or
A foreign entity not described above that is acting as an
intermediary for either withholdable payments or reportable
amounts that the IRS accepts as a qualified intermediary.
Qualified derivatives dealer (QDD). A QDD is a
qualified intermediary that is an eligible entity that agrees to
meet the requirements of Regulations section 1.1441-1(e)(6)
(i) and the QI agreement. An eligible entity is defined in
Regulations section 1.1441-1(e)(6)(ii).
A QDD, among other requirements provided for in the QI
agreement that will be effective on or after January 1, 2017,
and Regulations section 1.1441-1(e)(6), must (1) document
itself to a withholding agent with a Form W-8IMY indicating
that it is acting as a QDD for the payments with respect to
potential section 871(m) transactions and underlying
securities it receives in a principal capacity and (2) indicate to
the withholding agent that it will assume primary chapters 3
and 4 withholding responsibility and primary Form 1099
reporting and backup withholding responsibility for the
payments it makes and receives as a QDD (as provided in
the QI agreement).
Qualified securities lender (QSL). Notice 2010-46,
2010-24 I.R.B. 757, provided rules for QSLs acting with
respect to payments of substitute dividends. A QSL should
certify to its QSL status in Part III of this form, even if it is not

Flow-through entity. A flow-through entity is a foreign
partnership (other than a withholding foreign partnership), a
foreign simple or foreign grantor trust (other than a
withholding foreign trust), or, for payments for which a
reduced rate of withholding is claimed under an income tax
treaty, any entity to the extent the entity is considered to be
fiscally transparent (see above) with respect to the payment
by an interest holder’s jurisdiction.
Foreign financial institution (FFI). A foreign financial
institution (FFI) generally means a foreign entity that is a
financial institution.
Foreign person. A foreign person includes a nonresident
alien individual, a foreign corporation, a foreign partnership, a
foreign trust, a foreign estate, and any other person that is
not a U.S. person. It also includes a foreign branch or office
of a U.S. financial institution or U.S. clearing organization if
the foreign branch is a qualified intermediary. Generally, a
payment to a U.S. branch of a foreign person is a payment to
a foreign person.
Global intermediary identification number (GIIN). The
term GIIN means a global intermediary identification number.
A GIIN is the identification number assigned to an entity that
has registered with the IRS for chapter 4 purposes.
Hybrid entity. A hybrid entity is any person (other than an
individual) that is treated as fiscally transparent (rather than
as a beneficial owner) for purposes of declaring status under
the Code but is not treated as fiscally transparent by a
country with which the United States has an income tax
treaty. Hybrid entity status is relevant for claiming treaty
benefits for purposes of chapter 3. A hybrid entity, may,
however, be considered the payee for purposes of chapter 4
(see Regulations section 1.1471-3(a) defining who is a payee
of a withholdable payment). See the special instructions for
hybrid entities, later, and Regulations section 1.1471-3(d) for
the documentation requirements with respect to entities
receiving withholdable payments.
Intergovernmental Agreement (IGA). An IGA means a
Model 1 IGA or a Model 2 IGA. For a list of jurisdictions
treated as having in effect a Model 1 or Model 2 IGA, go to
www.treasury.gov/resource-center/tax-policy/treaties/Pages/
FATCA-Archive.aspx.
A Model 1 IGA means an agreement between the United
States or the Treasury Department and a foreign government
or one or more agencies to implement FATCA through
reporting by FFIs to such foreign government or agency
thereof, followed by automatic exchange of the reported
information with the IRS. An FFI in a Model 1 IGA jurisdiction
that performs account reporting to the jurisdiction’s
government is referred to as a reporting Model 1 FFI.
A Model 2 IGA means an agreement or arrangement
between the U.S. or the Treasury Department and a foreign
government or one or more agencies to implement FATCA
through reporting by FFIs directly to the IRS in accordance
with the requirements of an FFI agreement, supplemented by
the exchange of information between such foreign
government or agency thereof and the IRS. An FFI in a
Model 2 IGA jurisdiction that registered with the IRS to obtain
Instructions for Form W-8IMY (Rev. 9-2016)

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a qualified intermediary. The QSL regime is being replaced
by the QDD regime once the QDD regime is implemented.
Nonqualified intermediary. A nonqualified intermediary
is any intermediary that is not a U.S. person and that is not a
qualified intermediary.

U.S. branch treated as a U.S. person. The phrase U.S.
branch treated as a U.S. person means a U.S. branch of a
participating FFI, registered deemed-compliant FFI, or NFFE
that is treated as a U.S. person under Regulations section
1.1441-1(b)(2)(iv)(A).

Limited branch. A limited branch means a branch of a
participating FFI that is described in Regulations section
1.1471-4(e)(2).

Withholdable payment. The term withholdable payment
means an amount subject to withholding for purposes of
chapter 4 as described in Amounts subject to withholding,
earlier. Also see Regulations section 1.1473-1(a) for the
definition of withholdable payment.

Nonwithholding foreign partnership, simple trust, or
grantor trust. A nonwithholding foreign partnership is any
foreign partnership other than a withholding foreign
partnership. A nonwithholding foreign simple trust is any
foreign simple trust that is not a withholding foreign trust. A
nonwithholding foreign grantor trust is any foreign grantor
trust that is not a withholding foreign trust.

Withholding agent. Any person, U.S. or foreign, that has
control, receipt, custody, disposal, or payment of U.S. source
FDAP income subject to chapter 3 or a withholdable payment
under chapter 4 is a withholding agent. The withholding
agent may be an individual, corporation, partnership, trust,
association, or any other entity, including (but not limited to)
any foreign intermediary, foreign partnership, and U.S.
branches of certain foreign banks and insurance companies.
For purposes of section 1446, the withholding agent is the
partnership conducting the trade or business in the United
States. For a publicly traded partnership, the withholding
agent may be the partnership, a nominee holding an interest
on behalf of a foreign person, or both. See Regulations
sections 1.1446-1 through 1.1446-6.

Participating FFI. A participating FFI is an FFI (including a
reporting Model 2 FFI covered by an FFI agreement) that has
agreed to comply with the terms of an FFI agreement. The
term participating FFI also includes a QI branch of a U.S.
financial institution, unless such branch is a reporting Model
1 FFI.
Payee. A payee is generally a person to whom a payment is
made, regardless of whether such person is the beneficial
owner. For a payment made to a financial account, the payee
is generally the holder of the financial account. However,
under certain circumstances a person who receives a
payment will not be considered the payee. For purposes of
chapter 3, see Regulations section 1.1441-1(b)(2). For
purposes of chapter 4, see Regulations section 1.1471-3(a)
(3).

Withholding foreign partnership (WP) or withholding
foreign trust (WT). A WP or WT is a foreign partnership or
a foreign simple or grantor trust that has entered into a
withholding agreement with the IRS in which it agrees to
assume primary withholding responsibility for purposes of
chapter 4 and under sections 1441 and 1442 for all payments
that are made to its partners, beneficiaries, or owners, except
as otherwise provided in the withholding agreement.

Reportable amount. Solely for purposes of the statements
required to be attached to Form W-8IMY, a reportable
amount is an amount subject to withholding under chapter 3,
U.S. source deposit interest (including original issue
discount), and U.S. source interest or original issue discount
on the redemption of short-term obligations. It does not
include payments on deposits with banks and other financial
institutions that remain on deposit for 2 weeks or less or
amounts received from the sale or exchange (other than a
redemption) of a short-term obligation that is effected outside
the United States. It also does not include amounts of original
issue discount arising from a sale and repurchase transaction
completed within a period of 2 weeks or less, or amounts
described in Regulations section 1.6049-5(b)(7), (10), or (11)
(relating to certain obligations issued in bearer form). See the
instructions for Forms 1042-S and 1099 to determine
whether these amounts are subject to information reporting.

Withholding statement. A withholding statement provides
an allocation (by income type) to each payee (or withholding
rate pool, if applicable, or other pool of payees to the extent
permitted under the chapter 4 regulations) of each payment
an intermediary or flow-through entity receives. The
withholding statement forms an integral part of the
withholding certificate, and the penalties of perjury statement
provided on the withholding certificate shall apply to the
withholding statement. The withholding statement may be
provided in any manner the intermediary or the flow-through
entity and the withholding agent mutually agree, including
electronically if certain safeguards concerning electronic
transmission are met. A withholding statement also provides
information required for purposes of chapter 4 if the
intermediary or flow-through entity is receiving a withholdable
payment, in which case the entity must provide an FFI
withholding statement, chapter 4 withholding statement, or
exempt beneficial owner withholding statement (as
applicable). See Regulations section 1.1471-3(c)(3)(iii)(B).

Reverse hybrid entity. A reverse hybrid entity is any
person (other than an individual) that is not fiscally
transparent under U.S. tax law principles but that is fiscally
transparent under the laws of a jurisdiction with which the
United States has an income tax treaty.

Specific Instructions

Territory financial institution. The term territory financial
institution means a financial institution that is incorporated or
organized under the laws of any U.S. territory. However, an
investment entity that is not also a depository institution,
custodial institution, or specified insurance company is not a
territory financial institution. A territory financial institution
acting as an intermediary or that is a flow-through entity may
agree to be treated as a U.S. person under Regulations
section 1.1441-1(b)(2)(iv)(A).

Part I — Identification of Entity
Line 1. Enter your name. By doing so, you are representing
to the payer or withholding agent that you are not the
beneficial owner of the amounts that will be paid to you
(unless you are acting as a QDD or QSL for certain payments
associated with this form or you are a QI acting with respect
to payments of substitute interest, as permitted by the QI
agreement). If you are a disregarded entity, do not enter the
business name of the disregarded entity here. Instead, enter
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Instructions for Form W-8IMY (Rev. 9-2016)

the legal name of the entity that owns the disregarded entity
(looking through multiple disregarded entities, if applicable).

Form W-8IMY may be submitted and accepted to

TIP satisfy documentation requirements for purposes of

Line 2. If you are a corporation, enter the country of
incorporation. If you are another type of entity, enter the
country under whose laws you are created, organized, or
governed. If you are an individual, provide your country of
residence for tax purposes.

withholding on certain partnership allocations to
foreign partners under section 1446. Section 1446 generally
requires withholding when a partnership is conducting a
trade or business in the United States and allocates income
effectively connected with that trade or business (ECI) to
foreign persons that are partners in the partnership. Section
1446 can also apply when certain income is treated as
effectively connected income of the partnership and is so
allocated.

Line 3. If you are a disregarded entity receiving a payment,
enter your name (if required). You should complete line 3
only if you are a disregarded entity receiving a withholdable
payment or hold an account with an FFI requesting this form
and you:
Have registered with the IRS and been assigned a GIIN
associated with the legal name of the disregarded entity; and
Are a reporting Model 1 FFI or reporting Model 2 FFI .

An upper-tier partnership that is allocated ECI as a partner in
a partnership may, in certain circumstances, have the
lower-tier partnership perform its withholding obligation.
Generally, this is accomplished by the upper-tier partnership
submitting withholding certificates of its partners (for
example, Form W-8BEN) along with a Form W-8IMY, which
identifies itself as a partnership, and identifying the manner in
which ECI of the upper-tier partnership will be allocated to the
partners. For further information, see Regulations section
1.1446-5. A foreign grantor trust that is allocated ECI as a
partner in a partnership should provide the withholding
certificates of its grantor (for example, Form W-8BEN) along
with its Form W-8IMY which identifies the trust as a foreign
grantor trust. See Regulations section 1.1446-1(c)(2)(ii)(E)
for the rules requiring it to provide additional documentation
to the partnership.

If you are not required to provide the legal name of
the disregarded entity, however, you may want to
CAUTION notify the withholding agent that you are a
disregarded entity receiving a payment or maintaining an
account by indicating the name of the disregarded entity on
line 10. However, do not enter the name of the disregarded
entity on this line except in the circumstances described.

!

Line 4. Complete this line to establish your entity status for
purposes of chapter 3. Check the one box that applies. If you
are a foreign partnership receiving the payment on behalf of
your partners, check the “Withholding foreign partnership”
box or the “Nonwithholding foreign partnership” box,
whichever is appropriate. If you are a foreign simple trust or
foreign grantor trust receiving the payment on behalf of your
beneficiaries or owners, check the “Withholding foreign trust”
box, the “Nonwithholding foreign simple trust” box, or the
“Nonwithholding foreign grantor trust” box, whichever is
appropriate. If you are a foreign partnership (or a foreign
trust) receiving a payment on behalf of persons other than
your partners (or beneficiaries or owners), check the
“Qualified intermediary” box or the “Nonqualified
intermediary” box, whichever is appropriate. A foreign
reverse hybrid entity that is providing documentation from its
interest holders to claim a reduced rate of withholding under
a treaty should check the appropriate box (including
“Withholding foreign partnership” or “Withholding foreign
trust” if the entity has entered into a withholding agreement).
See Parts III through VIII, later, if you are acting in more than
one capacity. A partnership or grantor trust submitting Form
W-8IMY solely because it is allocated income effectively
connected with a U.S. trade or business as a partner in a
partnership should check the box for nonwithholding foreign
partnership or nonwithholding foreign grantor trust and, if it is
submitting or will submit documentation for its partners or
owners, it should complete Part VIII.

Line 5. Check the one box that applies to your chapter 4
status. You are only required to provide a chapter 4 status if
you are acting as an intermediary with respect to a
withholdable payment, you are a flow-through entity receiving
a withholdable payment on behalf of your owners (including a
reverse hybrid entity providing documentation on behalf of its
owners to claim treaty benefits), you are providing a
withholding statement associated with this form that allocates
a portion of the payment to a chapter 4 withholding rate pool
of U.S. payees with respect to your direct account holders
(as described in Regulations section 1.6049-4(c)(4)), you are
providing this form to an FFI requesting this form to
document your chapter 4 status, or you are a QI acting as a
QDD receiving payments as a principal or a QI acting with
respect to payments of substitute interest. By checking a box
on this line, you are representing that you qualify for this
classification.
For most of the chapter 4 classifications, you are

TIP required to complete additional certifications found in

a separate part of this form (see Parts IX through
XXVIII). Complete the appropriate part of this form certifying
that you meet the conditions of the status indicated on line 5
(as defined under Regulations sections 1.1471-5 or
1.1471-6). Make sure you complete the required portion of
this form before signing and providing it to the withholding
agent.

FFIs Covered by IGAs and Related Entities

A reporting FFI resident in, or established under the laws of,
a jurisdiction covered by a Model 1 IGA should check
“Reporting Model 1 FFI.” A reporting FFI resident in, or
established under the laws of, a jurisdiction covered by a
Model 2 IGA should check “Reporting Model 2 FFI.” If you
are treated as a registered deemed-compliant FFI under an
applicable IGA, you should check “Nonreporting IGA FFI”
rather than “registered deemed-compliant FFI” and provide
your GIIN. See the specific instructions for Part XIX. In

Instructions for Form W-8IMY (Rev. 9-2016)

-7-

your branch is receiving the payment and is required to be
identified in Part II, you are not required to provide a GIIN on
this line 9 unless such branch is a U.S. branch or limited
branch.
In addition, if you are a sponsored entity that has a GIIN,
you must provide that GIIN on line 9.
For payments made prior to January 1, 2017, a sponsored
direct reporting NFFE or sponsored FFI that has not obtained
a GIIN must provide the GIIN of its sponsoring entity.
If you are a QI acting as a QDD, you must provide your
GIIN on line 9 if you have one.

general, if you are treated as a nonreporting IGA FFI under
an applicable IGA, you should check “Nonreporting IGA FFI”
even if you meet the qualifications for deemed-compliant
status under the chapter 4 regulations. In such a case, you
need not also check your applicable status under the
regulations but should provide your GIIN on line 9. However,
an owner documented FFI that is treated as a nonreporting
IGA FFI under an applicable IGA must check
“Owner-documented FFI” and complete Part XI. An FFI that
is related to a reporting IGA FFI and that is treated as a
nonparticipating FFI in its country of residence should check
nonparticipating FFI in line 5. An FFI that is related to a
reporting IGA FFI and that is a participating FFI,
deemed-compliant FFI, or exempt beneficial owner under the
U.S. Treasury regulations or an applicable IGA should check
the appropriate box depending on its chapter 4 status rather
than the box for nonparticipating FFI.

If you are in the process of registering with the IRS as

TIP a participating FFI, registered deemed-compliant FFI,

reporting Model 1 FFI, reporting Model 2 FFI, direct
reporting NFFE, or sponsored direct reporting NFFE but have
not received a GIIN, you may complete this line by writing
“applied for.” However, the person requesting this form from
you must receive and verify your GIIN within 90 days.

If you are an FFI in a jurisdiction treated as having an IGA
in effect, you should not check “Participating FFI” and should
check “Reporting Model 1 FFI” or “Reporting Model 2 FFI” as
applicable.

Line 10. This line may be used by the filer of Form W-8IMY
or by the withholding agent or FFI to whom it is provided to
include any referencing information that is useful to the
withholding agent in carrying out its reporting and withholding
obligations. For example, a withholding agent who is required
to associate a particular Form W-8BEN or Form W-8BEN-E
with this Form W-8IMY may want to use line 10 for a
referencing number or code that will make the association
clear.

See www.treasury.gov/resource-center/tax-policy/treaties/
Pages/FATCA-Archive.aspx for a list of jurisdictions treated
as having an IGA in effect.
Line 6. Enter the permanent address of the entity identified
on line 1. Your permanent residence address is the address
in the country where you claim to be a resident for purposes
of that country's income tax. Do not show the address of a
financial institution (other than yourself), a post office box, or
an address used solely for mailing purposes unless such
address is the only permanent address you use and it
appears in your organizational documents (i.e., your
registered address). If you do not have a tax residence in any
country, the permanent residence address is where you
maintain your principal office or, if you are an individual,
where you normally reside.

Part II — Disregarded Entity or
Branch Receiving Payment
Complete Part II for a disregarded entity that has its
own GIIN and is receiving a withholdable payment, or
CAUTION for a branch (including a branch that is a disregarded
entity that does not have its own GIIN) of the FFI identified in
line 1 operating in a jurisdiction other than the country of
residence identified in line 2. For example, assume ABC Co.,
which is a participating FFI resident in Country A, operates
through a branch in Country B (which is a Model 1 IGA
jurisdiction) and the branch is treated as a reporting Model 1
FFI under the terms of the Country B Model 1 IGA. ABC Co.
should not enter its GIIN on line 9, and the Country B branch
should complete this Part II by identifying itself as a reporting
Model 1 IGA FFI and providing its GIIN on line 13.
Furthermore, if the Country B branch receiving the payment
is a disregarded entity, you may be required to provide its
legal name on line 3. See the instructions for Part I, line 3.

!

Line 7. Enter your mailing address only if it is different from
the address you show on line 6.
Line 8. You must provide an employer identification number
(EIN) if you are a U.S. branch or territory financial institution
that agrees to be treated as a U.S. person under Regulations
section 1.1441-1(b)(2)(iv)(A), an upper-tier partnership that is
allocated ECI as a partner in a partnership, or a foreign
grantor trust that is allocated ECI as a partner.
If you are acting as a qualified intermediary (including a
QDD), withholding foreign partnership, or withholding foreign
trust, check the appropriate box and enter the EIN that was
issued to you in such capacity (your “QI-EIN,” “WP-EIN,” or
“WT-EIN”). If you are not acting in that capacity, you must
use your U.S. taxpayer identification number (TIN), if any,
that is not your QI-EIN, WP-EIN, or WT-EIN.
A nonqualified intermediary, a nonwithholding foreign
partnership, or a nonwithholding foreign simple or grantor
trust is generally not required to provide a U.S. TIN.
However, a QSL providing this form with respect to a U.S.
source substitute dividend must provide an EIN (including a
QI-EIN if the QSL is a QI).

If the disregarded entity receiving a withholdable

TIP payment has its own GIIN, Part II should be

completed regardless of whether it is in the same
country as the single owner identified in Part I.
Line 11. Check the one box that applies. If you check
reporting Model 1 FFI, reporting Model 2 FFI, participating
FFI, or U.S. branch claiming a chapter 4 status other than
that of nonparticipating FFI, you must complete line 13. If you
are a limited branch or branch of a reporting IGA FFI that
cannot comply with the requirements of an applicable IGA or
the regulations under chapter 4, you must check limited
branch.

Line 9. If you are a participating FFI (including a reporting
Model 2 FFI), registered deemed-compliant FFI (including a
reporting Model 1 FFI), direct reporting NFFE (including a
sponsored direct reporting NFFE), or trustee of a trustee
documented trust, you are required to enter your GIIN (with
regard to your country of residence) on line 9. However, if

Line 12. Enter the address of the branch or disregarded
entity.
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Instructions for Form W-8IMY (Rev. 9-2016)

account(s) identified on this line or in a withholding statement
associated with this form.

Line 13. If you are a reporting Model 1 FFI, a reporting
Model 2 FFI, or a participating FFI, you must enter on line 13
the GIIN of your branch that receives the payment. If you are
a disregarded entity that completed Part I, line 3 of this form
and are receiving payments associated with this form, enter
your GIIN. Do not enter your GIIN (if any) on line 9. If you are
a U.S. branch, enter a GIIN applicable to any other branch of
the FFI (including in its residence country) of which the
branch is a part. If you are a QI that is an NFFE and a
withholding agent requests your chapter 4 status, you may
provide a statement certifying to your chapter 4 status as an
NFFE.

Check box 14d if you have assumed only primary Form
1099 reporting and backup withholding responsibility with
respect to the accounts identified on this line or in a
withholding statement associated with this form (including
satisfying as a participating FFI or registered
deemed-compliant FFI your Form 1099 reporting to the
extent permitted under Regulations sections 1.6049-4(c)(4)(i)
and (c)(4)(ii)).
Check box 14e only if you have not assumed primary
Form 1099 reporting and backup withholding responsibility.
Also check the applicable certification(s) in (i), (ii), and (iii).
Check box 14e(i) if you are transmitting Forms W-9 (or
otherwise providing information for the withholding agent to
report on Form 1099, including when backup withholding
applies or withholding under chapter 4 with respect to
recalcitrant account holders) with respect to each U.S.
non-exempt recipient account identified on this line or in a
withholding statement associated with this form. If you do not
have any U.S. non-exempt recipient account holders, you
should not check box 14e(i). If you subsequently acquire a
U.S. non-exempt recipient account holder that receives
payments associated with this form, you may be required to
update your form as well as your withholding statement and
transmit a Form W-9 (or other required information) in order
for your form to remain valid. If you are allocating any portion
of the payment on a withholding statement to a chapter 4
withholding rate pool of U.S. payees in lieu of providing
Forms W-9, you must additionally certify by checking boxes
14e(ii) and 14e(iii) that (as applicable):
For each account holder included in a chapter 4
withholding rate pool of U.S. payees who holds an account
that you maintain, you are permitted to provide this pool
under Regulations section 1.6049-4(c)(4)(iii) (including for
payments of income other than interest for which reporting
would be required under chapter 61 but for a coordination
rule similar to that provided in Regulations section
1.6049-4(c)(4)(iii)); and/or
For a withholding rate pool of U.S. payees that includes
account holders of another intermediary or flow-through
entity, you have obtained or will obtain documentation to
establish that the intermediary or flow-through entity is a
participating FFI, registered deemed-compliant FFI, or a
qualified intermediary. See Regulations sections 1.1471-3(d)
(4) and 1.1471-3(e) for more information on the requirements
for documenting such chapter 4 statuses.

If you are in the process of registering with the IRS as

TIP a participating FFI, a reporting Model 1 FFI, or a

reporting Model 2 FFI but have not received a GIIN,
you may complete this line by writing “applied for.” However,
the person requesting this form from you must receive and
verify your GIIN within 90 days.

Certification of Chapter 3 Status:
Parts III Through VIII

You should only complete one part from Parts III through VIII.
If you are acting in multiple capacities, provide separate
Forms W-8IMY for each capacity. For example, if you are
acting as a qualified intermediary for one account, but a
nonqualified intermediary for another account, provide one
Form W-8IMY in your capacity as a qualified intermediary
and a separate Form W-8IMY in your capacity as a
nonqualified intermediary.

Part III — Qualified Intermediary

Check box 14a if you are a qualified intermediary (QI)
(whether or not you assume primary withholding
responsibility) for the payments for which you are providing
this form. A QI that is an FFI must be a participating FFI,
registered deemed-compliant FFI, exempt beneficial owner
that is a central bank of issue that meets the requirements of
and agrees to be treated as a participating FFI (including a
reporting Model 2 FFI) or a registered deemed-compliant FFI
(including a reporting Model 1 FFI) with respect to any
account that it maintains and that is held in connection with a
commercial financial activity described in Regulations
section 1.1471-6(h) and for which it receives a withholdable
payment, or FFI treated as a deemed-compliant FFI under an
applicable IGA that is subject to due diligence and reporting
requirements similar to those applicable to a registered
deemed-compliant FFI. By checking the box, you are
certifying to the applicable statements contained on line 14a.
See the QI agreement for the definition of “account” for
purposes of Part III.

A payment that is subject to chapter 3 withholding or
that should be subject to chapter 4 withholding may
CAUTION not be included in a U.S. payee pool that is described
in Regulations section 1.6049-4(c)(4)(ii).

!

Check box 14b only if you are not providing a withholding
statement with this form because you are acting as a QI (but
not acting as a QDD) and have assumed primary withholding
responsibility under both chapter 3 (nonresident alien
withholding) and chapter 4 with respect to the account(s) and
you are either assuming primary Form 1099 reporting and
backup withholding responsibility or are permitted to satisfy
and do satisfy your chapter 61 requirements as a
participating FFI or registered deemed-compliant FFI as
described in Regulations section 1.6049-4(c)(4).

Check box 14f to certify that you are a QI that is acting as
a QSL with respect to all payments associated with this form
that are U.S. source substitute dividends made by a party to
a securities lending transaction (as described in Notice
2010-46).
Check line 14g to certify that you are a QI that is acting as
a QDD and assuming primary withholding responsibility
under chapter 3 and chapter 4 and primary Form 1099
reporting and backup withholding responsibility. This
certification means that you assume such responsibility and
have provided a withholding statement identifying all
accounts for which you are acting as a QDD (unless you are
acting as a QDD for all accounts) for the payments with

Check box 14c if you have assumed only primary
withholding responsibility under both chapter 3 (nonresident
alien withholding) and chapter 4 with respect to the
Instructions for Form W-8IMY (Rev. 9-2016)

-9-

Designate those accounts for which you are assuming
primary withholding and reporting responsibility under
chapter 3 and chapter 4 of the Code,
If applicable, designate those accounts or payments for
which you are acting as a QDD,
If applicable, designate those accounts or payments for
which you are acting as a QSL with respect to any U.S.
source substitute dividends, and
Provide information to allocate the payment, as applicable,
to chapter 3 withholding rate pools, chapter 4 withholding
rate pools, or other pools of payees permitted under the
chapter 4 regulations. See Regulations section 1.1471-3(c)
(3)(iii)(B)(2).

respect to potential section 871(m) transactions and
underlying securities you receive as a principal.
Check line 14h to certify that you are a QI that is assuming
primary withholding responsibility under chapter 3 and
chapter 4 and primary Form 1099 reporting and backup
withholding responsibility with respect to all payments
associated with this form that are U.S. source interest and
substitute interest payments, as permitted by (and described
in) the QI agreement. You may act as a QI with respect to
such substitute interest payments under the QI agreement
regardless of whether you are acting in a principal or
intermediary capacity with respect to payments of interest
and substitute interest you receive that are associated with
this form.

For chapter 4 purposes. A QI receiving a withholdable
payment must provide a withholding statement which
satisfies the requirements of an FFI withholding statement or
chapter 4 withholding statement (if the QI is not an FFI) when
the QI does not assume primary withholding responsibility
under chapter 3 and chapter 4 and Form 1099 reporting and
backup withholding responsibility for the payment.
A QI that is an FFI may provide an FFI withholding
statement to allocate the payment to chapter 4 withholding
rate pools (as applicable) or other pool of payees permitted
on an FFI withholding statement under the chapter 4
regulations. See Regulations section 1.1471-3(c)(3)(iii)(B)(2).
A QI may also provide on the withholding statement a single
pool of nonparticipating FFIs, a single pool of recalcitrant
account holders of the QI or another intermediary that is a
participating FFI or registered deemed-compliant FFI, and, if
the QI does not assume primary Form 1099 and backup
withholding responsibility, a chapter 4 withholding rate pool
of U.S. payees. See also Form 1099 reporting, later. A
chapter 4 withholding rate pool of U.S. payees may include:
If the QI is a reporting Model 1 FFI, an account holder that
is not withheld on under chapter 3, chapter 4, or section 3406
that the QI reports as a U.S. account pursuant to the Model 1
IGA because the account has U.S. indicia and the QI has not
obtained appropriate documentation to treat the account as
held by other than a specified U.S. person;
If the QI is a reporting Model 2 FFI, an account holder that
is not withheld on under chapter 3, chapter 4, or section 3406
that the QI reports as an account holder of a non-consenting
U.S. account as described in the Model 2 IGA;
For a non-U.S. payor (as described in Regulations section
1.6049-5(c)(5)) that is a participating FFI (including a
reporting Model 2 FFI), registered deemed-compliant FFI, or
reporting Model 1 FFI, an account holder not withheld on
under chapter 4 or section 3406 who the QI reports under
chapter 4 or an applicable IGA (including the account
holder’s TIN).
An FFI withholding statement must also identify each
intermediary or flow-through entity that is receiving a
payment on behalf of a payee and include such entity’s
chapter 4 status and GIIN (if applicable), excluding any
intermediary or flow-through entity that is an account holder
or interest holder in another QI, WP, or WT. An FFI
withholding statement of a QI may combine withholding rate
pool information provided by such an entity to the QI with
withholding rate pools comprised of accounts that the QI
maintains.
A QI that is not an FFI and that does not assume primary
withholding responsibility under chapter 3 and chapter 4
must provide, for a withholdable payment, a chapter 4
withholding statement that contains the name, address, TIN
(if any), entity type (if applicable), and chapter 4 status of

Although a QI obtains withholding certificates or
appropriate documentation from beneficial owners, payees,
and, if applicable, shareholders, as specified in its
withholding agreement with the IRS, a QI does not need to
attach the certificates or documentation to this form.
However, to the extent you have not assumed primary Form
1099 reporting or backup withholding responsibility and are
not permitted to allocate the payment to a chapter 4
withholding rate pool of U.S. payees under Regulations
section 1.6049-4(c)(4)(iii), you must disclose the names of
those U.S. persons for whom you receive reportable amounts
and that are not exempt recipients (as defined in Regulations
section 1.6049-4(c)(1)(ii) or under section 6041, 6042, 6045,
or 6050N). You should make this disclosure by attaching to
Form W-8IMY the Forms W-9 (or substitute forms) of
persons that are U.S. non-exempt recipients. If you do not
have a Form W-9 for a non-exempt U.S. payee, you must
attach to Form W-8IMY any information you do have
regarding that person’s name, address, and TIN for a
withholding agent to report the payment.
Withholding statement of a QI. As a QI, you must provide
a withholding statement to each withholding agent from
which you receive reportable amounts or withholdable
payments if you have not assumed primary reporting and
withholding responsibility under chapter 3 and chapter 4 with
respect to the payment and, if you are receiving a reportable
amount on behalf of a U.S. nonexempt recipient, you have
not assumed primary Form 1099 reporting and backup
withholding responsibility for the payment. In addition, a QI
that is acting as a QDD and also receives payments in a
non-QDD capacity whether or not it assumes primary
withholding responsibility for such payments must provide a
withholding statement that designates its QDD accounts (and
provides other information as necessary). The withholding
statement becomes an integral part of the Form W-8IMY and,
therefore, the certification statement that you sign in Part
XXIX of the form applies to the withholding statement as well
as to the form.
Note. If you are a QI that is acting as either a QDD or a QSL
(but not both), you do not have to provide a withholding
statement if you receive payments only in your QDD or QSL
capacity.
See your QI agreement for a more comprehensive
description of the rules applicable to your withholding
CAUTION statement, including the requirements of the
statement under both chapter 3 and chapter 4 for reportable
amounts that are also withholdable payments.

!

A QI withholding statement must:
Designate those accounts for which you act as a QI,
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Instructions for Form W-8IMY (Rev. 9-2016)

with a certified deemed-compliant FFI described in
Regulations section 1.1471-5(f)(2)); and
$10 each on behalf of two nonresident alien individuals
who are account holders of the QI, one of whom is entitled to
a 15% rate of withholding under an applicable income tax
treaty.
The dividend payment is both a withholdable payment
under chapter 4 and a reportable amount under chapter 3.
The QI assumes primary withholding and reporting
responsibility under chapter 3 and chapter 4 as well as
primary Form 1099 reporting and backup withholding
responsibility. As a result, the QI is not required to provide a
withholding statement allocating the payment to specific
payees or withholding rate pools. The QI will provide Form
W-8IMY and check boxes 14a and 14b.

each payee, the amount allocated to each payee, a valid
withholding certificate or other documentation sufficient to
establish the payee’s chapter 4 status. However, a chapter 4
withholding statement may include pooled information for
payees that are nonparticipating FFIs that hold accounts that
the QI maintains or hold accounts with an intermediary or
flow-through entity receiving the payment from the QI. A QI
may also provide another pool of payees as permitted under
the chapter 4 regulations for a chapter 4 withholding
statement. See Regulations section 1.1471-3(c)(3)(iii)(B).
For chapter 3 purposes. In the case of a reportable
amount that is a withholdable payment, any portion of the
payment for which you are acting as a QI that is not allocated
to a chapter 4 withholding rate pool or a U.S. non-exempt
recipient (including for backup withholding purposes) must
be allocated to a chapter 3 withholding rate pool or pool of
U.S. exempt recipients. A chapter 3 withholding rate pool is a
payment of a single type of income, based on the categories
of income reported on Form 1042-S or Form 1099 (for
example, interest or dividends), that is subject to a single rate
of withholding and is exempt from chapter 4 withholding. The
chapter 3 withholding rate pool may be established by any
reasonable method agreed upon by you and the withholding
agent. For example, you may agree to establish a separate
account for a single chapter 3 withholding rate pool or you
may agree to divide a payment made to a single account into
portions allocable to each chapter 3 withholding rate pool.
You must provide the chapter 3 withholding rate pool
information that is required for the withholding agent to meet
its withholding and reporting obligations. A withholding agent
may request any information reasonably necessary to
withhold and report payments correctly.

Example 2. The facts are the same as Example 1,
except QI is a non-U.S. payor under Regulations section
1.6049-5(c)(5) and does not assume primary Form 1099 and
backup withholding responsibility but reports the accounts of
A and B as U.S. accounts under Regulations section
1.1471-4(d).
QI must provide a withholding statement allocating $20 of
the payment to D, $10 to C, and $10 to a chapter 4
withholding rate pool of U.S. payees. QI need not allocate
any portion of the payment specifically to A or B because QI
is a non-U.S. payor that is permitted to include A and B in a
chapter 4 withholding rate pool of U.S. payees under
Regulations section 1.6049-4(c)(4)(i). QI must also provide a
W-9 (or alternatively, name and TIN) for D. A W-9 is not
required for C. The QI will provide Form W-8IMY and check
boxes 14a, 14c, 14e, 14e(i), and 14e(ii) .
Example 3. The facts are the same as Example 1, except
QI is a U.S. payor and does not assume primary Form 1099
and backup withholding responsibility.
Because QI is a U.S. payor, it is not permitted, under
Regulations section 1.6049-4(c)(4)(i) and (iii), to include A
and B in a chapter 4 withholding rate pool of U.S. payees. QI
must provide a withholding statement allocating $5 of the
payment to A, $5 of the payment to B, $10 of the payment to
C, and $20 of the payment to D along with Forms W-9 (or
name and TIN) for A, B, and D. QI will provide Form W-8IMY
and check boxes 14a, 14c, 14e, and 14e(i).

Form 1099 reporting. If you do not assume primary Form
1099 reporting and backup withholding responsibility, you
must provide payee specific information for each U.S.
non-exempt recipient account holder (other than those U.S.
payees included in a chapter 4 withholding rate pool of U.S.
payees (described in Regulations section 1.6049-4(c)(4)(iii)
and earlier in these instructions) or when the alternative
procedure is used (see later)). The pools are based on valid
documentation that you obtain under your withholding
agreement with the IRS or, if a payment cannot be reliably
associated with valid documentation, under the applicable
presumption rules.

Example 4. The facts are the same as Example 1,
except QI is a non-U.S. payor that does not assume primary
withholding and reporting responsibility under chapter 3 and
chapter 4. QI also does not assume primary Form 1099 and
backup withholding responsibility.
If the QI does not assume primary withholding and
reporting responsibility under chapter 3 and chapter 4 as well
as primary Form 1099 reporting and separate backup
withholding responsibilities, the QI will provide an FFI
withholding statement with the following pools:
Nonparticipating FFI Pool — $20 (which is subject to
chapter 4 withholding);
Recalcitrant Account Holder Pool — $20 (which is subject
to chapter 4 withholding and which is aggregated in a single
pool of recalcitrant account holders rather than each class
described in Regulations section 1.1471-4(d)(6));
Chapter 4 Withholding Rate Pool of U.S. Payees — $10
(for the portion of the payment allocable to A and B);
Chapter 3 30% Rate Pool — $10;
Chapter 3 15% Rate Pool — $10; and
0% Rate Pool — $10 (for the portion of the payment
allocable to C).

Example 1. A QI that is a participating FFI receives a
$100 payment of U.S. source dividends on an account for
which it acts as a QI held with the withholding agent for the
following recipients:
$20 to NPFFI, a nonparticipating FFI that is an account
holder of the QI;
$10 each on behalf of two recalcitrant account holders of
the QI ($20 total), each with U.S. indicia (as described in
Regulations section 1.1441-7(b)(5)) associated with the
account;
$5 each on behalf of A and B, U.S. individual account
holders of the QI that the QI reports as U.S. accounts
pursuant to its chapter 4 reporting obligations as a
participating FFI ($10 total);
$10 on behalf of C, a U.S. exempt recipient that is not a
specified U.S. person and is an indirect account holder of the
QI (who beneficially owns the payment through an account
with another participating FFI);
$20 on behalf of D, a U.S. non-exempt recipient that is a
specified U.S. person who is an indirect account holder of the
QI (that beneficially owns the payment through an account
Instructions for Form W-8IMY (Rev. 9-2016)

-11-

Check box 15c to certify that you are permitted under
Regulations section 1.6049-4(c)(4) to provide a chapter 4
withholding rate pool of U.S. payees to which a payment is
allocated on a withholding statement associated with the
Form W-8IMY.

QI will also be required to allocate $20 to a separate
withholding rate pool for D because D is a U.S. non-exempt
recipient who cannot be included in a chapter 4 withholding
rate pool of U.S. payees (because D’s account is maintained
by a certified deemed-compliant FFI). See Regulations
section 1.6049-4(c)(4)(iii), but see the alternative procedure
for U.S. non-exempt recipients, later.
Alternative procedure for U.S. non-exempt recipients.
If approved by the withholding agent, you can establish:
A single pool (not subject to backup withholding) for all
U.S. non-exempt recipient account holders for whom you
have provided Forms W-9 or are includible in a chapter 4
withholding rate pool of U.S. payees prior to the withholding
agent making any payments. Alternatively, you may include
such U.S. non-exempt recipients in a zero rate withholding
pool that includes U.S. exempt recipients and foreign
persons exempt from non-resident alien withholding provided
all the conditions of the alternative procedure are met; and
A separate pool for all U.S. non-exempt recipient account
holders subject to backup withholding for whom you have not
provided Forms W-9 prior to the withholding agent making
any payments.
If you elect the alternative procedure, you must provide
the allocation information required by your QI withholding
agreement to the withholding agent no later than January 15
of the year following the year in which the payments are paid.
Failure to provide this information may result in penalties
under sections 6721 and 6722 and termination of your
withholding agreement with the IRS.

!

CAUTION

Check box 15d to certify that you are acting as a QSL with
respect to the accounts identified on this line or in a
withholding statement associated with this form with respect
to a payment that is a U.S. source substitute dividend.
If you are acting on behalf of another NQI or on behalf of a
foreign partnership or foreign trust that is not a withholding
foreign partnership or a withholding foreign trust, you must
attach to your Form W-8IMY the Form W-8IMY of the other
NQI, foreign partnership, or foreign trust together with the
withholding certificates and other documentation attached to
that Form W-8IMY that are required, as applicable, for both
chapter 3 and chapter 4 purposes.
Withholding statement of an NQI. An NQI must provide a
withholding statement and appropriate documentation to
obtain reduced rates of withholding for its customers under
chapter 3 and chapter 61 and to avoid certain reporting
responsibilities. However, see the paragraph later describing
an NQI’s withholding statement for chapter 4 purposes for
when an NQI may provide a chapter 4 withholding rate pool
of U.S. payees without such documentation. The withholding
statement must be provided prior to a payment and becomes
an integral part of the Form W-8IMY and, therefore, the
certification statement that you sign in Part XXIX of the form
applies to the withholding statement as well as to the form.
For chapter 4 purposes. An NQI receiving a
withholdable payment must provide a withholding statement
which satisfies the requirements of an FFI withholding
statement or chapter 4 withholding statement (if the NQI is
not a participating FFI or registered deemed-compliant FFI).
An FFI withholding statement may allocate the payment to
chapter 4 reporting rate pools (as appropriate), including a
chapter 4 withholding rate pool for nonparticipating FFIs,
recalcitrant account holders (in each class of account holders
described in Regulations section 1.1471-4(d)(6)(i)), or other
pool of payees permitted on an FFI withholding statement
under the chapter 3 or 4 regulations (see Regulations
sections 1.1471-3(c)(3)(iii)(B) and 1.1441-1(e)(3)(iv)(C)),
and, for an NQI that is a participating FFI (including a
reporting Model 2 FFI) or a registered deemed-compliant FFI
(including a reporting Model 1 FFI), U.S. payees (see the
description of the chapter 4 withholding rate pool of U.S.
payees described in Withholding statement of a QI, earlier).
However, an NQI may allocate a portion of a reportable
amount (regardless of whether the payment is a withholdable
payment) to a chapter 4 withholding rate pool of U.S. payees
when the NQI satisfies the requirements to provide such a
pool (including the requirement to certify to its status as a
participating FFI (including a reporting Model 2 FFI) or
registered deemed-compliant FFI (including a reporting
Model 1 FFI)). The withholding statement must also identify
each intermediary or flow-through entity that is receiving a
payment (excluding any intermediary or flow-through entity
that is an account holder or interest holder in another QI, WP,
or WT), each such entity’s chapter 4 status and GIIN (if
applicable), and the chapter 4 withholding rate pools
associated with each such entity receiving the payment.
A chapter 4 withholding statement must contain the name,
address, TIN (if any), entity type, chapter 4 status of each
payee, the amount allocated to each payee, and a valid
withholding certificate or other documentation sufficient to

The amount allocable to these two pools under the
alternative procedure excludes amounts allocated to
the chapter 4 withholding rate pool of U.S. payees.

Updating the statement. The statement by which you
identify the relevant withholding rate pools must be updated
as often as is necessary to allow the withholding agent to
withhold at the appropriate rate on each payment and to
correctly report the income to the IRS. The updated
information becomes an integral part of Form W-8IMY.

Part IV — Nonqualified Intermediary

If you are providing Form W-8IMY as a nonqualified
intermediary (NQI), you must check box 15a. By checking
this box, you are certifying to all of the statements on
line 15a.

If you are required to provide a chapter 4 status on

TIP line 5 (see specific instructions for line 5) and are

acting as an intermediary for a withholdable
payment, you must provide your chapter 4 status on line 5 or
as otherwise permitted in these instructions to avoid
withholding at the chapter 4 rate of 30% being applied to any
withholdable payment you receive from the withholding agent
regardless of whether you check box 15b (except for
documentation provided with respect to exempt beneficial
owners). See the specific instructions for Part IX.
Check box 15b if you are using this form to transmit
withholding certificates or other documentation along with a
withholding statement (subject to the certifications on this
form) that satisfies the requirements of chapters 3 and 4
(including if you are providing pooled information for
purposes of chapter 61 under the alternative procedure for
U.S. non-exempt recipients, discussed later, or chapter 4
withholding rate pools (as applicable) for a withholdable
payment).
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Instructions for Form W-8IMY (Rev. 9-2016)

Include any other information the withholding agent
requests in order to fulfill its withholding and reporting
obligations under chapters 3 and 4 of the Code and/or Form
1099 reporting and backup withholding responsibility.
Alternative procedure for NQIs. To use the alternative
procedure you must inform the withholding agent on your
withholding statement that you are using the procedure and
the withholding agent must agree to the procedure.
Under this procedure, you must provide a withholding
agent with all the information required on the withholding
statement (see Withholding statement of an NQI, earlier) and
all payee documentation, except the specific allocation
information for each payee, prior to the payment of a
reportable amount. In addition, you must provide the
withholding agent with withholding rate pool information. The
withholding statement must assign each payee that is not
subject to withholding under chapter 4 to a chapter 3
withholding rate pool prior to the payment of a reportable
amount. The withholding rate pool may be established by any
reasonable method agreed upon by you and the withholding
agent. For example, you may agree to establish a separate
account for a single withholding rate pool, or you may agree
to divide a payment made to a single account into portions
allocable to each withholding rate pool. You must determine
withholding rate pools based on valid documentation or, to
the extent a payment cannot be reliably associated with valid
documentation, the applicable presumption rules.
You must provide the withholding agent with sufficient
information to allocate the income in each withholding rate
pool to each payee (including U.S. exempt recipients) within
the pool no later than January 31 of the year following the
year of payment. If you fail to provide allocation information, if
required, by January 31 for any withholding rate pool, you
may not use this procedure for any payment made after that
date for all withholding rate pools. You may remedy your
failure to provide allocation information by providing the
information to the withholding agent no later than February
14.
In the case of a reportable amount that is also a
withholdable payment, an NQI may include amounts
allocable to a chapter 4 withholding rate pool (other than a
chapter 4 withholding rate pool of U.S. payees) and payees
subject to chapter 4 withholding for whom the NQI will
provide payee specific information in a 30-percent rate pool
together with payees subject to chapter 3 withholding at the
30-percent rate and may not otherwise apply these
provisions for payments made to U.S. non-exempt recipients
(regardless of whether the payment is a withholdable
payment). For the amount of the payment allocable to a
chapter 4 withholding rate pool of U.S. payees, an NQI may
include such an amount in the withholding rate pool that is
exempt from withholding (an NQI can include such payees in
an exempt pool regardless of whether the payment is a
withholdable payment). The NQI must identify prior to the
payment each chapter 4 withholding rate pool to be allocated
a portion of the payment and must also allocate by January
31 the portion of the payment to each such pool in addition to
allocating the payment to each other payee as described in
the preceding paragraph. See Regulations section
1.1441-1(e)(3)(iv)(D) for further information on alternative
procedures for an NQI.

establish each payee’s chapter 4 status. However, a
chapter 4 withholding statement may instead include pooled
information for payees that are nonparticipating FFIs or
another pool of payees as permitted under the chapter 4
regulations for a chapter 4 withholding statement. The
withholding statement must also identify each intermediary or
flow-through entity that is receiving a payment (excluding any
intermediary or flow-through entity that is an account holder
or interest holder in another QI, WP, or WT), each such
entity’s chapter 4 status and GIIN (if applicable), and the
chapter 4 withholding rate pools associated with each such
entity receiving the payment.
A payment that is subject to chapter 3 withholding or
that should be subject to chapter 4 withholding
CAUTION should not be included in a U.S. payee pool that is
described in Regulations section 1.6049-4(c)(4)(ii).

!

For chapter 3 and chapter 61 purposes. For chapter 3
and chapter 61 purposes, a withholding statement for a
reportable amount must include the information described
later. For such payments that are also withholdable
payments, the withholding statement should allocate only the
portion of the payment that was not allocated to a chapter 4
withholding rate pool (as described earlier) or a pool
described in Regulations section 1.1441-1(e)(3)(iv)(C) or to a
payee identified on the withholding statement to whom
withholding was applied under chapter 4, as follows:
Include the name, address, U.S. TIN (if any), chapter 4
status (for a foreign person receiving a withholdable
payment), and the type of documentation (documentary
evidence, Form W-9, or type of Form W-8) for every person
for whom documentation has been received and must state
whether that person is a U.S. exempt recipient, a U.S.
non-exempt recipient, or a foreign person. The statement
must indicate whether a foreign person is a beneficial owner
or an intermediary, flow-through entity, U.S. branch, or
territory financial institution and the type of recipient, based
on the recipient codes shown on Form 1042-S;
Allocate each payment by income type to every payee for
whom documentation has been provided. The type of income
is based on the income codes reported on Form 1042-S (or,
if applicable, the income categories for Form 1099). If a
payee receives income through another NQI, flow-through
entity, or U.S. branch acting as an intermediary, your
withholding certificate must also state the name, address,
U.S. TIN (if known), and, for a withholdable payment, the
chapter 4 status (if required) and GIIN (if applicable) of the
other NQI or U.S. branch from which the payee directly
receives the payment or the flow-through entity in which the
payee has a direct ownership interest. If another NQI,
flow-through entity, or U.S. branch fails to allocate a
payment, you must provide, for that payment, the name of
the NQI, flow-through entity, or U.S. branch that failed to
allocate the payment;
If a payee is identified as a foreign person, you must
specify the rate of withholding under chapter 3 to which the
payee is subject, the payee’s country of residence and, if a
reduced rate of withholding is claimed, the basis for that
reduced rate (for example, treaty benefit, portfolio interest, or
exemption under section 501(c)(3), 892, or 895). The
statement must also include the U.S. or foreign TIN (if
required) and, if the beneficial owner is not an individual and
is claiming treaty benefits, state whether the limitation on
benefits and section 894 statements have been provided by
the beneficial owner. You must inform the withholding agent
as to which payments those statements relate; and
Instructions for Form W-8IMY (Rev. 9-2016)

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Part V — Territory Financial
Institution

treated as a U.S. person. You must certify that you are
transmitting withholding certificates or other documentation
for persons for whom you are receiving the payment. You
must also certify that you have provided or will provide a
withholding statement (as required) and, if you are receiving
a withholdable payment, provide your chapter 4 status in Part
I, line 5 (if required). The withholding statement must provide
the same information outlined under Withholding statement
of an NQI, earlier, including the applicable chapter 4
information required for the withholding statement if you are
receiving a withholdable payment. See the information for an
FFI withholding statement or a chapter 4 withholding
statement in Withholding statement of an NQI, earlier.

Line 16

Check box 16a to certify that you are a financial institution
(other than an investment entity that is not also a depository
institution, custodial institution, or specified insurance
company) incorporated or organized under the laws of a
possession of the United States.
You must also check either box 16b or 16c. Check
box 16b to certify that you have agreed to be treated as a
U.S. person for purposes of both chapter 3 and chapter 4
with respect to payments associated with this Form W-8IMY.
In this case, you will be responsible for chapter 3 withholding
and reporting, backup withholding under section 3406, and
chapter 4 withholding and reporting for any payments you
make to persons for whom you are receiving a reportable
amount or withholdable payment. If you check this box 16b,
you must provide an EIN on line 8.

Part VII — Withholding Foreign
Partnership (WP) or Withholding
Foreign Trust (WT)

Check box 18 if you are a WP or a WT for the accounts for
which you are providing this form and you are receiving the
income on behalf of your partners, beneficiaries, or owners. If
you are not receiving the income on behalf of your partners,
beneficiaries, or owners, do not complete this Part VII.
Instead, complete Part III or Part IV, whichever is appropriate.

Check box 16c to certify that you are a territory financial
institution that has not agreed to be treated as a U.S. person.
You must certify that you are transmitting withholding
certificates or other documentation for persons for whom you
are receiving a payment (as required for chapter 3,
chapter 61, and section 3406 purposes, and, in the case of a
withholdable payment, documentation required for chapter 4
withholding and reporting purposes). See Regulations
section 1.1471-3(a)(3)(iv). You must also certify that you
have provided or will provide a withholding statement (as
required). The withholding statement must provide the same
information outlined under Withholding statement of an NQI,
earlier, including the applicable chapter 4 information if you
are receiving a withholdable payment.

If you are acting as a WP or WT, you must assume
primary withholding and reporting responsibility under
chapter 3 and chapter 4 for all payments that are made to
you for your partners, beneficiaries, or owners. Therefore,
you are not required to provide information to the withholding
agent regarding each partner’s, beneficiary’s, or owner’s
distributive share of the payment and the information for the
withholding agent to report under section 1472 (if otherwise
required). If you are also receiving payments from the same
withholding agent for persons other than your partners,
beneficiaries, or owners, you must provide a separate Form
W-8IMY for those payments. If you are receiving a
withholdable payment, you must provide your chapter 4
status in line 5 and provide your GIIN (if applicable).

A territory entity that is a flow-through entity but is not
a territory FI may not complete this Part V and agree
CAUTION to be treated as a U.S. person. Instead, complete
Part IV or Part VIII, as appropriate.

!

Part VIII — Nonwithholding Foreign
Partnership, Simple Trust, or Grantor
Trust

Part VI — Certain U.S. Branches
Line 17

Check box 19a if you are a foreign partnership or a foreign
simple or grantor trust that is not a WP or WT. Check box 19b
if you are a foreign partnership or foreign grantor trust
providing this form for purposes of section 1446. If you are a
foreign partnership or grantor trust receiving payments of
reportable amounts and providing this form for purposes of
section 1446, you may check both boxes. By checking either
box, you are certifying to the applicable statements on the
form.

Check box 17a to certify that you are a U.S. branch
described in Regulations section 1.1441-1(b)(2)(iv) receiving
income that is not effectively connected with the conduct of a
trade or business in the United States.
You must also check either box 17b or 17c. Check
box 17b to certify that you are a U.S. branch of a foreign bank
or insurance company described in this certification that is a
participating FFI, registered deemed-compliant FFI, or NFFE
that has agreed with the withholding agent to be treated as a
U.S. person with respect to payments associated with this
Form W-8IMY. In such case, you will be responsible for
chapter 3 withholding and reporting, backup withholding
under section 3406, chapter 4 withholding and reporting for
any payments you make to persons for whom you are
receiving a withholdable payment, and will be treated as a
U.S. payor for chapter 61 purposes. See Regulations section
1.6049-5(c)(5)(i)(F). You must provide your EIN on line 8
and, if you are a branch of an FFI receiving a withholdable
payment, a GIIN on line 9 of another branch of the FFI of
which you are a part.

Note. If you are receiving income that is effectively
connected with the conduct of a trade or business in the
United States, provide Form W-8ECI (instead of Form
W-8IMY). If you are not receiving the income on behalf of
your partners, beneficiaries, or owners, do not complete Part
VIII. Instead, complete Part III or Part IV, whichever is
appropriate. If you are a hybrid entity claiming treaty benefits,
provide Form W-8BEN-E. However, if you are receiving a
withholdable payment you may also be required to provide
this Form W-8IMY and disclose your chapter 4 status and the
chapter 4 status of each of your owners. See the instructions
for Form W-8BEN-E for more information about hybrid
entities claiming treaty benefits.

Check box 17c to certify that you are a U.S. branch that
does not have an agreement with the withholding agent to be
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Instructions for Form W-8IMY (Rev. 9-2016)

If you are acting on behalf of an NQI or another foreign
partnership or foreign trust that is not a withholding foreign
partnership or a withholding foreign trust, you must associate
with your Form W-8IMY the Form W-8IMY of the other
foreign partnership or foreign trust together with the
withholding certificates and other documentation attached to
that other form.
If you are receiving a withholdable payment, you must
provide a chapter 4 status in line 5 other than that of a
nonparticipating FFI and provide your GIIN (if applicable) and
the information required for the withholding agent to report
under section 1472.

If you are providing this Form W-8IMY solely for

TIP purposes of section 1446, you generally are not

required to provide a chapter 4 status because items
of effectively connected income are not withholdable
payments. However, if you do not provide a chapter 4 status
and subsequently receive a withholdable payment, you will
also be required to provide a Form W-8IMY to provide your
chapter 4 status or the lower-tier partnership may have to
withhold on the payment. You may provide your chapter 4
status on this form even if you are not required to do so.

Certification of Chapter 4 Status:
Parts IX Through XXVIII

Withholding statement of nonwithholding foreign partnership or nonwithholding foreign trust. You must
provide the withholding agent with a withholding statement to
obtain reduced rates of withholding and relief from certain
reporting obligations. The withholding statement must
provide the same information outlined under Withholding
statement of an NQI, earlier. The withholding statement
becomes an integral part of the Form W-8IMY. Thus, if you
are an FFI and allocate any portion of the payment to a
chapter 4 withholding rate pool of U.S. payees with respect to
accounts that you maintain, you must meet the requirements
of Regulations section 1.6049-4(c)(4)(iii) and certify to your
status in Part I, line 5 as a participating FFI, registered
deemed-compliant FFI, reporting Model 1 FFI, or reporting
Model 2 FFI. By providing a withholding statement making
such an allocation with this form, you certify that you meet the
requirements outlined for an NQI withholding statement
described earlier.

You should complete only one part certifying to your
chapter 4 status (if required). Identify which part (if any) you
should complete by reference to the box you checked on
line 5.

Part IX — Nonparticipating FFI With
Exempt Beneficial Owners
You are not required to complete this part unless you

TIP are a nonparticipating FFI providing documentation
on behalf of an exempt beneficial owner.

Check box 20 to certify that you are transmitting
withholding certificates or other documentation for exempt
beneficial owners for chapter 4 purposes on whose behalf
you are receiving a payment that is a withholdable payment.
See Regulations section 1.1471-6. You must also certify that
you have provided or will provide a withholding statement (as
required) allocating a portion of the payment to the exempt
beneficial owners as required under Regulations section
1.1471-3(d)(8)(ii). The withholding statement must include
the name, address, TIN (if any), entity type, and chapter 4
status of each exempt beneficial owner on behalf of which
the nonparticipating FFI is receiving the payment, the amount
of the payment allocable to each exempt beneficial owner, a
valid withholding certificate or other documentation sufficient
to establish the chapter 4 status of each exempt beneficial
owner under the requirements of chapter 4, and any other
information the withholding agent reasonably requests in
order to fulfill its obligations under chapter 4. Additionally, the
withholding statement must provide all information required
for purposes of chapter 3 with respect to each exempt
beneficial owner if the payment is subject to withholding
under chapter 3. The withholding statement must allocate the
remainder of the payment that is not allocated to an exempt
beneficial owner to the nonparticipating FFI receiving the
payment.

Certain special rules for partnerships and trusts. Under
certain conditions, a QI, WP, or WT may apply special
provisions of the relevant withholding agreement to certain
partnerships and trusts that are not acting as a WP or WT.
See the QI agreement, WP agreement, or WT agreement (as
applicable) specifying these special procedures.
Foreign partnerships and trusts providing Form W-8IMY
for purposes of section 1446. In general, a partnership is
required to withhold under section 1446 on effectively
connected taxable income (ECTI) allocable to a foreign
partner. A foreign upper-tier partnership (UTP) that is a
partner in a lower-tier partnership (LTP) should provide the
LTP with a Form W-8IMY and documentation sufficient for
the LTP to determine the status of the indirect partner to
whom the ECTI is allocable (looking through additional
foreign UTPs, if applicable) and to determine such partner’s
share of the lower-tier partnership’s ECTI.
A foreign grantor trust that is a partner in a partnership
should provide Form W-8IMY to the partnership along with
documentation and information concerning the grantor or
other owner sufficient for the partnership to reliably associate
the portion of the trust’s allocable share of ECTI with the
grantor or other owner.
Check line 19b to certify that you are a foreign partnership
or grantor trust providing this Form W-8IMY to a lower-tier
partnership for purposes of section 1446.

Part X — Sponsored FFI

On line 21a, enter the name of the sponsoring entity that has
agreed to fulfill your chapter 4 due diligence, reporting, and
withholding obligations on your behalf. Enter the GIIN of the
sponsoring entity identified in line 21a.
Note. A sponsored FFI is not required to have obtained its
own GIIN before the date specified in published guidance
(i.e., January 1, 2017). However, a sponsored entity that has
already obtained a GIIN must provide it on line 9.
You must check the applicable box in line 21b or 21c to
certify that you are either an investment entity or controlled
foreign corporation (within the meaning of section 957(a))

Instructions for Form W-8IMY (Rev. 9-2016)

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Part XVI — Certified
Deemed-Compliant Investment
Advisors and Investment Managers

and satisfy the other relevant requirements for this
classification.

Part XI — Owner-Documented FFI
An owner-documented FFI should only complete
Form W-8IMY if it is a flow-through entity receiving
CAUTION income allocable to its partners, owners, or
beneficiaries. An owner-documented FFI is not permitted to
act as an intermediary with respect to a withholdable
payment.

An investment advisor or investment manager must check
the box to certify that it meets all of the requirements for this
certified deemed-compliant status.

!

Part XVII — Restricted Distributor

All restricted distributors must check box 28a to certify that
you satisfy the requirements for this classification.

All owner-documented FFIs must check box 22a to certify
that you satisfy the requirements for this classification and
are providing this form to a U.S. financial institution, a
participating FFI, or a reporting Model 1 FFI that has agreed
to act as a designated withholding agent with respect to the
entity identified on line 1 (see Regulations section 1.1471-5(f)
(3)).

You must also check either box 28b or 28c, as
appropriate, to certify that your distribution agreement meets
the requirements of this classification.

Part XVIII — Foreign Central Bank of
Issue

You must also check either box 22b or 22c. Check
box 22b to certify that you have provided or will provide the
documentation set forth in the certifications, including the
owner reporting statement described in this line 22b. Check
box 22c to certify that you have provided or will provide an
auditor’s letter (in lieu of the information required by
line 22(b)) that satisfies the requirements described in this
line.

A foreign central bank of issue must check box 29 to certify
that you are acting as an intermediary and are an entity
defined in Regulations section 1.1471-6 that is treated as the
beneficial owner of the payment for chapter 4 purposes
(applying the rule in Regulations section 1.1471-6(d)(4)). You
cannot be treated as an intermediary for purposes of this Part
XVIII if you are receiving the payment in connection with a
commercial activity described in Regulations section
1.1471-6(h)(1) or are not receiving payments subject to
chapter 3 withholding.

Part XII — Certified
Deemed-Compliant Nonregistering
Local Bank

Part XIX — Nonreporting IGA FFI

Check box 30 to indicate that you are treated as a
nonreporting IGA FFI under an applicable IGA, including an
entity treated as a registered deemed-compliant FFI under an
applicable IGA. You must identify the applicable IGA by
entering the name of the jurisdiction that has the applicable
IGA in effect with the United States and indicate whether it is
a Model 1 or a Model 2 IGA. You must also provide the
withholding agent with the specific category of entity
described in Annex II of the IGA applicable to your status. In
providing the specific category of FFI described in Annex II,
you should use the language from Annex II that best and
most specifically describes your status in the IGA. For
example, indicate “investment entity wholly owned by exempt
beneficial owners” rather than “exempt beneficial owner.” If
you are a nonreporting IGA FFI claiming a deemed-compliant
status under the regulations, you must instead indicate on
this line which section of the regulations you qualify under.

All nonregistering local banks must check box 23 to certify
that you satisfy all of the requirements for this certified
deemed-compliant classification.

Part XIII — Certified
Deemed-Compliant FFI with Only
Low-Value Accounts

All FFIs with only low-value accounts must check box 24 to
certify that you satisfy all of the requirements for this certified
deemed-compliant classification.

Part XIV — Certified
Deemed-Compliant Sponsored,
Closely Held Investment Vehicle

On line 25a, enter the name of the sponsoring entity that has
agreed to fulfill your chapter 4 due diligence, reporting, and
withholding obligations on your behalf. You must also enter
the GIIN of your sponsoring entity on line 9.

If you are a nonreporting FFI under an applicable IGA
because you qualify as an owner-documented FFI under the
regulations, do not check “Nonreporting IGA FFI.” Instead
you must check “Owner-documented FFI” and complete Part
XI rather than this Part XIX.

All sponsored, closely held investment vehicles must
check box 25b to certify that you satisfy the requirements for
certified deemed-compliant classification as a sponsored
entity.

If you are an FFI treated as a registered
deemed-compliant FFI under an applicable Model 2 IGA, you
must provide your GIIN in the space provided. The GIIN does
not need to be provided on line 9. See www.treasury.gov/
resource-center/tax-policy/treaties/Pages/FATCAArchive.aspx for a list of jurisdictions treated as having an
IGA in effect for purposes of making this certification.

Part XV — Certified
Deemed-Compliant Limited Life Debt
Investment Entity

All limited life debt investment entities must check box 26 to
certify that you satisfy the requirements for this certified
deemed-compliant classification.

Note. If you are a nonreporting IGA FFI and you have
registered and received a GIIN and have not provided it in
line 9 because your trustee's or sponsor's GIIN is in line 9,
you should provide it here.
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Instructions for Form W-8IMY (Rev. 9-2016)

Part XXVI — Active NFFE

Part XX — Exempt Retirement Plans

All exempt retirement plans must check the appropriate box
to certify that you satisfy the requirements for this
classification.

All active NFFEs must check box 37 to certify that you satisfy
the requirements for this classification.

Part XXVII — Passive NFFE

If you are not a flow-through entity or acting as an
intermediary with respect to the payment for
CAUTION chapter 3 purposes, do not complete Form W-8IMY.
If you are the beneficial owner of the payment and are
claiming an exemption under sections 115(2), 892, or 895 as
well as exempt beneficial owner status under Regulations
section 1.1471-6 you should provide Form W-8EXP. If you
are receiving payments which do not qualify for a statutory
exemption from tax but for which you are claiming benefits
under an applicable income tax treaty, provide Form
W-8BEN-E.

All passive NFFEs must check box 38 to certify that you are
not a financial institution (other than an investment entity
organized in a possession of the United States). You must
also certify that you have provided a withholding statement
associated with Form W-8IMY to the extent you are required
to provide a withholding statement.

!

Part XXVIII— Sponsored Direct
Reporting NFFE

All sponsored direct reporting NFFEs must check the box on
line 40 to certify that you are not a financial institution and
that you satisfy all relevant requirements for this
classification. Provide your GIIN or, prior to the date specified
in published guidance (i.e., January 1, 2017), the GIIN of
your sponsor on line 9.

Part XXI — Excepted Nonfinancial
Group Entity

All excepted nonfinancial group entities must check box 32 to
certify that you satisfy the requirements for this classification.

Enter the name and the GIIN of the sponsoring entity in
line 39.

Part XXII — Excepted Nonfinancial
Start-Up Company

Part XXIX — Certification

All excepted nonfinancial start-up companies must check
box 33 to certify that you satisfy the requirements for this
classification. You must also provide the date you were
formed or your board passed a resolution (or equivalent
measure) approving a new line of business (which cannot be
that of a financial institution or passive NFFE).

Form W-8IMY must be signed and dated by a person
authorized to sign a declaration under penalties of perjury on
behalf of the person whose name is on the form. By signing
Form W-8IMY the authorized representative, officer, or agent
also agrees to provide a new form within 30 days following a
change in circumstances (unless no future payments will be
made to the intermediary or flow-through entity by the
withholding agent and the requestor does not need an
updated form for chapter 4 purposes).

Part XXIII — Excepted Nonfinancial
Entity in Liquidation or Bankruptcy

All excepted nonfinancial group entities in liquidation or
bankruptcy must check box 34 to certify that you satisfy the
requirements for this classification. You must also provide the
date that you filed a plan of liquidation, plan of reorganization,
or bankruptcy petition.

Special Instructions
Entities Providing Certifications Under an
Applicable IGA (Do Not Complete Line 5)

An FFI in an IGA jurisdiction with which you have an account
may provide you with a chapter 4 status certification other
than as shown in Parts IX through XXVIII in order to satisfy its
due diligence requirements under the applicable IGA. In such
a case, you may attach the alternative certification to this
Form W-8IMY in lieu of completing a certification otherwise
required in Parts IX through XXVIII provided that you: 1)
determine that the certification accurately reflects your status
for chapter 4 purposes or under an applicable IGA; and 2) the
withholding agent provides a written statement to you that it
has provided the certification to meet its due diligence
requirements as a participating FFI or registered
deemed-compliant FFI under an applicable IGA. For
example, Entity A organized in Country A holds an account
with an FFI in Country B. Country B has a Model 1 IGA in
effect. The FFI in Country B may ask Entity A to provide a
chapter 4 status certification based on the terms of the
Country B IGA in order to fulfill its due diligence and
documentation requirements under the Country B IGA.

Part XXIV — Publicly Traded NFFE or
NFFE Affiliate of a Publicly Traded
Corporation
All publicly traded NFFEs must check box 35a to certify that
you are not a financial institution and provide the name of a
securities exchange on which the stock of the NFFE is
publicly traded.

An NFFE that is a member of the same expanded
affiliated group (as described in Regulations section
1.1471-5(i)) as a publicly traded U.S. or foreign entity must
check this box, provide the name of the publicly traded entity,
and identify the securities market on which the stock of the
publicly traded entity is traded. See Regulations section
1.1472-1(c)(1)(i) to determine if an entity is publicly traded.

Part XXV — Excepted Territory NFFE

All excepted territory NFFEs must check box 36 to certify that
you satisfy the requirements for this classification. See
Regulations section 1.1472-1(c)(1)(iii) for the definition of an
excepted territory NFFE.

Instructions for Form W-8IMY (Rev. 9-2016)

You may also provide with this form an applicable IGA
certification if you are determining your chapter 4 status
under the definitions provided in an applicable IGA and your
certification identifies the jurisdiction that is treated as having
an IGA in effect and describes your status as an NFFE or FFI
in accordance with the applicable IGA. However, if you
-17-

determine your status under an applicable IGA as an NFFE,
you must still determine if you are an excepted NFFE under
the regulations in order to complete this form unless you are
provided an alternative certification by an FFI described in
the preceding paragraph that covers your certification as an
NFFE (such as “active NFFE”) as defined in an applicable
IGA. Additionally, you are required to comply with the
conditions of your status under the law of the IGA jurisdiction
if you are determining your status under that IGA. If you
cannot provide the certifications in Parts IX through XXVIII,
do not check a box in line 5. However, if you determine your
status under the definitions of the IGA and can certify to a
chapter 4 status included on this form, you do not need to
provide the certifications described in this paragraph unless
required by the FFI to whom you are providing this form.

and is subject to the penalty of perjury statement and other
certifications made in Part XXIX.
Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal Revenue
laws of the United States. You are required to provide the
information. We need it to ensure that you are complying with
these laws and to allow us to figure and collect the right
amount of tax.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally,
tax returns and return information are confidential, as
required by section 6103.

Any certifications provided under an applicable IGA
remain subject to the penalty of perjury statement and other
certifications made in Part XXIX.

The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
average time is: Recordkeeping,11 hr., 43 min.; Learning
about the law or the form, 5 hr., 55 min.; Preparing the
form, 7 hr., 34 min.

Entities Providing Alternate Certifications Under
Regulations

If you qualify for a chapter 4 status that is not shown in Part I,
line 5, of this form, you may attach applicable certifications
for such status from any other Form W-8 on which the
relevant certifications appear. If the applicable certifications
do not appear on any Form W-8 (if, for example, new
regulations provide for an additional chapter 4 status and this
form has not been updated) then you may provide an
attachment certifying that you qualify for the applicable status
described in a particular Regulations section in lieu of
checking a box in Part I, line 5. Include a citation to the
applicable provision in the Regulations. Any such attached
certification becomes an integral part of this Form W-8IMY

If you have comments concerning the accuracy of these
time estimates or suggestions for making this form simpler,
we would be happy to hear from you. You can send us
comments from www.irs.gov/formspubs. Click on “More
Information” and then on “Give us feedback.” You can write
to the Internal Revenue Service, Tax Forms and Publications,
1111 Constitution Ave. NW, IR-6526, Washington, DC
20224. Do not send Form W-8IMY to this office. Instead, give
it to your withholding agent.

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Instructions for Form W-8IMY (Rev. 9-2016)