Certificate of Foreign Person's Claim That Income Is Effectively
Connected With the Conduct of a Trade or Business in the United States
(Rev. October 2021)
Department of the Treasury
Internal Revenue Service
OMB No. 1545-1621
▶ Section references are to the Internal Revenue Code.
to www.irs.gov/FormW8ECI for instructions and the latest information.
▶ Give this form to the withholding agent or payer. Do not send to the IRS.
Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business. See instructions.
Do not use this form for:
Instead, use Form:
• A beneficial owner solely claiming foreign status or treaty benefits . . . . . . . . . . . . . . . . . W-8BEN or W-8BEN-E
• 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(s) 115(2), 501(c), 892, 895, or 1443(b)
. . . .
Note: These entities should use Form W-8ECI if they received effectively connected income and are not eligible to claim an exemption for chapter 3
or 4 purposes on Form W-8EXP.
• A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively connected with the
conduct of a trade or business in the United States) . . . . . . . . . . . . . . . . . . . . .
W-8BEN-E or W-8IMY
• A person acting as an intermediary . . . .
Note: See instructions for additional exceptions.
Name of individual or organization that is the beneficial owner
Name of disregarded entity receiving the payments (if applicable)
Type of entity (check the appropriate box):
Foreign Government - Controlled Entity
Foreign Government - Integral Part
2 Country of incorporation or organization
Central bank of issue
Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate.
Identification of Beneficial Owner (see instructions)
Business address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state, and ZIP code
U.S. taxpayer identification number (required—see instructions)
Foreign tax identifying number (FTIN)
Reference number(s) (see instructions)
SSN or ITIN
Check if FTIN not legally required
Date of birth (MM-DD-YYYY)
Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or
business in the United States (attach statement if necessary).
Check here to certify that: you are a dealer in securities (as defined in section 475(c)(1)); you are a transferor of an interest in a publicly traded partnership
(PTP) claiming an exception from withholding under Regulations section 1.1446(f)-4(b)(6); and any gain from the transfer of the PTP interest associated
with this form is effectively connected with the conduct of a trade or business within the United States without regard to section 864(c)(8). . . .
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and
complete. I further certify under penalties of perjury that:
• I am the beneficial owner (or I am authorized to sign for the beneficial owner) of all the payments to which this form relates,
• The amounts for which this certification is provided are effectively connected with the conduct of a trade or business in the United States,
• The income for which this form was provided is includible in my gross income (or the beneficial owner’s gross income) for the taxable year, and
• The beneficial owner is not a U.S. person.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the payments of which I am the
beneficial owner or any withholding agent that can disburse or make payments of the amounts of which I am the beneficial owner.
I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.
I certify that I have the capacity to sign for the person identified on line 1 of this form.
Signature of beneficial owner (or individual authorized to sign for the beneficial owner)
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25045D
|File Title||Form W-8 ECI (Rev. October 2021)|