W-8IMY - Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding

Instructions for Form W-8IMY

Department of the Treasury
Internal Revenue Service

(Rev. October 2021)

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
IRS.gov/Formw8imy.

What’s New
Guidance under section 1446(f). The Tax Cuts and Jobs
Act (TCJA), added section 1446(f), which generally requires
that if any portion of a gain on any disposition of an interest in
a partnership would be treated under section 864(c)(8) as
effectively connected gain, the transferee purchasing an
interest in such a partnership from a non-U.S. transferor must
withhold a tax equal to 10% of the amount realized on the
disposition unless an exception to withholding applies. T.D.
9926 (84 FR 76910), published on November 30, 2020,
contains final regulations (section 1446(f) regulations)
relating to the withholding and reporting required under
section 1446(f), which include withholding requirements that
apply to brokers effecting transfers of interests in publicly
traded partnerships (PTPs). The section 1446(f) regulations
also revise certain requirements under section 1446(a)
relating to withholding and reporting on distributions made by
PTPs, including by expanding the entities permitted to act as
nominees for PTP distributions to include certain qualified
intermediaries and U.S. branches of foreign persons that
agree to act as U.S. persons. Withholding on transfers of
interests in PTPs and the revisions included in the section
1446(f) regulations relating to withholding on PTP
distributions under section 1446(a) apply to transfers and
distributions that occur on or after January 1, 2023. See
Notice 2021-51, 2021-36 I.R.B. 361, for more information.
The provisions of the section 1446(f) regulations relating to
withholding and reporting on transfers of interests in
partnerships that are not PTPs generally apply to transfers
occurring after January 29, 2021. See Pub. 515 for an
additional discussion of section 1446(f) withholding. The
Form W-8IMY and these instructions have been updated to
incorporate the use of this form by brokers and certain
transferors of partnership interests for purposes of certain of
the requirements of the section 1446(f) regulations for
withholding on dispositions of partnership interests (in both
PTPs and other partnerships) and for withholding on PTP
distributions.
Section 871(m) regulations and qualified securities
lenders (QSLs). Notice 2020-2, 2020-3 I.R.B. 327, further
extended the transition relief provided in Notice 2018-72,
2018-40 I.R.B. 522, for certain provisions of the section
871(m) regulations, generally for 2021 and 2022. Notice
2020-2 also further extended the period that a withholding
agent may apply the transition rules to act as a QSL
described in obsoleted Notice 2010-46, 2010-24 I.R.B. 757,
Part III, for substitute dividend payments made in 2021 and
Nov 02, 2021

2022. As a result, this Form W-8IMY includes chapter 3
status certifications for entities acting as QSLs (applicable to
either a qualified intermediary (QI) or other entity acting as a
QSL) and clarifies (as provided in the QI agreement) when a
QI may continue to claim status as a QSL in a case in which it
is also a qualified derivatives dealer (QDD).
New lines 9a and 9b. Line 9b, foreign taxpayer
identification number, if required, has been added for a QDD
to indicate its foreign taxpayer identification number (FTIN)
on this form (with line 9, GIIN (if applicable), redesignated as
line 9a). See QDD withholding statement, later, for when a
QDD is required to provide its FTIN on line 9b.
Nonqualified intermediary (NQI) that provides an alternative withholding statement. The Form W-8IMY and
these instructions have been updated to allow an NQI that is
to provide alternative withholding statements and beneficial
owner withholding certificates for payments associated with
this form to represent on the form that the information on the
withholding certificates will be verified for consistency with
any other account information the NQI has for the beneficial
owners for determining the rate of withholding with respect to
each payee (applying the standards of knowledge under
section 1441 or 1471 regulations, as applicable). See T.D.
9890 and Regulations section 1.1441-1(e)(3)(iv)(C)(3). When
applicable, an NQI may make this representation on new
line 17e instead of on its withholding statement. The Form
W-8IMY and these instructions have also been updated to
allow nonwithholding foreign partnerships and
nonwithholding foreign trusts to make this representation
when providing an alternative withholding statement. For
further information, see the instructions for line 21f.
Electronic signature. These instructions have been
updated to include additional guidance included in final
regulations issued under chapter 3 (T.D. 9890) concerning
the use of electronic signatures on withholding certificates.
See Part XXIX Certification, later, and Regulations section
1.1441-1(e)(4)(i)(B).
Section 6050Y reporting. These instructions have been
updated to reference the use of this form by a foreign
partnership, foreign simple trust, or foreign grantor trust that
is the seller of a life insurance contract (or interest therein) or
a recipient of a reportable death benefit for purposes of
reporting under section 6050Y.

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
the beneficial owner or to another person, such as an

Cat. No. 25904R

intermediary, agent, trustee, executor, or partnership, for the
benefit of the beneficial owner.

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.

Under chapter 4, withholding agents must withhold at a
30% rate under sections 1471 and 1472 on withholdable
payments made to nonparticipating foreign financial
institutions (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.

Who Must Provide Form W-8IMY

Except as otherwise provided, you should provide Form
W-8IMY when receiving a reportable amount or withholdable
payment on behalf of another person or as a flow-through
entity or when acting as a QDD or QSL. When receiving a
withholdable payment, your chapter 4 status is generally
required to be included on the form unless otherwise
provided in accordance with these instructions. In some
cases you should provide Form W-8IMY for an amount
realized or a PTP distribution. 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 QI 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 and/or primary Form 1099 reporting and
backup withholding responsibility.
• A foreign person, a foreign branch of a foreign person, or a
foreign branch of a U.S. person, to establish that it is a QI
acting as a QDD, as permitted by the person’s QI agreement.
A QDD that receives payments for which the QDD is entitled
to a reduced rate of withholding under an income tax treaty
may use its Form W-8IMY to both certify to its status as a QI
acting as a QDD and to claim treaty benefits with respect to
such payments. A QDD may also use its Form W-8IMY to
claim an exemption from withholding that may apply based
on the QDD’s status as a foreign beneficial owner of a
payment.
• A foreign person, or a foreign branch of a U.S. person, to
establish that it is a QI assuming primary withholding
responsibility with respect to payments of substitute interest,
as permitted by the QI agreement.
• For purposes of withholding under section 1446(f), a
foreign person, or foreign branch of a U.S. person, to
establish that it is a QI that is not acting for its own account
and to represent that it has assumed primary withholding
responsibility for a payment of an amount realized from the
sale of an interest in a PTP or has provided, or will provide, a
withholding statement, as required, for the amounts realized.
• A foreign person, or a foreign branch of a U.S. person, to
establish that it is a QI not acting for its own account, to
represent that it has assumed primary withholding
responsibility for distributions from PTPs for which the QI acts
as a nominee or has provided, or will provide, a withholding
statement, as required, for the distributions.
• A foreign person to establish that it is an NQI that is not
acting for its own account for chapter 3 purposes (including
for amounts subject to withholding under section 1446(a) or
(f)), 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 (when permitted) and has provided, or will provide,
a withholding statement, when required (including for
payments subject to withholding under section 1446(a) and,
in certain cases, for section 1446(f)).
• 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 (1) to

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(a) on the foreign person’s distributive share of
the partnership’s effectively connected taxable income or, in
the case of a PTP, on the amount of a distribution attributable
to effectively connected taxable income of the PTP as
provided in Regulations section 1.1446-4 (excluding when a
nominee rather than the PTP is required to withhold). For
purposes of section 1446(a), the partnership may generally
accept any beneficial owner withholding certificate submitted
for purposes of section 1441 or 1442, with few exceptions, to
establish the foreign status of the partner, including a
withholding certificate that is associated with a Form W-8IMY
submitted by an upper-tier foreign partnership, a foreign
grantor trust, or a foreign intermediary. See Regulations
sections 1.1446-1 through 1.1446-6 to determine whether a
withholding certificate submitted for purposes of section
1441 or 1442 will be accepted for purposes of section
1446(a).
Withholding may also be required under the section
1446(f) regulations by a transferee paying the amount
realized from a transfer of a partnership interest to a
transferor of the interest or, for a transfer of an interest in a
PTP, by a broker effecting the transfer. This withholding is
generally required when any portion of the gain from the
transfer would be treated as effectively connected gain under
section 864(c)(8). The withholding required of a broker on an
amount realized on the transfer of a PTP interest is subject to
certain exceptions such as when an amount realized is paid
to a qualified intermediary assuming withholding
responsibility under section 1446(f) or to a U.S. branch acting
as a U.S. person for the amount realized. See Regulations
section 1.1446(f)-4. For certain withholding exceptions, an
applicable withholding certificate is required for a transfer of a
PTP interest, such as for an entity to represent its status as
an entity described in the preceding sentence (made on this
Form W-8IMY) or for a transferor to claim an exemption from
withholding based on an income tax treaty. A withholding
certificate may also be required to establish the status of a
broker or partner withheld upon under section 1446(f).
Separate withholding exceptions apply to transfers of
interests in partnerships other than PTPs, certain of which
require the collection of a withholding certificate or other
applicable certification. See Regulations section 1.1446(f)-2.
-2-

Instructions for Form W-8IMY (Rev. 10-2021)

represent that it has provided, or will provide, a withholding
statement with respect to a modified amount realized for
purposes of withholding under section 1446(f) on the
transfer.
• A foreign grantor trust transferring a partnership interest
providing, on behalf of each grantor or other owner of the
trust under Regulations section 1.1446(f)-1(c)(2)(vii), a
withholding statement to allocate an amount realized to each
grantor or owner for withholding under section 1446(f) on the
transfer.
• 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
documentation for exempt beneficial owners described in
Regulations section 1.1471-6 with respect to its receipt of a
withholdable payment.
• A QSL that is either a QI (to the extent not acting as a
QDD) or other entity certifying to a withholding agent that it is
acting as a QSL in Part IV of Form W-8IMY with respect to
U.S. source substitute dividends received from the
withholding agent prior to January 1, 2023, pursuant to a
securities lending transaction within the meaning of Notice
2010-46. See also Notice 2020-2.
• 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 its chapter 4 status as an account holder. No
withholding statement is required to be provided along with
Form W-8IMY in this case. The entity may instead provide
Form W-8BEN-E to document its chapter 4 status as an
account holder of an FFI when it is not receiving withholdable
payments or reportable amounts.
• A foreign partnership, foreign simple trust, or foreign
grantor trust that is the seller of a life insurance contract (or
interest therein) or a recipient of a reportable death benefit to
establish its foreign status and to associate this form with any
other applicable documentation for purposes of section
6050Y or chapter 3. See Regulations sections 1.6050Y-3
and 1.6050Y-4.

evidence it is treated as a U.S. person under Regulations
section 1.1441-1(b)(2)(iv)(A) with respect to reportable
amounts associated with the Form W-8IMY, or (2) to transmit
the documentation of the persons for whom it receives a
payment of such an amount and has provided, or will
provide, a withholding statement, as required, and to certify it
is applying the rules described in Regulations section
1.1471-4(d)(2)(iii)(C) when receiving a withholdable
payment.
• For purposes of section 1446(f), a U.S. branch that is
acting as an intermediary, to certify that it agrees to act as a
U.S. person with respect to amounts realized on sales of
interests in PTPs.
• A U.S. branch, to represent that it is treated as a U.S.
person and is acting as a nominee for distributions from
PTPs under Regulations section 1.1446-4(b)(3) (or has
otherwise provided (or will provide) a withholding statement
for a distribution).
• 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 (1) to evidence it
is treated as a U.S. person under Regulations section
1.1441-1(b)(2)(iv)(A) with respect to payments of income that
are not effectively connected with the conduct of a trade or
business in the United States associated with the Form
W-8IMY, or (2) to certify that it is transmitting documentation
of the persons for whom it receives such payment and has
provided, or will provide, a withholding statement, as
required.
• For withholding under section 1446(f), a financial
institution incorporated or organized under the laws of a U.S.
territory that is acting as an intermediary or that is a
flow-through entity, to certify that it is acting as a U.S. person
for amounts realized on sales of interests in PTPs.
• A financial institution incorporated or organized under the
laws of a U.S. territory that is acting as an intermediary or that
is a flow-through entity, to certify that it agrees to act as a
U.S. person and as a nominee for distributions from PTPs
under Regulations section 1.1446-4(b)(3) (or has otherwise
provided (or will provide) a withholding statement for a
distribution).
• A foreign partnership or a foreign simple or grantor trust to
establish that it is a withholding foreign partnership or
withholding foreign trust for purposes of chapters 3 and 4.
• 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 reportable
amounts and withholdable payments, to certify to its
chapter 4 status (if required), to represent that the income is
not effectively connected with a U.S. trade or business, and
to certify 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(a) and, except for a
partnership that is a PTP, 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 foreign partnership to establish that it is the transferor of
an amount realized from the transfer of a partnership interest
for purposes of section 1446(f) and, when applicable, to
Instructions for Form W-8IMY (Rev. 10-2021)

This form may serve to establish foreign status for
purposes of sections 1441, 1442, and 1446(a) or (f).
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(a) or (f), as
the partnership will undertake its own analysis.

Do Not Use Form W-8IMY If You Are Described
Below
• You are the beneficial owner (other than a QDD acting in

its QDD capacity or a QSL acting as a principal for substitute
dividend payments) 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 or Form
W-8BEN-E.

-3-

• You are a hybrid entity claiming treaty benefits on your
own behalf (unless you are a QDD acting in your QDD
capacity). 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 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 foreign reverse hybrid entity (unless you are a
QDD acting in your QDD capacity or a QSL acting as a
principal for substitute dividend payments) 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.
• 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
or Form W-4.
• You are a disregarded entity, other than a hybrid entity that
is a disregarded entity claiming treaty benefits on your own
behalf (see above bullet). Instead, the single owner (if a
foreign person) should provide the appropriate Form W-8
based on the single owner's status. If you are a disregarded
entity that is a QDD acting in your QDD capacity, your single
owner (whether or not a QDD) should provide Form W-8IMY
as a QI.
• You are a QI receiving payments of U.S. source income
that you beneficially own other than payments received as a
QDD in respect of potential section 871(m) transactions or
underlying securities or received as a QSL acting as a
principal in a security lending or sale-repurchase transaction
(that is, you are receiving payments that you beneficially own
that are not covered by your QI agreement). Instead, provide
the appropriate Form W-8 based on your status for those
payments you beneficially own.
• 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. 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.

When to provide Form W-8IMY to the withholding agent.
Give Form W-8IMY to the person requesting it before income
is paid, 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 an amount 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.
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. If you
are a QDD, the attachment associated with your Form
W-8IMY used to claim treaty benefits (if applicable) is treated
as a beneficial owner withholding certificate that is not valid
indefinitely. For the validity period of a Form W-8IMY used by
a QDD to claim an exemption from withholding that applies
based on a QDD’s status as a foreign beneficial owner of the
payment, see Regulations section 1.1441-1(e)(4)(ii)(A)(1).
Change in circumstances. If a change in circumstances
makes any information on the Form W-8IMY (or any
documentation or 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 and Regulations section 1.1471-3(c)(6)(ii)(E) for
the definition of a change in circumstances for purposes of
chapter 4.
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 (for example, from Model 2 to Model 1).
The list of agreements is maintained at www.treasury.gov/
resource-center/tax-policy/treaties/Pages/FATCAArchive.aspx.

!

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 will be the person from
whom you receive the payment, the person who credits your
account, or a partnership that allocates income to you. If you
are an account holder of an FFI, the FFI may request this
form from you to document the status of your account for
chapter 4 purposes.

Definitions

You may provide a single Form W-8IMY if you have
TIP multiple branches receiving payments from the same
withholding agent rather than separate Forms
W-8IMY to identify each branch receiving payments
associated with the form. In such a case, you should provide
a schedule that includes all required information for each
branch. See the instructions for Part II.

Account. With respect to QI, including a QI acting as a
QDD, an account is defined in section 2.01 of the QI
Agreement.
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).
-4-

Instructions for Form W-8IMY (Rev. 10-2021)

to a foreign partnership are generally the partners in the
partnership, provided that the partner is not itself a
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.
Generally, these beneficial owner rules apply for purposes
of sections 1441, 1442, and 1446(a) and (f), except that
sections 1446(a) and (f) require a foreign simple trust to
provide a Form W-8 on its own behalf rather than on behalf of
the beneficiary of such trust.
The beneficial owner of income paid to a foreign estate is
the estate itself.
A payment to a U.S. partnership, U.S. trust, or U.S. estate
is treated as a payment to a U.S. payee. A U.S. partnership,
trust, or estate should provide the withholding agent with a
Form W-9. However, for purposes of section 1446(a), a U.S.
grantor trust or disregarded entity shall not provide the
withholding agent a Form W-9 pertaining to itself. Instead,
the entity must provide a Form W-8 or Form W-9 pertaining
to each grantor or owner, as appropriate, and in the case of a
trust, a statement identifying the portion of the trust treated as
owned by each such person. For purposes of section
1446(f), the grantor or owner must provide a Form W-8 or
Form W-9 to certify its status and the amount realized
allocable to the grantor or owner, which, alternatively, can be
provided by the U.S. grantor trust on behalf of a grantor or
owner.

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. With respect to a QI
acting as a QDD, see section 2.02 of the QI Agreement for
the definition of account holder.
Amount realized. For purposes of section 1446(f), an
amount realized on the transfer of an interest in a partnership
other than a PTP is determined under section 1001 (including
Regulations sections 1.1001-1 through 1.1001-5) and section
752 (including Regulations sections 1.752-1 through
1.752-7). See Regulations section 1.1446(f)-2(c)(2). An
amount realized on the transfer of a PTP interest is the
amount of gross proceeds (as defined in Regulations section
1.6045-1(d)(5)) paid or credited to a partner or broker (as
applicable) that is a transferor of the interest. The amount
realized on a PTP distribution is the amount of the distribution
reduced by the portion of the distribution that is attributable to
the cumulative net income of the partnership (as determined
under Regulations section 1.1446(f)-4(c)(2)(iii)).
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 (including such an amount on a
PTP distribution unless indicated otherwise). FDAP income is
all income included in gross income, including interest (as
well as OID), dividends (including dividend equivalents),
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).
Amounts subject to chapter 4 withholding are payments of
U.S. source FDAP income that are withholdable payments as
defined in Regulations section 1.1473-1(a) and to which no
exception under Regulations section 1.1473-1(a)(4) applies
(for example, certain nonfinancial payments are excepted
from the definition of withholdable payment). The exemptions
from withholding provided for under chapter 3 are not
applicable when determining whether withholding applies
under chapter 4.
For purposes of section 1446(a), the amount subject to
withholding is the foreign partner’s share of the partnership’s
effectively connected taxable income. For purposes of
section 1446(f), the amount subject to withholding is the
amount realized on the transfer of a partnership interest.

Broker. A person described in Regulations section
1.1446(f)-1(b)(1) when referenced in connection with a
transfer of a PTP interest.
Chapter 3. Chapter 3 of the Internal Revenue Code
(Withholding of Tax on Nonresident Aliens and Foreign
Corporations), excluding sections 1445 and 1446.
Chapter 3 withholding rate pool. 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 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.

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
Instructions for Form W-8IMY (Rev. 10-2021)

Chapter 4. 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. 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 Non-Financial Foreign Entity (NFFE) or
passive NFFE.
Chapter 4 withholding rate pool. A pool identified on a
withholding statement provided by an intermediary or
flow-through entity with respect to a withholdable payment
that is allocated to payees that are nonparticipating FFIs. The
-5-

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.

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 as described in Regulations
section 1.1471- 4(d)(6) (or with respect to an FFI that is a QI,
a single pool of recalcitrant account holders without the need
to subdivide into each class of recalcitrant account holder),
including a pool of account holders to which the escrow
procedures for dormant 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.

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
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.

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.

Flow-through entity. 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 with respect to the
payment by an interest holder’s jurisdiction.

Disclosing QI. For purposes of section 1446(a) or (f), a QI
that provides with its withholding statement the specific
payee documentation referenced in Regulations section
1.1446(f)-4(a)(7)(iii) (for an amount realized) or Regulations
section 1.1446-4(e)(4) (for withholding on a PTP distribution
under section 1446(a)) instead of the chapter 3 withholding
rate pool information otherwise permitted to be included on
the withholding statement. A QI that acts as a disclosing QI
for a payment must act as a disclosing QI for the entire
payment.

Foreign financial institution (FFI). 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.

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 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 that is not a
QDD). 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, see the
instructions to Part II of Form W-8IMY for when to provide the
chapter 4 status of the disregarded entity receiving the
payment.
Certain entities that are disregarded for U.S. tax purposes
may nevertheless be treated as treaty residents 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.

Global intermediary identification number (GIIN). The
identification number assigned to an entity that has
registered with the IRS for chapter 4 purposes.
Hybrid entity. Any person (other than an individual) that is
treated as fiscally transparent (rather than as a beneficial
owner) 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, earlier, under Who Must
Provide Form W-8IMY, and Regulations section 1.1471-3(d)
for the documentation requirements with respect to entities
receiving withholdable payments.

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;
• Certain cash value insurance contracts; and
• Annuity contracts.

Intergovernmental Agreement (IGA). 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/FATCAArchive.aspx.

-6-

Instructions for Form W-8IMY (Rev. 10-2021)

foregoing, a QDD may not act as a QSL for potential section
871(m) transactions, except with respect to a payment on a
securities lending or sale-repurchase transaction for which
the QI has determined that it is acting as an intermediary for
the payment. While Notice 2010-46 was obsoleted, Notice
2020-2 permits withholding agents to apply the transition
rules described in Notice 2010-46 for payments made in
2021 and 2022.
Nonqualified intermediary. Any intermediary that is not
a U.S. person and that is not a qualified intermediary.

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 United States 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 a GIIN and agreed to comply with the terms of an FFI
agreement with respect to a branch 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.

Modified amount realized. In the case of an amount
realized under section 1446(f) received by a transferor that is
a foreign partnership, the amount determined under
Regulations section 1.1446(f)-4(c)(2)(ii) (for a transfer of a
PTP interest) or under Regulations section 1.1446(f)-2(c)(2)
(iv) (for a transfer of an interest in a partnership other than a
PTP).
Nominee. When referenced in connection with a PTP
distribution, a person that holds an interest in a PTP on
behalf of a foreign person and that is either a U.S. person, a
QI that assumes primary withholding responsibility for a PTP
distribution, or a U.S. branch of a foreign person (or territory
financial institution) that agrees to be treated as a U.S.
person with respect to the distribution. See Regulations
section 1.1446-4(b)(3).

Intermediary. 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 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 (including a reporting Model
2 FFI), a registered deemed-compliant FFI (including an FFI
treated as a deemed-compliant FFI under an applicable 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), or any other category of FFI
identified in the QI agreement;
• A foreign person that is a home office or has a branch that
is an eligible entity (as described in Regulations section
1.1441-1(e)(6)(ii);
• A foreign branch or office of a U.S. financial institution or a
foreign branch or office of a U.S. clearing organization; or
• A foreign entity not described above that the IRS accepts
as a qualified intermediary.
Qualified derivatives dealer (QDD). A QI that is an
eligible entity that agrees to meet the requirements of
Regulations section 1.1441-1(e)(6)(i) and the QI agreement
and has been approved by the IRS to so act. An eligible
entity is defined in Regulations section 1.1441-1(e)(6)(ii).
The home office or branch, as applicable, that is a QDD
must represent itself as a QDD on its Form W-8IMY and
separately identify the home office or branch as a recipient
on a withholding statement (if necessary). Each home office
or branch that obtains QDD status is treated as a separate
QDD.
Qualified securities lender (QSL). Notice 2010-46,
provided rules for QSLs acting with respect to payments of
substitute dividends. A QSL that is a QI should certify to its
QSL status in Part III of this form, regardless of whether it is
acting as a principal or an agent with respect to its QSL
transactions. A QSL that is not a QI, including a QSL acting
as a principal with respect to QSL transactions, should certify
its QSL status in Part IV of this form. Notwithstanding the
Instructions for Form W-8IMY (Rev. 10-2021)

Nonreporting IGA FFI. An FFI that is a resident of, or
located or established in, a Model 1 or Model 2 IGA
jurisdiction that meets the requirements of:
• A nonreporting financial institution described in a specific
category in Annex II of the Model 1 or Model 2 IGA;
• A registered deemed-compliant FFI described in
Regulations section 1.1471-5(f)(1)(i)(A) through (F);
• A certified deemed-compliant FFI described in
Regulations section 1.1471-5(f)(2)(i) through (v); or
• An exempt beneficial owner described in Regulations
section 1.1471-6.
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.
Participating FFI. An FFI that has agreed to comply with the
terms of an FFI agreement with respect to all branches of the
FFI, other than a branch that is a reporting Model 1 FFI or a
U.S. branch. The term participating FFI also includes a
reporting Model 2 FFI and 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) and for
chapter 4, see Regulations section 1.1471-3(a)(3).
Publicly traded partnership (PTP). A PTP is an entity that
has the same meaning as in section 7704 and Regulations
sections 1.7704-1 through 1.7704-4 but does not include a
PTP treated as a corporation under that section.

-7-

any foreign intermediary, foreign partnership, and U.S.
branches of certain foreign banks and insurance companies.
For purposes of section 1446(a), in general, the
withholding agent is the partnership conducting the trade or
business in the United States. For purposes of section
1446(a), the withholding agent for a PTP may be the
partnership or a nominee for a distribution holding an interest
on behalf of a foreign person. See Regulations section
1.1446-4.

PTP distribution. A PTP distribution is a distribution made
by a PTP.
PTP interest. A PTP interest is an interest in a PTP if the
interest is publicly traded on an established securities market
or is readily tradable on a secondary market (or the
substantial equivalent thereof).
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).

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 sections 1441 through 1443 for all payments
that are made to its partners, beneficiaries, or owners, except
as otherwise provided in the withholding agreement. A WP
also includes a foreign reverse hybrid entity that has entered
into a withholding agreement.
Withholding statement. A withholding statement for a
reportable amount 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 section 1441
and chapter 4 regulations) of each payment an intermediary
or flow-through entity receives. For purposes of section
1446(a), a withholding statement provided by an upper-tier
foreign partnership (or foreign grantor trust to a lower-tier
partnership or intermediary receiving the amount on behalf of
the foreign partnership or grantor trust) provides an allocation
of the effectively connected income to each partner or owner
in the upper-tier partnership or the trust. For purposes of
section 1446(f), a withholding statement provided by an
intermediary for an amount realized on the transfer of a PTP
interest provides an allocation of the amount realized to each
transferor of the PTP interest or to a chapter 3 or 4
withholding rate pool when permitted under Regulations
section 1.1446(f)-4(a)(7). The withholding statement
provided by an intermediary for a PTP distribution provides
allocation information with respect to each partner receiving
a distribution of an amount subject to withholding under
section 1446(a) or (f), with respect to each beneficial owner
or payee receiving an amount subject to withholding under
chapter 3 or 4 on the distribution (such as a beneficiary of a
partner in the PTP that is a simple trust receiving a payment
subject to chapter 3 withholding), or with respect to a
chapter 3 or 4 withholding rate pool as permitted (including a
QI not assuming withholding responsibility for the distribution,
but excluding an allocation to a U.S. partner or when the QI
acts as a disclosing QI). For the limitation on when a
nonqualified intermediary may provide a withholding
statement for an amount realized, however, see Withholding
statement for amount realized or PTP distribution in Part IV,
later. Also, see Regulations section 1.1446-4(d)(1) for when
the amounts subject to withholding on a PTP distribution
cannot be determined from a qualified notice issued by the
PTP. For a withholding statement provided by a foreign
partnership to claim a modified amount realized for purposes
of section 1446(f), see the instructions for Line 21d, later.
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 upon which the intermediary or the
flow-through entity and the withholding agent mutually agree,
including electronically if certain safeguards concerning

Reverse hybrid entity. 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.
Territory financial institution. 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), for
purposes of withholding on a PTP distribution as a nominee
under Regulations section 1.1446-4(b)(3), or for an amount
realized under section 1446(f).
Transfer. A sale, exchange, or other disposition of an
interest in a partnership, and includes a distribution from a
partnership to a partner, as well as a transfer treated as a
sale or exchange under section 707(a)(2)(B).
Transferee. Any person, foreign or domestic, that acquires
a partnership interest through a transfer, and includes a
partnership that makes a distribution.
Transferor. A transferor is any person, foreign or domestic,
that transfers an interest in a partnership. In the case of a
trust, to the extent 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, the term transferor means the
grantor or other person.
Underlying security. The term underlying security is
defined in Regulations section 1.871-15(a)(15).
Withholdable payment. The term withholdable payment is
defined in Regulations section 1.1473-1(a).
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)

-8-

Instructions for Form W-8IMY (Rev. 10-2021)

a treaty should check the appropriate box (including
“Withholding foreign partnership” or “Withholding foreign
trust” if the entity has entered into a withholding agreement).
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.

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).
Additional information is required for a withholding statement
from a QDD. See QDD withholding statement, later.

Specific Instructions

Form W-8IMY may be provided to satisfy

TIP documentation requirements for purposes of

Part I — Identification of Entity

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

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

An upper-tier foreign partnership that is allocated ECTI as a
partner in a lower-tier partnership (LTP) may request, if
certain requirements are met, the lower-tier partnership
perform withholding under section 1446(a) on that ECTI
taking into account the status of the partners in the upper-tier
partnership. Upper-tier PTPs are not permitted to use these
look-through rules. 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 ECTI of the upper-tier
partnership will be allocated to the partners. Domestic
non-PTPs that meet similar requirements may be able to
elect to apply look-through rules, if the LTP agrees, by using
Form W-9, instead of a W-8IMY. For further information, see
Regulations section 1.1446-5. A foreign grantor trust that is
allocated ECTI 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.

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.
Line 3. If you are a disregarded entity receiving a payment,
enter your name (if required). You are required to complete
line 3 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.
If you are a disregarded entity that is a QDD, identify the
QDD by the name used by the QDD for the QI application.
For instructions for identifying the names of multiple QDDs,
see QDD withholding statement, later.
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.

!

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 (including a
QDD), WP, or WT. If you are a U.S. branch that does not
agree to be treated as a U.S. person and that does not make
the certification on line 19c, you should check
nonparticipating FFI; otherwise, leave line 5 blank. By
checking a box on this line, you are representing that you
qualify for this classification.

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
Instructions for Form W-8IMY (Rev. 10-2021)

-9-

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, an upper-tier partnership or trust that is allocated
ECTI (or receives a PTP distribution attributable to ECTI) as a
partner in a lower-tier partnership is required to provide a
U.S. TIN. The requirement to include a U.S. TIN in this line 8
also applies to a foreign partnership or a foreign trust
receiving an amount realized from a transfer of an interest in
a partnership conducting a trade or business in the United
States. Additionally, a QSL providing this form with respect to
a U.S. source substitute dividend must provide an EIN (a
QI-EIN if the QSL is a QI).

For most of the chapter 4 classifications, you are

TIP required to complete additional certifications found in

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). 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
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 on 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.

Line 9a. Complete line 9a if you are a participating FFI
(including a reporting Model 2 FFI), registered
deemed-compliant FFI (including a reporting Model 1 FFI
and a sponsored FFI described in Regulations section
1.1471-5(f)(1)(i)(F)), direct reporting NFFE (including a
sponsored direct reporting NFFE), or trustee of a trustee
documented trust that is a foreign person, you are required to
enter your GIIN (with regard to your country of residence) on
line 9a. If you are a trustee of a trustee-documented trust and
you are a foreign person, you should provide the GIIN that
you received when you registered as a participating FFI or
reporting Model 1 FFI. In addition, you must provide your
GIIN on line 9a if you are a nonreporting IGA FFI that is: (1)
treated as registered deemed-compliant under Annex II to an
applicable Model 2 IGA, or (2) a registered
deemed-compliant FFI under Regulations section 1.1471-5(f)
(1).
If you are a QI acting as a QDD, you must provide your
GIIN on line 9a if you have one.
If you are a certified deemed-compliant FFI described in
Part XIV of this form, provide the GIIN of your sponsoring
entity on line 9a.

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.

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

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.

TIP a participating FFI, registered deemed-compliant FFI

(including a sponsored FFI), reporting Model 1 FFI,
reporting Model 2 FFI, direct reporting NFFE, sponsored
direct reporting NFFE, or nonreporting IGA FFI but have not
received a GIIN, you may complete line 9a by writing “applied
for.” However, the person requesting this form from you must
receive and verify your GIIN within 90 days.

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 (that is, 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.

If you are a disregarded entity that completed Part I, line 3,
do not enter your GIIN on line 9a. Instead, enter it on line 13.
Line 9b. Complete line 9b if you are a QDD that must
provide a foreign taxpayer identification number (FTIN). For
information on this requirement (and when an FTIN is not
required), see QDD withholding statement, later.

Line 7. Enter your mailing address only if it is different from
the address you show on line 6.

Line 10. You, or a withholding agent, may use this line 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 use line 10 for a referencing
number or code that will make the association clear.

Line 8. You must provide an employer identification number
(EIN) if you are a U.S. branch or are a territory financial
institution that certifies that it has agreed to be treated as a
U.S. person for any payments associated with this Form
W-8IMY.
If you are acting as a QI (including a QDD), withholding
foreign partnership, or withholding foreign trust, check the
-10-

Instructions for Form W-8IMY (Rev. 10-2021)

Part II — Disregarded Entity or
Branch Receiving Payment

If you are in the process of registering your branch

TIP with the IRS 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.

Complete Part II for a disregarded entity that has its own GIIN
and is receiving a withholdable payment or for a branch
(including a branch that is a disregarded entity that does not
have its own GIIN) operating in a jurisdiction other than the
country of residence identified on 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 9a,
and the Country B branch should complete this Part II by
identifying itself as a reporting Model 1 FFI and providing its
GIIN on line 13. If the Country B branch receiving the
payment is a disregarded entity, you may be required to
provide its legal name on line 3.

Certification of Chapter 3 Status:
Parts III Through VIII

You should only complete one part from Parts III through VIII.
Generally, if you are acting in multiple capacities, you should
provide separate Forms W-8IMY for each capacity. For
example, if you are acting as a QI for one account, but an
NQI for another account, you should provide one Form
W-8IMY in your capacity as a QI and a separate Form
W-8IMY in your capacity as an NQI.
You may, however, provide a single Form W-8IMY that
covers more than one category of QI provided that you
properly identify the accounts and/or transactions, as
required, on a withholding statement. For example, if you are
a QI that acts as both a QI and a QDD, you may provide a
single Form W-8IMY with a withholding statement
designating each type of account or transaction.

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.
If you have multiple branches/disregarded entities
receiving payments from the same withholding agent and the
information in Part I is the same for each branch/disregarded
entity that will receive payments, you may provide (and a
withholding agent may accept) a single Form W-8IMY with a
separate schedule attached that includes all of the Part II
information for each branch/disregarded entity rather than
separate Forms W-8IMY to identify each branch receiving
payments associated with the form. You must also provide
the withholding agent with sufficient information to associate
the payments with each branch/disregarded entity.

Part III — Qualified Intermediary
Line 14. Check the box on line 14 if you are a QI (whether or
not you assume primary withholding responsibility) for the
payments for which you are providing this form. By checking
the box, you are certifying to the applicable statements
contained on line 14. See the QI agreement for the definition
of “account” for purposes of Part III.
Line 15. Complete line 15 only if you are acting as a QI that
is not a QDD. To the extent you are a QI acting as a QDD,
see the instructions for line 16. If you are acting in both QI
capacities, you should complete both lines 15 and 16 to the
extent applicable.
Line 15a. Check the box on line 15a if you have assumed
primary withholding responsibility under both chapter 3 and
chapter 4 with respect to the account(s) identified on a
withholding statement attached to this form (or, if no
withholding statement is attached to this form, for all
accounts). The representation made in this box on line 15a
may be made regardless of whether you assume primary
withholding responsibility for a PTP distribution (by checking
the box on line 15c) as the representation made on this
line 15a does not apply to an amount subject to chapter 3
withholding on a PTP distribution.
Furthermore, the box on line 15a may be checked
regardless of which boxes you check on lines 15b through
15i for any accounts identified on a withholding statement.
Line 15b. Check the box on line 15b if you have assumed
primary withholding and reporting responsibilities under
section 1446(f) for each payment of an amount realized on a
sale of a PTP interest associated with each account identified
on a withholding statement attached to this form for receiving
such amounts (or, if no withholding statement is attached to
this form, for all accounts).
Line 15c. Check the box on line 15c if you have assumed
primary withholding responsibility as a nominee for each
distribution by a PTP that is associated with each account
identified on a withholding statement attached to this form for
receiving such distributions (or, if no withholding statement is
attached to this form, for all accounts).

If you are a QDD home office or you are a QI and have
one or more QDD branches, do not complete Part II for any
branches that are acting in their QDD capacities. Instead,
provide the relevant branch information that you would
otherwise provide on Part II (including the information
required for chapter 4 purposes, as required) on your
withholding statement.
Line 11. Check the one box that applies. If no box applies
to the disregarded entity, you do not need to complete Part II.
If you check reporting Model 1 FFI, reporting Model 2 FFI, or
participating FFI, you must complete line 13. If you are a
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 branch treated as nonparticipating
FFI. 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.
Line 12. Enter the address of the branch or disregarded
entity.
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 9a. If you
are a U.S. branch, do not enter a GIIN on line 13.

Instructions for Form W-8IMY (Rev. 10-2021)

-11-

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.

Line 15d. Check the box on line 15d if you are a QI that is
acting as a QSL with respect to payments associated with
each account identified on a withholding statement attached
to this form (or, if no withholding statement is attached to this
form, for all accounts) that are U.S. source substitute
dividends made in 2021 or 2022 by a party to a securities
lending transaction (as described in Notice 2010-46) for
which you are not acting as a QDD. See Notice 2020-2 and
Qualified securities lender (QSL), earlier, for the limitation on
when a QI is permitted to act as a QSL.
Line 15e. Check the box on line 15e 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 and regardless of whether you act
as a QDD or QSL.
Line 15f. Check the box on line 15f if you have assumed
primary Form 1099 reporting and backup withholding
responsibility with respect to the accounts identified in a
withholding statement associated with this form or if you are
a participating FFI or registered deemed-compliant FFI that
meets the requirements to report only under Regulations
sections 1.6049-4(c)(4)(i) and (c)(4)(ii). For accounts for
which you check this box on line 15f, you should not check
the boxes on lines 15g through 15i.

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).

!

Although, as a QI, you obtain withholding certificates or
appropriate documentation from beneficial owners or
payees, as specified in your QI agreement, you do not need
to attach the certificates or documentation to this form unless
you are acting as a disclosing QI with respect to an amount
realized or PTP distribution. Also, 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.
Line 16a. Check the box on line 16a to certify that each
QDD identified on the form or on the QDD withholding
statement that is acting as a QDD meets the requirements to
act as a QDD in Regulations section 1.1441-1(e)(6) and
assumes primary withholding and reporting responsibilities
under chapters 3, 4, and 61, and section 3406 with respect to
potential section 871(m) transactions and has been
approved by the IRS to act as a QDD.

If you checked boxes 15a and 15f with respect to any

TIP accounts, or box 15b or 15c (as applicable) and the

box on line 15f when this form is associated with an
amount realized or PTP distribution, you do not have to
provide a withholding statement for any payments made to
those accounts.

A QDD must act as a QDD for all payments it
receives as a principal with respect to potential
CAUTION section 871(m) transactions and underlying
securities, excluding any payments that are treated as
effectively connected with the conduct of a trade or business
within the United States within the meaning of section 864. A
QDD may not act as a QDD for any other payments it
receives. To certify your foreign status for any other payment
of U.S. source income you beneficially own, see Who Must
Provide Form W-8IMY and Do Not Use Form W-8IMY If You
are Described Below, earlier.

Line 15g. Check the box on line 15g if you have not
assumed primary Form 1099 reporting and backup
withholding responsibility with respect to the account(s)
identified on a withholding statement attached to this form
(or, if no withholding statement is attached to this form, for all
accounts). This box applies to an amount realized only if you
have not checked the box on line 15b and does not apply to a
payment made by a QSL that is described on line 15d. If you
check the box on line 15g, check the applicable
certification(s) on line 15h or 15i.
Lines 15h and 15i. 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 certify by checking the boxes on lines
15h and/or 15i (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

!

Line 16b. Check the box to indicate your status, including if
you are a QDD that is a disregarded entity claiming treaty
benefits. If the QDD is a branch other than a disregarded
entity (that is, a branch that is not a separate legal entity from
its home office), check the box to indicate the status of the
entity identified in Part I. If the Form W-8IMY is being used for
more than one QDD and different boxes must be checked for
different QDDs, check all relevant boxes and include the
applicable information on the withholding statement for each
QDD. See QDD withholding statement, later.
Claim of treaty benefits or beneficial ownership. If you
are acting as a QDD, you may be entitled to claim treaty
benefits for certain payments that are subject to withholding
that you receive in your principal capacity (for example,
interest payments or payments of dividends beginning in
-12-

Instructions for Form W-8IMY (Rev. 10-2021)

specific partners receiving the payment (rather than including
any part of the payment in any chapter 3 withholding rate
pool) when you act as a disclosing QI for a payment of an
amount realized or PTP distribution.
For chapter 4 purposes. If you are a QI and you receive
a withholdable payment, you must provide a withholding
statement which satisfies the requirements of an FFI
withholding statement or chapter 4 withholding statement (if
you are not an FFI) when you do not assume primary
withholding responsibility under chapter 3 and chapter 4 and
Form 1099 reporting and backup withholding responsibility
for the payment.
If you are a QI that is an FFI you 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). You may also provide on the withholding
statement a single pool of nonparticipating FFIs, a single pool
of recalcitrant account holders of yours or of or another
intermediary that is a participating FFI or registered
deemed-compliant FFI, and, if you do not assume primary
Form 1099 and backup withholding responsibility, a
chapter 4 withholding rate pool of U.S. payees. A chapter 4
withholding rate pool of U.S. payees may include:
• If you are a reporting Model 1 FFI, an account holder that
is not withheld on under chapter 3, chapter 4, or section 3406
that you report as a U.S. account pursuant to the Model 1
IGA because the account has U.S. indicia and you have not
obtained appropriate documentation to treat the account as
held by other than a specified U.S. person;
• If you are a reporting Model 2 FFI, an account holder that
is not withheld on under chapter 3, chapter 4, or section 3406
that you report as an account holder of a non-consenting
U.S. account as described in the Model 2 IGA;
• If you are 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 you report under
chapter 4 or an applicable IGA (including the account
holder’s TIN).
Additionally, a chapter 4 withholding rate pool of U.S.
payees may be provided in the above-described cases for a
payment of an amount realized for which a withholding
statement is provided for purposes of section 1446(f) that
allocates some amount of the payment to a U.S. person.
See, For a payment of an amount realized, later, and
Example 5 and Example 6, later.
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.
If you are a QI that is not an FFI and that does not assume
primary withholding responsibility under chapter 3 and
chapter 4, you 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 each payee, the amount allocated to each payee, a

2023). See Notice 2020-2. To make a claim for treaty
benefits in such a case, you may provide your withholding
agent a statement associated with your Form W-8IMY that
contains the information required in Part III of Form
W-8BEN-E, including (if applicable) a treaty claim by a hybrid
entity that is a disregarded entity that is identified on a QDD's
withholding statement described in the instructions for Part II.
Alternatively, a Form W-8BEN-E may be used for this
purpose. An entity acting as a QDD (other than a
flow-through entity or disregarded entity) for a payment of
U.S. source FDAP income may also use Form W-8IMY to
claim status as the foreign beneficial owner of the payment
when the entity provides its foreign TIN (when required) on
line 9b to this form).
If you are acting as a QDD and fiscally transparent in
your jurisdiction of organization, do not claim treaty
CAUTION benefits as described in these instructions. Instead,
you must include the withholding certificates or documentary
evidence of the owners claiming treaty benefits and provide
an allocation on the withholding statement.

!

QDD branch of a U.S. person. If you are a foreign branch
of a U.S. person that is acting as a QDD and you receive a
payment that otherwise would be subject to withholding
except for the U.S. person’s status as a U.S. person, you
may associate this Form W-8IMY with a Form W-9 from the
U.S. person.
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 withholding
responsibility under chapter 3 and chapter 4 with respect to
the payment for one or more accounts (as indicated
otherwise on line 15a), or if you are receiving a reportable
amount on behalf of a U.S. non-exempt recipient, you have
not assumed primary Form 1099 reporting and backup
withholding responsibility for the payment. You must also
provide a withholding statement for an amount realized or a
PTP distribution for which you have not assumed primary
withholding responsibility. 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. If you are a QDD, see also QDD withholding statement,
later.
A QI withholding statement must also:
• Designate those accounts for which you act as a QI;
• Designate those accounts for which you are assuming
primary withholding and reporting responsibility under
chapter 3 and chapter 4;
• If you receive an amount realized or a PTP distribution,
designate those accounts for which you are assuming
primary withholding and reporting responsibility for either
such amount;
• 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
• For any account for which you are not assuming primary
withholding and reporting responsibility, 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)
(with respect to a chapter 4 withholding rate pool). You must,
however, provide information to allocate the payment to the
Instructions for Form W-8IMY (Rev. 10-2021)

-13-

allocate the amounts subject to withholding on the
distribution to each U.S. partner.
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))
or when the alternative procedure is used. The pools are
based on valid documentation that you obtain or, if a
payment cannot be reliably associated with valid
documentation, the applicable presumption rules.

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 you maintain or hold accounts with an
intermediary or flow-through entity receiving the payment
from you. You 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, if it is not required to be separately
reported. 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.
For a payment of an amount realized. In the case of a
payment of an amount realized, you must provide chapter 3
withholding rate pool information with respect to the foreign
transferors receiving the payment for your broker to meet its
withholding and reporting obligations (except when you act
as a disclosing QI). See Regulations section 1.1446(f)-4(a)
(7)(iii). The chapter 3 withholding rate pool information you
provide on a withholding statement may be properly adjusted
to take into account the withholding required on a transferor
that is a foreign partnership for which you permit a modified
amount realized. With respect to U.S. transferors receiving
an amount realized, and regardless of whether you act as a
disclosing QI, you must allocate the payment to each such
transferor to the extent of the amount that may not be
allocated to a chapter 4 withholding rate pool of U.S. payees
(to the extent permitted for chapter 4 purposes).
For a PTP distribution. In the case of a PTP distribution,
you must provide to the PTP or nominee from which you
receive the distribution chapter 3 withholding rate pool
information and chapter 4 withholding rate pool information
(when permitted for chapter 4 purposes) for your foreign
partners with respect to the amounts subject to withholding
on the distribution (except when you act as a disclosing QI).
For determining the amounts to include in each withholding
rate pool, the QI must rely on the allocation of each amount
subject to withholding on the distribution as determined by
the PTP or nominee that pays the distribution to the QI. When
acting as a disclosing QI for a PTP distribution, you must
provide with respect to each partner an allocation of the
income attributable to the distribution that is subject to
withholding under section 1446(a) or (f) (and, for an amount
subject to chapter 3 or 4 withholding, an allocation of such
amount to each beneficial owner or payee). See Withholding
statement, earlier, for the requirements of a withholding
statement provided by an intermediary for a PTP distribution.
Regardless of whether you act as a disclosing QI, you must

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
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 the boxes on lines 14, 15a, and 15f.
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).
The 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. The QI need not
allocate any portion of the payment specifically to A or B
because the 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). For
payments made on or after April 1, 2017, see the instructions
for Part IV of this form for when a withholding statement
includes an allocation of a payment of an amount subject to
chapter 3 withholding that is made to a pool of U.S. payees.
-14-

Instructions for Form W-8IMY (Rev. 10-2021)

information specified in Regulations section 1.1446(f)-4(c)(2)
(ii)(C) for QI to determine a modified amount realized of $10
(one-half of the $20 is allocable to partners of F who are
nonresident alien individuals and one-half allocable to a U.S.
partner of F (USP)), and QI does not report F’s account as a
U.S. account for purposes of chapter 4 reporting;
• $10 on behalf of foreign grantor trust H, an account holder
of QI that has provided to QI the documentation from which
QI can associate the amount realized with G, a nonresident
alien that is the sole grantor of the trust;
• $10, on behalf of N, an account holder of the QI that is a
nonqualified intermediary.
As QI is not acting as a disclosing QI for this payment, QI
may provide to its U.S. broker a withholding statement that
allocates the amount realized to chapter 3 withholding rate
pools, excluding amounts allocable to a U.S. partner or to a
chapter 4 reporting pool of U.S. payees. QI must report on
the withholding statement the payment allocated as follows:
• To a chapter 3 withholding rate pool at a 10% rate - $70
(for the $40 allocable to A and B, $10 allocable to F’s
nonresident alien partners; $10 allocable to G, and $10
allocable to N);
• To a chapter 4 withholding rate pool of U.S. payees - $20
(for the total amount allocable to C and D); and
• To USP, for the $10 of the $20 of amount realized by F that
is allocable to USP.
The QI will complete Form W-8IMY and check the box on
line 14. As QI does not assume primary withholding
responsibility under section 1446(f) for the amount realized,
QI must not check the box on line 15b but should check the
boxes on lines 15g and 15h because it has not assumed
Form 1099 reporting and backup withholding responsibility.
QI does not account for any of the account holders of N on its
withholding statement as withholding applies to N at the 10%
rate on the payment regardless of the statuses of N’s
account holders receiving the payment. See Regulations
section 1.1446(f)-4(a)(2) for this withholding requirement.
See Withholding statement for amount realized or PTP
distribution in Part IV, later, however, for when N (as an NQI)
would be permitted to provide to QI allocation information
and beneficial owner withholding certificates for the account
holders of N receiving the amount realized from the sale.
With respect to grantor trust H, the withholding is determined
with respect to grantor G, rather than H, as G is the transferor
of the PTP interest. With respect to foreign partnership F, the
withholding statement includes the $10 allocable to F’s
foreign partners in a chapter 3 withholding rate pool at the
10% rate as these partners did not claim any exception to
withholding based on an income tax treaty. With respect to
USP, QI discloses the identity of USP on the withholding
statement because it does not assume primary Form 1099
reporting and backup withholding responsibility and does not
report the account of USP for purposes of QI’s chapter 4
requirements as a participating FFI. QI must also provide the
documentation permitted for section 1446(f) purposes to
support USP’s non-foreign status. With respect to C and D,
however, as QI reports their accounts under QI’s
requirements as a participating FFI, QI may report the
amount realized allocable to C and D in a chapter 4
withholding rate pool of U.S. payees.

The QI must also provide a Form W-9 (or alternatively, name
and TIN) for D. A Form W-9 is not required for C. The QI will
provide Form W-8IMY and check the boxes on lines 14, 15a,
and 15g and 15h.
Example 3. The facts are the same as Example 1, except
the QI is a U.S. payor and does not assume primary Form
1099 and backup withholding responsibility.
Because the 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.
The 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. The QI will provide Form
W-8IMY and check the boxes on lines 14 and 15a.
Example 4. The facts are the same as Example 1,
except the QI is a non-U.S. payor that does not assume
primary withholding and reporting responsibility under
chapter 3 and chapter 4. The 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).
The 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). The QI will provide
Form W-8IMY and check the boxes on lines 14, 15g, and
15h.
Example 5. A QI that is foreign corporation and a
Participating FFI does not assume primary withholding and
reporting responsibility for a payment of $100 from a U.S.
broker that is an amount realized from the sale of a PTP
interest. The QI also does not assume primary Form 1099
reporting and backup withholding responsibility for any of its
accounts. The QI holds the PTP interest in an account with a
U.S. broker and does not act as a disclosing QI for the
payment of the amount realized. The QI determines that the
amount realized from the sale is allocable to the following
transferors of the interest in the PTP on whose behalf the QI
held the interest:
• $20 each on behalf of A and B, two nonresident alien
individuals who are account holders of the QI;
• $10 each on behalf of C and D, two 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;
• $20 on behalf of F, a foreign partnership and account
holder of the QI that has provided the certification and other
Instructions for Form W-8IMY (Rev. 10-2021)

Example 6. The facts are the same as Example 5, except
the QI acts as a disclosing QI for the payment of the amount
realized. Unlike Example 5, because the QI is a disclosing
QI, it may not allocate any portion of the payment to a
chapter 3 withholding rate pool on the withholding statement
-15-

provided to the U.S. broker. QI must instead allocate the
payment of the amount realized to each account holder that
is a transferor of the PTP interest, excluding any transferors
that are includible in a chapter 4 withholding rate pool of U.S.
payees. See Regulations section 1.1446(f)-4(a)(7)(iii). Thus,
with respect to QI’s account holders that are foreign
transferors, QI must allocate $20 of the amount realized each
to A and B and must associate a valid Form W-8BEN for
each of them with the withholding statement. With respect to
foreign partnership F, QI must identify F as the transferor of
the interest (with a valid Form W-8IMY from F completed in
accordance with Part VIII , later), must indicate on its
withholding statement that QI has determined a modified
amount realized of $10 from the $20 of the amount realized
allocable to F, and must allocate the amount realized
between each of the partners of F based on the certification
and withholding statement provided by F for this payment in
accordance with Regulations section 1.1446(f)-4(c)(2)(ii)(C).
QI must include on the withholding statement the amount
allocable to USP for the reasons noted in Example 5, earlier,
(with the documentation permitted to support USP’s
non-foreign status) that F should have provided to QI with its
withholding statement. With respect to foreign grantor trust
H, QI must allocate the $10 received on behalf of H to G (as
G is the transferor), and must associate with the withholding
statement a valid Form W-8IMY from H (completed in
accordance with Part VIII, later), a valid Form W-8BEN from
G, and information provided by H regarding the amount
realized allocable to G. With respect to nonqualified
intermediary N, QI must allocate the $10 received on behalf
of N to N and associate this amount with the withholding
statement and a valid Form W-8IMY from N. See Withholding
statement for amount realized or PTP distribution in Part IV,
later, however, for when N would also be permitted to provide
to QI allocation information and beneficial owner withholding
certificates for the account holders of N receiving the amount
realized from the sale. As indicated in Example 5, earlier, QI
may include C and D in a chapter 4 withholding rate pool of
U.S. payees with respect to the amount allocable to them (an
allowance that applies even when a QI acts as a disclosing
QI for an amount realized).
Alternative procedure for reportable amounts paid to
U.S. non-exempt recipients (and for chapter 4). 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

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. Your withholding statement 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.
QDD withholding statement. Similar to a QI withholding
statement, a QDD withholding statement becomes an
integral part of a QDD's Form W-8IMY. In addition to the
information required on a withholding statement (if any) you
provide in your QI capacity, generally a QDD withholding
statement should (as applicable) for each QDD (identifying
the QDD by name used for the QI application):
• Designate the accounts for which the QDD is receiving
payments with respect to potential section 871(m)
transactions or underlying securities as a QDD;
• Designate the accounts for which the QDD is receiving
payments with respect to potential section 871(m)
transactions as a QDD (and that are not underlying
securities) for which withholding is not required;
• Designate the accounts for which the QDD is receiving
payments with respect to underlying securities as a QDD for
which withholding is required; and
• Identify the home office or branch that is treated as the
owner for U.S. income tax purposes.
If you are acting as a QDD that meets the conditions
described below, you must provide on line 9b, your foreign
taxpayer identification number (FTIN) issued by the
jurisdiction in which you are tax resident identified on line 6,
unless you were not issued an FTIN (including if the
jurisdiction does not issue FTINs). If you do not provide your
FTIN, you must provide on your QDD withholding statement
a reasonable explanation of why you have not been issued
an FTIN. For this purpose, such an explanation includes a
statement that you are not legally required to obtain an FTIN
in your jurisdiction of tax residence. Do not write “not
applicable.” If you are acting as a QDD, you are required to
provide your FTIN or an explanation of why you have not
been issued an FTIN if:
• You are providing this Form W-8IMY to document yourself
as an account holder (as defined in Regulations section
1.1471-5(a)(3)) with respect to a financial account (as
defined in Regulations section 1.1471-5(b)) that you hold at a
U.S. office of a financial institution (including a U.S. branch of
an FFI);
• You receive U.S. source income reportable on a Form
1042-S associated with this form; and
• This form is treated as a beneficial owner withholding
certificate under Regulations section 1.1441-1(e)(2)(i).
If you are a QDD using its Form W-8IMY to make a claim
for treaty benefits, see Claim of treaty benefits or beneficial
ownership, earlier, for the information required for the claim
(including for a hybrid entity that is a disregarded entity).

Part IV — Nonqualified Intermediary
Line 17a. If you are providing Form W-8IMY as a
nonqualified intermediary (NQI), you must check the box on
line 17a. By checking this box, you are certifying to all of the
statements on line 17a.
Line 17b. Check the box on line 17b if you are using this
form to transmit withholding certificates or other
-16-

Instructions for Form W-8IMY (Rev. 10-2021)

For chapter 4 purposes. If you are an NQI that is a
participating FFI or registered deemed-compliant FFI and
you receive a withholdable payment, you must provide a
withholding statement which satisfies the requirements of an
FFI withholding statement or chapter 4 withholding
statement.
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 a participating FFI (including a reporting Model 2 FFI)
or a registered deemed-compliant FFI (including a reporting
Model 1 FFI), U.S. payees. However, if you are an NQI, you
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 you
satisfy the requirements to provide such a pool (including the
requirement to certify to your 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 a 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
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 a 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.

documentation along with a withholding statement that
satisfies the requirements of chapters 3 and 4 (including for
purposes of section 1446(a) and including if you are
providing pooled information for purposes of chapter 61
under the alternative procedure for U.S. non-exempt
recipients, or chapter 4 withholding rate pools (as applicable)
for a withholdable payment).
If you are required to provide a chapter 4 status on

TIP 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 the
box on line 17b (except for documentation provided with
respect to exempt beneficial owners).
Line 17c. Check the box on line box 17c 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. This checkbox does not
apply to a PTP distribution. You may check this box with
respect to U.S. source substitute dividends you receive as a
QSL regardless of whether you act as an intermediary or
principal for those amounts. See the instructions to line 8 for
a QSL's requirement to provide a U.S. TIN.
Line 17d. Check the box on line 17d 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. You may check this box with respect to
U.S. source substitute dividends you receive as a QSL
regardless of whether you act as an intermediary or principal
for those amounts. See the instructions for line 8 for a QSL's
requirement to provide a U.S. TIN.
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 for both chapter 3 and
chapter 4 purposes.
If you are an NQI receiving an amount realized from
the transfer of a PTP interest, however, the
CAUTION preceding paragraph and the representation made
on line 17b applies only to the extent indicated in Withholding
statement for amount realized or PTP distribution, later.

!

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). Instead,
an allocation of a payment of an amount subject to chapter 3
withholding to a withholding rate pool of U.S. payees must
identify the payees as described in Regulations section
1.1471-3(c)(3)(iii)(B)(2).

!

Withholding statement of an NQI. If you are an NQI, you
must provide a withholding statement and appropriate
documentation to obtain reduced rates of withholding under
chapter 3 and section 3406 for your customers receiving
reportable amounts 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 instead of documentation for those payees.
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.
Instructions for Form W-8IMY (Rev. 10-2021)

For chapter 3 and chapter 61 purposes. For chapter 3
and chapter 61 purposes, in the case of a reportable amount
that is also a withholdable payment, the withholding
statement should allocate only the portion of the payment
that was not allocated to a chapter 4 withholding rate pool 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. The withholding
statement must generally include the following information.
-17-

• 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 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, the
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, 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.
• 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.
Withholding statement for amount realized or PTP
distribution. In the case of a PTP distribution, an NQI may
provide a withholding statement and appropriate
documentation for each of its account holders receiving the
distribution to allocate to its account holders the amounts
subject to withholding on the distribution under chapters 3
and 4 (or under section 1446(a)). See Withholding statement,
earlier, for additional requirements of a withholding statement
provided by an intermediary for a PTP distribution.
In the case of an amount realized (including on a PTP
distribution), however, an NQI may provide a withholding
statement and appropriate documentation on the transferors
of the PTP interest only when:
• The broker paying the amount realized to the NQI agrees
to report (or ensures another broker will report) under section
1461 (and, if required, under section 6045) with respect to
the amount realized allocated each of the account holders
that are the transferors of the PTP interest (and provide NQI
a copy of each Form 1042-S issued due to this reporting);
• The NQI provides to the broker the statement described in
Regulations section 1.6031(c)-1T(a)(1) with respect to each
NQI account holder that is a partner required to be issued a
statement under section 6031(b) for the calendar year of the

payment and the information for the broker to allocate the
amount realized to each transferor; and
• The NQI receives from the broker paying the amount
realized a written representation that the broker is acting as
an agent of the PTP with respect to the statement described
in Regulations section 1.6031(c)-1T(a) or otherwise
designates the broker as its agent for providing the statement
to the PTP (or the PTP's agent).
The allowance for an NQI to provide a withholding
statement and transferor documentation applies
CAUTION despite that an NQI may not obtain reduced
withholding on an amount realized it receives from the
transfer of a PTP interest.

!

Alternative procedure for NQIs receiving reportable
amounts (and for chapter 4). 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 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, you 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 you 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, you may
include such an amount in the withholding rate pool that is
exempt from withholding (you can include such payees in an
exempt pool regardless of whether the payment is a
withholdable payment). You must identify prior to the
payment each chapter 4 withholding rate pool to be allocated
-18-

Instructions for Form W-8IMY (Rev. 10-2021)

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.
Alternative withholding statement. If a withholding
agent agrees, instead of providing a withholding statement
that contains all of the information described previously, you
may provide an alternative withholding statement for a
payment of a reportable amount. You may only use an
alternative withholding statement if you are providing the
withholding agent with withholding certificates (and not
documentary evidence) from the beneficial owners of the
payment. The alternative withholding statement is not
required to include information that is already on the
withholding certificates (including name, address, TIN,
chapter 4 status, and GIIN), and you are not required to
provide the rate of withholding applicable to each beneficial
owner, so long as the withholding agent can determine the
appropriate rate based on the withholding certificates. Just
as for a nonqualified intermediary withholding statement, the
alternative withholding statement must provide information
for allocating the payment to each payee and must include
any other information the withholding agent needs to fulfill its
withholding and reporting obligations.
Line 17e. As part of providing any alternative withholding
statements that are associated with your Form W-8IMY, you
may make the representation indicated on line 17e. If you
check the box line 17e, you are not required to represent on
each alternative withholding statement that the information
on the withholding certificates provided with the alternative
withholding statement is not inconsistent with any other
account information you have for the beneficial owners for
determining the appropriate rate of withholding. See
Regulations section 1.1441-1(e)(3)(iv)(C)(3) for further
information on the representation otherwise required on each
alternative withholding statement.

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,
for chapter 4 withholding and reporting purposes). You must
also certify that you have provided or will provide a
withholding statement (as required) with the information
required on an NQI withholding statement.
If this form is being provided for purposes of the entity’s
holding of an interest in a PTP, check the box on line 18d to
certify that you have agreed to be treated as a U.S. person
under Regulations section 1.1446(f)-4(a)(2)(i)(B) with respect
to an amount realized from a sale of a PTP interest. You may
provide a withholding statement when you do not act as a
U.S. person for an amount realized under the same
conditions that apply to an NQI receiving an amount realized.
See Withholding statement for amount realized or PTP
distribution in Part IV, earlier. Check the box on line 18e to
certify that you have agreed to be treated as a U.S. person
(as described in Regulations section 1.1441-1(b)(2)(iv)) and
as a nominee under Regulations section 1.1446-4(b)(3) with
respect to distributions made by PTPs. If you check either the
box on line 18d or 18e, you must provide an EIN on line 8. If
you receive PTP distributions for which you do not act as a
nominee under Regulations section 1.1446-4(b)(3), check
the box on line 18f instead of the box on line 18e. You should
provide a withholding statement to allocate the amounts
subject to withholding on a distribution and provide the
appropriate account holder documentation, taking into
account the limitation on an NQI providing this
documentation for an amount realized (to the extent
applicable). See Withholding statement, earlier, for the
requirements of a withholding statement provided by an
intermediary for a PTP distribution.

Part V — Territory Financial
Institution

Part VI — Certain U.S. Branches

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

!

Line 19. Check the box on line 19a to certify that you are a
U.S. branch receiving payments of income that are
reportable amounts or withholdable payments not effectively
connected with the conduct of a trade or business in the
United States, payments of PTP distributions, or payments of
amounts realized.
You must also check either the box on line 19b or 19c if
you are receiving payments of reportable amounts or
withholdable payments associated with this form. Check the
box on line 19b to certify that you are a U.S. branch of a
foreign bank or insurance company described in this
certification that has agreed with the withholding agent to be
treated as a U.S. person under Regulations section
1.1441-1(b)(2)(iv) with respect to such payments associated
with this Form W-8IMY. In such case, you will be responsible
for chapter 3 withholding and reporting and chapter 4
withholding and reporting for any such payments you make
to persons for whom you are receiving a withholdable
payment (including any of your branches treated as NPFFIs).
In addition, you will be treated as a U.S. payor for chapter 61
purposes by checking the box on line 19b (including for
backup withholding under section 3406). You must provide
your EIN on line 8. You do not need to provide a chapter 4
status on line 5 or a GIIN on line 9.

Line 18. Check the box on line 18a 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 territory of the United States.
You must also check either the box on line 18b or 18c, the
box on line 18d, and either the box line on 18e or 18f (each
box as applicable based on the types of payments received).
Check the box on line 18b 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 of reportable
amounts and withholdable 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 the box on line 18b, you must provide an EIN on
line 8.
Check the box on line 18c to certify that you are a territory
financial institution that has not agreed to be treated as a
U.S. person for reportable amounts and withholdable
payments associated with this form. You must certify that you
are transmitting withholding certificates or other
Instructions for Form W-8IMY (Rev. 10-2021)

-19-

or any other amount subject to withholding on a PTP
distribution. 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 on line 5 and provide your GIIN (if applicable).

Check the box on line 19c to certify that you are a U.S.
branch that does not have an agreement with the withholding
agent to be treated as a U.S. person under Regulations
section 1.1441-1(b)(2)(iv). You must certify that you are
transmitting withholding certificates or other documentation
for persons for whom you are receiving the payment of a
reportable amount or withholdable payment. You must also
certify that you have provided or will provide a withholding
statement (as required) with the information required on an
NQI withholding statement. Also, check the box on line 19c to
certify that, when you are receiving a withholdable payment
associated with this form, you are applying the rules
described in Regulations section 1.1471-4(d)(2)(iii)(C). You
must also provide your EIN on line 8 but do not need to
include a chapter 4 status in Part I, line 5, or a GIIN on line 9.
If you are unable to make this certification, you cannot fill out
this part but instead must check the box on line 5 indicating
you are a nonparticipating FFI.
If this form is being provided for purposes of the entity’s
holding of an interest in a PTP, check the box on line 19d to
certify that you are a U.S. branch described in Regulations
section 1.1446(f)-4(a)(2)(i)(B) that is acting as a U.S. person
with respect to an amount realized from the sale of a PTP
interest. You may provide a withholding statement when you
do not act as a U.S. person for an amount realized under the
same conditions that apply to an NQI receiving an amount
realized. See Withholding statement for amount realized or
PTP distribution in Part IV, earlier. Check the box on line 19e
to certify that you are a U.S. branch described in Regulations
section 1.1441-1(b)(2)(iv) that is acting as a nominee with
respect to distributions by PTPs under Regulations section
1.1446-4(b)(3). You must provide your EIN on line 8 but do
not need to provide a chapter 4 status on line 5 or a GIIN on
line 9 when you check either the box on line 19d or 19e. If
you are a U.S. branch receiving PTP distributions associated
with the form and are not acting as a nominee for the
distributions under Regulations section 1.1446-4(b)(3), you
should check the box on line 19f instead of the box on
line 19e. You should provide a withholding statement to
allocate the amounts subject to withholding on a distribution
and provide the appropriate account holder documentation,
taking into account the limitation on an NQI providing this
documentation for an amount realized (to the extent
applicable). See Withholding statement, earlier, for the
requirements of a withholding statement provided by an
intermediary for a PTP distribution.

Part VIII — Nonwithholding Foreign
Partnership, Simple Trust, or Grantor
Trust
Line 21a. Check the box on line 21a if you are a foreign
partnership or a foreign simple or grantor trust that is not a
WP or WT, and is providing this form for payments that are
not effectively connected, or are not treated as effectively
connected, with the conduct of a trade or business in the
United States.
Line 21b. Check the box on line 21b if you are a foreign
partnership or foreign grantor trust providing this form for
purposes of section 1446(a). See Foreign partnerships and
trusts providing Form W-8IMY for purposes of section
1446(a), later. If you are a foreign partnership (other than a
WP) or grantor trust receiving payments of both the amounts
described on line 21a and for purposes of section 1446(a),
you should check both boxes. By checking either box, you
are certifying to the applicable statements on the form.
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), when you are permitted to use that form to claim an
exemption from withholding. If you are not receiving the
income on behalf of your partners, beneficiaries, or owners,
do not complete Part VIII. 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 provide 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.
If you are receiving a withholdable payment, you must
provide a chapter 4 status on line 5 and provide your GIIN (if
applicable) and the information required for the withholding
agent to report under section 1472 (to the extent required).

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

Withholding statement of nonwithholding foreign partnership or nonwithholding foreign trust for purposes of
chapters 3 and 4. 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 as
required for an NQI withholding statement, including the
information required with respect to an NQI, foreign
partnership, or foreign trust (other than a WP or WT) for
which you receive a payment. The withholding statement
becomes an integral part of the Form W-8IMY. 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

Line 20. Check the box on line 20 if you are a WP or a WT
and you are receiving the payment on behalf of your
partners, beneficiaries, or owners.
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). You are not, however, permitted to assume
primary withholding and reporting responsibility for payments
subject to withholding under section 1445, 1446(a), 1446(f),
-20-

Instructions for Form W-8IMY (Rev. 10-2021)

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

requirements outlined for an NQI withholding statement
described earlier.

TIP purposes of section 1446(a) or (f), you 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 or broker
making the payment to you 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.

Foreign partnerships and trusts providing Form W-8IMY
for purposes of section 1446(a). In general, a partnership
is required to withhold under section 1446(a) on effectively
connected taxable income (ECTI) allocable to a foreign
partner (or in the case of a PTP distribution, to the extent the
distribution is attributable to ECTI, unless withholding is
required by a nominee). 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, for a
partnership other than a PTP, documentation sufficient for
the LTP (or nominee for the amounts) 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.
Also, for purposes of section 1446(a), 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 the box on line 21b 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(a).

Line 21f. To the extent that the entity identified in Part 1 of
this form is providing an alternative withholding statement
described in Regulations section 1.1441-1(e)(3)(iv)(C)(3),
you may check the box on this line to make the
representation included on this line instead of making the
representation on each alternative withholding statement.
See Alternative withholding statement, earlier.

Certification of Chapter 4 Status:
Parts IX Through XXVIII

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

Lines 21c and 21d. Check the box on line 21c if you are a
foreign partnership that is a transferor of an interest in a
partnership receiving an amount realized from the transfer. If
you check the box on line 21c and are providing a
withholding statement for a modified amount realized on the
transfer, also check the box on line 21d. The withholding
statement for a modified amount realized must show the
allocation of the gain from the transfer to each of the partners
for which a lower rate of withholding is being requested, and
you must provide withholding certificates for each of the
partners to avoid the requirement that the transferee (or your
broker for a transfer of a PTP interest) treat a partner as a
presumed foreign partner.

You are not required to complete this part unless you

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

Line 22. Check the box on line 22 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 you are 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 an amount
subject to chapter 3 withholding. The withholding statement
must allocate the remainder of the payment that is not
allocated to an exempt beneficial owner to you.

For a modified amount realized, you may not use a
withholding statement that you provided to your
CAUTION transferee or broker that only allocates a reportable
amount or withholdable payment to your partners. You must
provide a withholding statement that allocates the gain from
the transfer of the PTP interest. Once you have provided that
withholding statement, you may provide it for a subsequent
amount realized provided that the gain allocations have not
changed. You may instead provide a withholding statement
that indicates both that it may be used for all reportable
amounts, withholdable payments and gains on transfers
allocable to your partners and that you will update the
withholding statement for a change to any of these
allocations.

!

Line 21e. Check the box on line 21e if you are a foreign
grantor trust providing the form on behalf of each grantor or
owner of the trust under Regulations section 1.1446(f)-1(c)(2)
(vii) that is transmitting withholding certificates and providing
a withholding statement to allocate an amount realized to
each grantor or other owner in the trust for purposes of
section 1446(f).

Instructions for Form W-8IMY (Rev. 10-2021)

Part X — Sponsored FFI
Line 23a. If you are a sponsored FFI described in
Regulations section 1.1471-5(f)(1)(i)(F), on line 23a, enter
the name of the sponsoring entity that has agreed to fulfill
your chapter 4 due diligence, reporting, and withholding

-21-

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

obligations on your behalf. You must provide your GIIN on
line 9.
Lines 23b and 23c. You must check the applicable box on
line 23b or 23c to certify that you are either an investment
entity or controlled foreign corporation (within the meaning of
section 957(a)) and satisfy the other relevant requirements
for this classification.

Line 28. You must check the box on line 28 to certify that
you satisfy the requirements for certified deemed-compliant
limited life debt investment entity status.

Part XI — Owner-Documented FFI

Part XVI — Certain Investment
Entities that Do Not Maintain
Financial Accounts

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.

!

Line 29. You must check the box on line 29 to certify that
you meet all of the requirements for certified
deemed-compliant status as an investment entity that does
not maintain financial accounts.

Line 24a. You must check the box on line 24a to certify that
you satisfy the requirements for owner-documented FFI
status 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 you (see Regulations section 1.1471-5(f)(3)).

Part XVII — Restricted Distributor
Line 30a. You must check the box on line 30a to certify that
you satisfy the requirements of restricted distributor status.
Lines 30b and 30c. You must also check either the box on
line 30b or 30c, as appropriate, to certify that your distribution
agreement meets the requirements of this classification.

Lines 24b and 24c. You must also check either the box on
line 24b or 24c. Check the box on line 24b to certify that you
have provided or will provide the documentation set forth in
the certifications, including the owner reporting statement
described on this line 24b. Check the box on line 24c to
certify that you have provided or will provide an auditor’s
letter (in lieu of the information required by line 24b) that
satisfies the requirements described on this line.

Part XVIII — Foreign Central Bank of
Issue
Line 31. You must check the box on line 31 to certify that
you are a foreign central bank of issue 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
Line 25. You must check the box on line 25 to certify that
you satisfy all of the requirements for certified
deemed-compliant nonregistering local bank status.

Part XIX — Nonreporting IGA FFI

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

Line 32. Check the box on line 32 to indicate that you are
treated as a nonreporting IGA FFI. You must identify the 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.
If you are a nonreporting financial institution 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.
See instructions for line 9 for when a GIIN is required for a
nonreporting IGA FFI (including a trustee of a
trustee-documented trust that is a foreign person).

Line 26. You must check the box on line 26 to certify that
you satisfy all of the requirements for certified
deemed-compliant FFI with only low-value account status.

Part XIV — Certified
Deemed-Compliant Sponsored,
Closely Held Investment Vehicle
Line 27a. On line 27a, 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.
Line 27b. You must check the box on line 27b to certify that
you satisfy the requirements for certified deemed-compliant
classification as a sponsored closely held investment vehicle.

-22-

Instructions for Form W-8IMY (Rev. 10-2021)

Part XX — Exempt Retirement Plans

status. See Regulations section 1.1472-1(c)(1)(iii) for the
definition of an excepted territory NFFE.

Line 33. You must check the appropriate box on line 33a, b,
c, d, e, or f to certify that you satisfy the requirements of
exempt retirement plan status.

Part XXVI — Active NFFE
Line 39. You must check the box on line 39 to certify that
you satisfy the requirements of active NFFE status.

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.

!

Part XXVII — Passive NFFE
Line 40. If you are a passive NFFE, you must check the box
on line 40 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.
Note. If you would be a passive NFFE but for the fact that
you are managed by certain types of financial institutions
(see Regulations section 1.1471-5(e)(4)(i)(B)), you should
not complete Part XXVII as you would be considered a
financial institution and not a passive NFFE.

Part XXI — Excepted Nonfinancial
Group Entity
Line 34. You must check the box on line 34 to certify that
you satisfy the requirements of excepted nonfinancial group
entity status.

Part XXVIII— Sponsored Direct
Reporting NFFE

Part XXII — Excepted Nonfinancial
Start-Up Company

Lines 41 and 42. If you are a sponsored direct reporting
NFFE, you must check the box on line 42 to certify that you
are not a financial institution and that you satisfy all relevant
requirements for this classification. Enter the name of the
sponsoring entity on line 41.

Line 35. You must check the box on line 35 to certify that
you satisfy the requirements of excepted nonfinancial
start-up company status. 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).

Part XXIX — Certification

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
Line 36. You must check the box on line 36 to certify that
you satisfy the requirements of excepted nonfinancial entity
in liquidation or bankruptcy status. You must also provide the
date that you filed a plan of liquidation, plan of reorganization,
or bankruptcy petition.

A withholding agent may allow you to provide this form
with an electronic signature. The electronic signature must
indicate that the form was electronically signed by a person
authorized to do so (for example, with a time and date stamp
and a statement that the form has been electronically
signed). Simply typing your name into the signature line is not
an electronic signature. A withholding agent may also rely on
an electronically signed withholding certificate if you provide
any additional information or documentation requested by
the withholding agent to support that the form was signed by
you or other person authorized to do so. See Regulations
section 1.1441-1(e)(4)(i)(B).

Part XXIV — Publicly Traded NFFE or
NFFE Affiliate of a Publicly Traded
Corporation
Lines 37a and 37b. If you are a publicly traded NFFE, you
must check the box on line 37a to certify that you are not a
financial institution and provide the name of a securities
exchange on which your stock is publicly traded. If you are 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, you must check the box
on line 37b to certify that you are an NFFE affiliate of a
publicly traded corporation, 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.

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 (a)

Part XXV — Excepted Territory NFFE
Line 38. You must check the box on line 38 to certify that
you satisfy the requirements for excepted territory NFFE
Instructions for Form W-8IMY (Rev. 10-2021)

-23-

determine that the certification accurately reflects your status
for chapter 4 purposes or under an applicable IGA; and (b)
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.
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
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 on 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.
Any certifications provided under an applicable IGA
remain subject to the penalties of perjury statement and other
certifications made in Part XXIX.

(if, for example, new regulations provide for an additional
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. Include a citation to the applicable provision in the
Regulations. Any such attached certification becomes an
integral part of this Form W-8IMY and is subject to the
penalties 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.
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
burden for business taxpayers filing this form is approved
under OMB control number 1545-0123. The estimated
burden for all other taxpayers who file this form is shown
below. The estimated average time is: Recordkeeping,15
hrs., 04 mins.; Learning about the law or the form, 6 hrs.,
31 mins.; Preparing the form, 8 hrs.; Sending 16 mins.
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 IRS.gov/FormComments. 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.

Entities Providing Alternate or Additional
Certifications Under Regulations

If you qualify for a status that is not shown on 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

-24-

Instructions for Form W-8IMY (Rev. 10-2021)