Form W-8BEN-E (Rev. April 2016) Department of the Treasury Internal Revenue Service Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities) For use by entities. Individuals must use Form W-8BEN. Section references are to the Internal Revenue Code. Information about Form W-8BEN-E and its separate instructions is at www.irs.gov/formw8bene. Give this form to the withholding agent or payer. Do not send to the IRS. OMB No. 1545-1621 Do NOT use this form for: · U.S. entity or U.S. citizen or resident . · A foreign individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Instead use Form: . . . . . . . . . W-9 W-8BEN (Individual) or Form 8233 . . . . W-8ECI · A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S. (unless claiming treaty benefits) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . · A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions) . . W-8IMY · 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 that income is effectively connected U.S. income or that is claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions for other exceptions) . . . . . . . . . W-8ECI or W-8EXP · Any person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY Part I 1 3 4 Identification of Beneficial Owner 2 Country of incorporation or organization Name of organization that is the beneficial owner Name of disregarded entity receiving the payment (if applicable, see instructions) Chapter 3 Status (entity type) (Must check one box only): Simple trust Grantor trust Central Bank of Issue Tax-exempt organization Corporation Complex trust Private foundation Disregarded entity Estate International organization Partnership Government 5 Yes No Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status). Nonparticipating FFI (including a limited FFI or an FFI related to a Nonreporting IGA FFI. Complete Part XII. Reporting IGA FFI other than a deemed-compliant FFI, Foreign government, government of a U.S. possession, or foreign participating FFI, or exempt beneficial owner). central bank of issue. Complete Part XIII. Participating FFI. Reporting Model 1 FFI. Reporting Model 2 FFI. Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII). See instructions. Sponsored FFI. Complete Part IV. Certified deemed-compliant nonregistering local bank. Complete Part V. Certified deemed-compliant FFI with only low-value accounts. Complete Part VI. Certified deemed-compliant sponsored, closely held investment vehicle. Complete Part VII. Certified deemed-compliant limited life debt investment entity. Complete Part VIII. Certified deemed-compliant investment advisors and investment managers. Complete Part IX. Owner-documented FFI. Complete Part X. International organization. Complete Part XIV. Exempt retirement plans. Complete Part XV. Entity wholly owned by exempt beneficial owners. Complete Part XVI. Territory financial institution. Complete Part XVII. Nonfinancial group entity. Complete Part XVIII. Excepted nonfinancial start-up company. Complete Part XIX. Excepted nonfinancial entity in liquidation or bankruptcy. Complete Part XX. 501(c) organization. Complete Part XXI. Nonprofit organization. Complete Part XXII. Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIII. Excepted territory NFFE. Complete Part XXIV. Active NFFE. Complete Part XXV. Passive NFFE. Complete Part XXVI. Excepted inter-affiliate FFI. Complete Part XXVII. Direct reporting NFFE. Sponsored direct reporting NFFE. Complete Part XXVIII. If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty claim? If "Yes" complete Part III. 6 Restricted distributor. Complete Part XI. Account that is not a financial account. Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address). City or town, state or province. Include postal code where appropriate. Country 7 Mailing address (if different from above) City or town, state or province. Include postal code where appropriate. Country b Foreign TIN 8 10 U.S. taxpayer identification number (TIN), if required Reference number(s) (see instructions) 9a GIIN Note: Please complete remainder of the form including signing the form in Part XXX. For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 59689N Form W-8BEN-E (Rev. 4-2016) American LegalNet, Inc. www.FormsWorkFlow.com Form W-8BEN-E (Rev. 4-2016) Part II 11 Page 2 Disregarded Entity or Branch Receiving Payment. (Complete only if a disregarded entity with a GIIN or a branch of an FFI in a country other than the FFI's country of residence. See instructions.) Chapter 4 Status (FATCA status) of disregarded entity or branch receiving payment Limited Branch (see instructions). Reporting Model 1 FFI. U.S. Branch. Participating FFI. Reporting Model 2 FFI. Address of disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address). City or town, state or province. Include postal code where appropriate. Country 12 13 GIIN (if any) Part III 14 a b Claim of Tax Treaty Benefits (if applicable). (For chapter 3 purposes only.) within the meaning of the income tax I certify that (check all that apply): The beneficial owner is a resident of treaty between the United States and that country. The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable, meets the requirements of the treaty provision dealing with limitation on benefits. The following are types of limitation on benefits provisions that may be included in an applicable tax treaty (check only one; see instructions): Government Tax exempt pension trust or pension fund Other tax exempt organization Publicly traded