FO''W'88Eil-E Certificate of Status of Beneficial Ovlrner for

(Rev. July 201 7) United states Tax withhording and Repor[ini'(intities)

) For use bv entities. rndividuars must use Form w-8BEN. >i"ction
Department of the Treasury
lnternal Revenue Service
) Go lo www.ire.ooilformWCaEuEroitn"i,ir-"iion" ,"t"r*i.;;;;;"]r;;;;'";;j"
the latclst information.
.*". OMB No.
> Give this for;'to ih; ;ithho-tdi;s';U;L;;;y"r. "nd
Do not send to the tBS.
Do NOT use this form for:
. U.S. entity or U.S. citizen or resident lnstead use Form:

' A foreign individual ' l ,W-9

oA w-gBEN (rndividuar) or Form 8233
foreign individual or entity claiming that income is effectively
connected with the conduct of trarle or business within the
(unless claiming treaty benefits) . U.s.
oA W_8EC|
foreign partnership' a foreign simple trust, or a foreign grantor
trust (unless claiming treaty benerfits) (see instructions for
exceptions)
'A foreign government' international organization, foreign central bank of rssue, foreign tax-exempt organization, foreign private foundation, w-8lMy
government of a u's possession claiming that income or
is effectively connected u.s. income or that is'claiminf
ine appticaoirity of section(s) ,5(2),
lil]?:lT" ::::::1.-1.9]
runre;; cr1lmi1s treaty benefits) (see instructions for other exceptions) . .
'. Any person acting
w_8ECr or w_8EXp
as an intermediary (including a qualified intermediary acting
as a qualified derivatives dealer)
W-8IMY
loenttticffi
Name of organization that is the beneficial ownJ 2 Country of incorporation or organization
Limited
3 Name of disregarded entity receiving tmr")
Chapter 3 Status (entity type) (Must check one box;tg, --E C"rp"r"ti"; [-l oisregarOeo entity E Partnership
E
L--l Simple Irust
Drrnpre trust E
L-J Grantor trust trust E trust
LJ Complex trust []
E Central Bank of lssue E
fstate n Government
Tax-exempt organization E priruiu foundation [] lnternational organization
lf you entered disregarded entity, partnership, simple trust,
or grantor trust above, is the entity a hybrid making a treaty
claim? lf "Yes" complete part lll.

be*t
I Nonparticipating FFt (including an FFI related to a Reporting tcA X Nonreporting IGA FFt. Comptete part Xil.
FFI other than a deemed-compliant FFl, participating FFl,
o-r I t"r"igl g*ernr,ent, government of a u.s. possession, or foreign
owner)
exempt beneficial
central bank of issue. complete part xlll.
E Participating FFI E lrrternational organization. complete part xlv.
E Reporting Model 1 FFI E Exempt retiremL'nt plans. complete part XV.
E Reporting Model 2 n Entity wholly owrred by exempt beneficial owners. complete parl XVl.
! Registered deemed-compliant FFI (other than a reporting Model 1
tr fenitory financi;al institution. Complete part XVll.
or nonreportins IGA FFI covered in Fart xll)'
5:::Xi[:lff.:Fl' I r-""0,* nonfirranciar sroup entity. comprete part XVu.
n Ercepted nonfirrancial start-up company. Complete part XlX.
E sponsored FFl complete Part IV E Excepted nonfirancial entity in liquidation or bankruptcy.
E c"'titieo deemed-compliant nonregistering local bank. complete complete part )lX.
Part v-
tr 501(c) organization. Complete pad XXt.
E CertifieO deemed-compliant FFI with only low-value accounts. tr N,cnprotit organization. Complete part XXll.
complete Part vl
n nuollcly traded trlFFE or NFFE affiliate of a publicly traded
E Certitied deemed-compliant sponsored, closely held investment corporation. Complete part XXlll.
vehicle complete Part Vll
I E>rcepted territory NFFE. complete part XXIV.
X C"rtiti"d deemed-compliant limited life debt investment entity. X Ac,tire NFFE. Complete part XXV.
complete Part Vlll.
E passive NFFE. Complete part XXVI.
f] Curt"in investment entities that do not maintain financial accounts. E Excepted inter_affiliate FFl. Complete part XXV|l.
complete Part lX'
E Direct reporting lrJFFE.
I owner-documented FFl complete Part X. tr Sponsored direct reporting NFFE. comptete part XXVlll.

Mall, Kamaladi Rqad, Kathmandu,

City or town, state or province. lnclude postal coa" *n"Elppropriat", Country
Kathmandu
7 Mailing address (if different from above)
Same as above
City or town, state or province. lnclude postal code where appropriate.
Country
No. 03
U.S. taxpayer identification number fflN), if required
b Foreign TIN
HDI SUK99999SL524 3A$O1241
10 Reference numbe(s) (see instructions)

Note: Please remainder of the form the form in Part XXX.

Cat. No. 59689N rorm W-8BEN-E (Bev. 7-2017)
 Form W-8BEN-E (Rev. t -2017)
or eage2
Payment. a disregarded entitv with a
branch of an FFI in a other than the FFI's Nora
See instructions.)
Chapter 4,S.tatus (FATCA.tutr. tffi
E Branch treated as nonparticipating FFl.
n Reporting Modet 1 FFt.
E Participating FFt. E u.s. Branch.
12
n Reporting Modet 2 FF:|.

registered address). a P.O. box or in-care-of address (other than a

City or town, state o

Country

13 GllN (if any)

14 , I certify that (check all that apply):

a f] tire beneficial owner is a resident of
within the meaning of the income tax
treaty between the United States and that country.
tr rhe item..(or items) of income for which the treaty
*:,,:*:fg.".y:::^*iiy""
requirements of the treaty provision dearing with ri.itrti". are claimed, and, if applicable, meets the
be included in an applicable tax treaty (che-ck only "ri"."ii;;i'iJldff..I;;l
on.;."" instructions):
of limitation on benefits provisions that may

n Government
base erosion test
test
n Other tax exempt organization
active trade or business test
E RuOlicty traded corporation
the U.S. competent authority received
n Srbsid,ary of a pubticty traded corporation I Oin"r. t"*"n, *,"," j"a ,"r"rrarr,
foreign corporation or interest from a U.S. trade
or business of a foreign corporation and meets quarified resident
status (see instructions).
't5 Special rates and conditions (if applicable_see instructions):
The beneficial owner is claiming the provisions of Arlicle and paragraph

(specify type of income):

of withholding:

16 Name of sponsoring entity:

17 Check whichever box applies.
n I certfy that the entity identified in part l:
. ls an investment entity;

' ls not a Ql, wP (except to the extent permitted in the withhording

foreign partnership agret or WT: and
' Has agreed with the entity identified above (that is not a nonparticipating
FFI) to act as the entity for this entity.
fJ I certity that the entity identified in part l:
. ls a controlled foreign corporation as defined in section 957(a);
. ls not a Ql, WP, or WT;
o ls wholly owned, directly or indirectly,
by the U.S. financial instrtution identified above that agreers
act as the sponsoring entity for this entity; and
' shares a common electronic account system with the sponsoring
entity (identified above) t I enables the sponsoring entity to identify all
account holders and payees of the entity and to access all
account and cus;tomer informat maintained by the entity including, but not
limited to, customer identification information, customer documentation,
account balance, all payments made to account holders or
payees.

rorm W-8BEN-E F.ev T-zo1tl

V
 Form W-8BEN-E (Rev. 7 -2017)

I certify that the FFI identified in part l:

as a bank or credit union (or similar cooperative credit ,rrganization

;:ff:l",t":lX;J::;::lJ:-lv operated without prorit) in its country of

' Engages primarily in the business of receiving,deposits from and making loans to, with respect to a bank, retail customers
unrelated to such
:i:Xifl'J:l:"fi:,Tjffi:::1il:ffJ;fii::,"""Ii.T:j:iliio,.gu'ni,ution, membtxs, p,,ro.Jtn.t no member n.. u s,.ut., thans%
. Does not solicit account holders outside its
country of organization;
'
Has no fixed place of business outside such country
(for this purpose, a fixed place of business
does not include a location that is not
advertised to the public and from which the FFI performs
solely administrative support functions);
' Has no more than $175 million in assets on its
balance sheet and, if it is a member of an expanded
affiliated group, the group has no more
than $500 million in total assets on its consolidated
or combined balance sheets; and
' Does not have any member of its expanded affiliated group
that is a foreign financial institution, other than a foreign
financial institution that
is incorporated or organized in the same country
as the FFI identified in Part I and that meets the requirements
set forth in this part.

' ls not engaged primarily in the business of investing, reinvesting, or trading in securities, partnership interests, commodities,
principal contracts' insurance or annuity contracts, notional
or any interesi (inclurling a futures or forward contract or option)
partnership interest, commodity, notional principal in such security,
contract, in.rran"e contract or annuity contract;
o No financial account maintained
by the FFI or any member of its expanrJed affiliated r;roup, if
$50,000 (as determined after appryingappricabre any, has a balance or value in excess of
account aggregation rures); and
.
Neither the FFI nor the entire expanded affiliated group,
if any, of the FFl, have more than $50 millir:n in assets on its
combined balance sheet as of the end of its most rece-nt consolidated or
accounting year.
Deemed-C C losely Helolnvestiir:nt
20 Name of sponsoring entity:
21 E I certify that the lO*titi"O , Cu.t t.
"ntity
o ls an FFI solely because it is an investment entity described in Regulations section 1 .1471 -5(e)(4);
. ls not a Ql, WP, or WT;
and reportins responsibilities (determined as ir the FFt were participatins
:#iffi :[,il ftlffi"lffffi: #]:i".ldins,
a FFt) rutriled by the

'
20 or fewer individuals own all of the debt and equity interests-in the
participating FFls, registered deemed-compliant FFls,
entity (disregarding debt interests owned by U.s. financial institutions,
and certified d"il;e-;orpliant FFls and equity interests owned by an
entity owns 100% of the equity interests in the FFr and is itserf a -' entity if that
sponsored FFr)
Life !nvestment
certify that the entity identified in part
I l:
. Was in existence as of January 17, 2}lg;

' lssued all classes of its debt or equity interests to investors

on or before January 17,2o13,pursuant to a trust indenture or
similar agreement; and
the requirements to be tre;rted as a rimited rire debt investment entity (such
:":T:*k1^:,,"f::::::I1i:11:::^":::,1^:1,1.P.
restrictions with respect to its assets and other requirements under Regulations as the
section I .1 al,1 -5(f)(2)(iv))
lnvestmen nEEllc*rro
certify that the entity identified in part l:
I

' ls a financial institution solely because it is an investment

entity described in Regulations section 1..1471-5(e)(a)0(A), and
. Does not maintain financial accounts.
Owner-Documented FFI
Note:ThisStatusonlyappliesiftheU.S.tin,n"l,l@"sM"d"l1FFlt.*hi"htl,i.m
treat the FFI as an owner-documented FFI (see instructions for
eligibility requirements). ln addition, the FFI must mak,3 the certifications
below.
24a (All owner-documented FFls check here) I cerilfy that the FFI identified in piart l:
D
. Does not act as an intermediary;
' Does not accept deposits in the ordinary course of a banking or sinrirar business;
' Does not hold, as a substantial portion of its business, financial assets for the account of others;
' ls not an insurance company (or the holding company of an insurance company) that issues or is obligated to make payments with respect to
a financial account;

' ls not owned by

or in an expanded affiliated group with an entity that accepts depositsi in the
business' holds' as a substantial portion of its bus]ness, financial ordinary course of a banking or similar
assets for the account of others, or is an irsurance company (or the holding
company of an insurance company) that issues or is obligated to
make paymenls with respect to a financial account;
o Does not maintain a financial
account for any nonparticipating FFI; and
' Does not have any specified U.s. persons that own an equity interest
or debt interest (other than a debt interest that is not a financial
account or that has a balance or value not exceeding $50,000) in ihe FFI
other than those identiti.o on tn" ifl
o*n.l- reporting statement.

v rff\ffi,ffi,
rorm W-8BEN-E (Rev. z-2012)
 Form W-8BEN-E (Rev. 7 -201 7\

-Docu FFI
Check box 24b or 24c, whichever applies.
O X f certify that the FFt identified in part l:
o Has provided, or wiil provide,
an FFr owner reporting statement that contarns:
(i)
The name' address, TIN (if any), chapter 4
status, and type of docunrentation provided (if required) of every individual
owns a direct or indirect equitv interesi'in the and specified
u.3. [:I]liJl't
owner-documenteo i]i xoffi inrougt ail entities other than specified
(ii) rne name' address' TIN (if any), and chapter 4 status of every
indivicluar and specilied U.s. person that owns
owner-documented FFI (including any indirect a debt interest in the
oebt interesl ivnicn inclrou, debt irrterests iriany
the pavee or anv direct or indireci eqiitv interest entity that direcly or indirecry owns
in a debt n"rJ"ior t,r"
$50'000 (disregarding all such debt interests ou1n9d bv participating
pr;*I;;, ;;;;i;,rii I rnrn"irr account in excess of
FFls, iegistered o""r"o-"orpriant FFls, certified
compliant FFls' excepted NFFES, exempt beneficial deemed-
Lj.s: persons other than specified U.S. persons);
(iii) Any additional information the withholding ";;";.,;
agent requests in order to furfiil its obligations with respect
and
to the entity.
meetins the requirements or Regurations section r r47r-3(d)(6xiii)
;IfiiJ?;',f"1r::#:ffiJ:T;JX[,"T::I"ntation ror each person
c E I certify that the FFI identified in Part I has provided, or will provide, an auditor's letter, s;igned within 4 years of the date of payment,
from an independent accounting firm or legal representative
witn a tocation in the Unit,ei states stating that the firm
reviewed the FFI's documentation with respect to all or representative has
of its owners and debt hotders identified in-Regulations section
and that the FFI meets all the requirements to be an r.1a71-3(d)(6)(iv)(A)(2),
owner_documented FFl. The FFI i,Jentified in iart I has
an FFI owner reporting statement of its owners that also provided, or wiil provide,
are specified U.s. persons and Fonrr(s) w-g, with
applicable waivers.
Check box 2M it applicable (optional, see instructions).
o E r certify that the entity identified on line 1 is a trust that
does not have any contingent breneficiaries or designated
beneficiaries. crasses with unidentified

Restricted Distributor
(All restricted distributors check here) r certify
th;;rtity,d""t,fi"d i. F,rrt r
that
operates as a distributor with respect to debt or equity interests
' of the restricted fund with respect to which this form is furnished;
o Provides investment services to
at least 30 customers unrelated to each other and less thern half
of its customers are related to each other;
' ls required to perform AML due diligence procedures under
the anti-money laundering laws of its country of organization (which
is an FATF-
compliant jurisdiction);

' operates solely in its country of incorporation or organization, has

no fixed place of business outside of that country, and has the
same
country of incorporation or organization as a[ members of its
affiliated group, if any;
' Does not soricit customers outside its country of incorporation
or organization;
' Has no more than $175 million in total assets under management
and no more than $7 million in gross revenue on its income statement
for
the most recent accounting year;
.ls not a member of an expanded affiliated group that has more than
$500 million in total assets under management or more than g20 million
in gross revenue for its most recent accounting year on a combined
or consolidated income rstatement; and
' Does not distribute any debt or securities of the restricted fund
to specified U.s. persons, passive NFFEs with one or more substantial
U.s.
owners, or nonparticipating FFls.
Check box 25b or 2Sc, whichever applies.
I further certify that with respect to all sales of debt or
equity interests in the restricted l,und with respect to which this form is furnished
after December 31 , 201 1, the entity identified in part l: that are made

b n uas been bound by a distribution agreement that contained a general prohibition

on the sale of debt or securities to u.s. entities and u.s.
resident individuals and is currently bound by a distribution ,do"r"ni that
contains a ryonioition-ot the sale of debt or securities to any
specified U.S- person, passive NFFE with one or more substanlial U.S. owners,
or nonparticipating FFl.
c E ls currently bound by a distribution agreement that contains a prohibition
on the sale of debt or securities to any specified u.s. person,
passive NFFE with one or more substantial U.s. owners,
or nonparticip€lting FFI and, for all sales made prior to the time that such a
restriction was included in its distribution agreement, has reviewed
all accounts related to such sales in accordance with the procedures
identified in Regulations section 1.1471-4(c) applicable to preexisting
accounts and has redeemed or retired any, or caused the restricted
fund to transfer the securities to a distributor that is a participating Fil
or reporting Model 1 FFI securities which were sold to specified U.s.
persons, passive NFFEs with one or more substantial U.S.
owneri, or nonparticipiting FFls.

@
 Form W-8BEN-E (Rev. I -ZO1 7\

Etcertitythutm
' Meets the requirements to be considered a nonrepofting
financial institution pursuant to an applicable IGA between
the United states and

is treated as a
The appticabte teA is a n UoO"t 1 tGA or uE Mod"t 2 tGA; and
under the provisions of the applicable IGA or Treasury regulations
(if applicable, see instructions);
o lf you are a trustee documented
trust or a sponsored entity, provide the name of the trustee
or sponsor
The trustee is: X U.S. n Foreign

27 E l certify tnu, *
inffi
ment, and is not engaged
yrffijlXf,""X
obligations for which
Jl,, this] #Hi::: ^":I:iir::::1"^1,1^,:ll:1,:i,jiLp""itory
tr" form is submitted (except institution"il,i,n ,""p"", to the payments,
.. p"irittJln'R;grr;il;;;J";i;; ;.;;;1;il)(;;i accounts, or

lnternational
Check box 28a or 2Bb, whichever applies.
28a I certiry that the entity identified in Part I is an international organization
I
described in sec;tion 7701(a)(i g).
b n certify that the entity identified in part l:
f
o ls comprised primarily of foreign governments:
o ls recognized as an intergovernmental
or supranational organization under a foreign law :similar to the lnternational
Act or that has in effect a headquarters agreement with a foreign government;- organizations lmmunities

r The benefit of the entity's income does not inure

to any private person; and
' ls the beneficial owner of the payment and is not engaged in
commercial financial activitres of a type engaged in by an insurance
company,
custodial institution' or depository institution with respecito
the payments, accounts, or obligations ior which this form is
permitted in Begulations section 1.1 471 _6(h)(2)). submitted (except as

Retirement Plans
Check box 29a, b, c, d, e, or f, whichever applies.
Na E I certify that the entity identified in part l:
' ls established in a country with which the United states has an income
tax treaty in force (:see part lll if claiming treaty benefits);
o ls operated principaily to administer
or provide pension or retirement benefits; and
' ls entitled to treaty benefits on income that the fund derives from
U.s. sources (or would tre entiiled to benefits if it derived any such income)
as a resident of the other country which satisfies any applicable limitation
on benefits requirement.
U I t certify that the entity identified in part l:
' ls organized for the provision of retirement, disability, or death benefits (or any combination thereoO to beneficiaries that
are former
employees of one or more employers in consideration for services rendered;
o No single beneficiary has a right to more
than S%o of the FFl,s assets;
' ls subiect to government regulatlon and provides annual information reporting
about its beneficiaries to the relevant tax authorities in the
country in which the fund is established or operated; and
(i) ls generally exempt from tax on investment income under the laws
of the country in rruhich it is established or operates due to its status
as a retirement or pension plan;
(ii) Heceives at least 50% of its total contributions from sponsoring
employers (disregarcling transfers of assets from other plans described
in this part, retirement and pension accounts described in an appticatile
Model 1 or Model 2 lGA, other retirement funds described in
an applicable Model 1 or Model 2 lGA, or accounts described in Regulations
section i .1 471 -5(b)(2XiX4);
(iii) Either does not permit or penalizes distributions or withdrawals
made before the ocr:urrence of specified events related to retirement,
disability, or death (except rollover distributions to accounts described in
Regulations section 1.1471-s(b)(2xixA) (referring to retirement
and pension accounts), to retirement and pension accounts described in an applicable Model
1 or Model 2 lGA, or to other retirement
funds described in this part or in an appricabre Moder 1 or Moder 2
rGA); or
bv emplovees to the fund bv reference to earned income of the emptoyee
or may not exceed $50,000 annuaily.
- ,1'1":T]:t:::"'Y:tT
certity that the entity identified in part l:
L_-t r

ls
' organized for the provision of retirement, disability, or death benefits (or any comb,ination thereof) to beneficiaries that
employees of one or more employers in consideration for services rendered; are former
. Has fewer than 50 participants;
o ls sponsored by one or more employers
each of which is not an investment entity or passiv€, NFFE;
' Employee and employer contributions to the fund (disregarding transfers
pension accounts described in an applicable Model 1 or Model
of assets from other plans described in this part, retirement and
2lGA, or accounts described in Regulations section 1.1471-5(b)(2)(i)(A)) are
limited by reference to earned income and compensation of the emproyee,
respectivery;
'Participantsthatarenotresidentsofthecountryinwhichthefundisestablishedoroperatedarenotentifledtomorethan20%ofthefund,sassets;and
r ls subject to government regulation and provides annual information
reporting about its b,eneficiaries to the relevant tax authorities in the
country in which the fund is established or operates.

rorm W-8BEN -E Fiev. 7-20171

ftI
B,q^,
*nE#ti,l
 Form W-8BEN-E (Rev. 7-2017\

Retirement Plans
o E ""r,'t. pi"rth"t**d.""tt@
than the requirement that the plan be funded by a trust created
or organized in the united states.
X I certify that the entity identified in Part I is established exclusively to earn income for the
benefit of one or more retirement funds
described in this part or in an applicable Model 1 or Model
2 lGA, or accounts described in Regulations section
retirement and pension accounts), or retirement and pension 1.1471-s(b)(2)(i)(A) (refening to
accounts described in an applicable Model 1 or Model
2 lGA.
E I certity that the entity identified in part l:
' ls established and sponsored by a foreign government, international
organization, centrar bank of issue, or government of a U.s. possession
(each as defined in Regulations section t i +zt -6)
or an exempt beneficiai owner describecr in an appricabie
trl-ooet t or Model 2 IGA to provide
to benericiaries or participants that are current or rormer emproyees
:*;ffi::rrt:::ff;&:Xtl,|";'"t'tt or the sponsor (or persons

' ls established and sponsored by a foreign government,

international organization, central bank of issue,
or government of a U.s. possession
(each as defined in Regulations section 1.14i1-6)
or an exempt beneficiaf owner described in an appticable Modet
retirement' disability' or death 1 or Model 2 tGA to provide
benefits to beneficiaries or participants that are not current
consideration of personal services performed for the sponsor. or former employees of such sponsor, but are in

Owned by Ex Benefic Owners

E I certity tf'rt tn"
iO"ntified in part t:
"r,tity
. ls an FFI solely because it is an investment entity;
o Each direct holder of an equity
interest in the investment entity is an exempt beneficial orilner
described in Regulations section 1.1471_6 or in
an applicable Model 1 or Model 2 IGA;

' Each direct holder of a debt interest in the investment

entity is either a depository institution (with respect to a loan made
to such entity) or an
exempt beneficial owner described in Regulations section 1
.1 471 -6 or an applicabie Model 1 or Model 2 tGA.

' Has provided an owner reporting statement that contains the

name, address, TIN (if any), chapter 4 status, and a description
of the type
of
documentation provided to the withholding agent for every person
that owns a debt interest constituting a financial account or direct
interest in the entity; and equity

' Has provided documentation establishing that every owner of the

entity is an entity described in Regulations section 1 .1471 -6(b), (c), (d), (e),
(f) and/or (g) without regard to whether such owners
aie beneficial owners.

3.|UlcertifythattheentityidentifiedinPartlisafinancialinstitution1ott.,u,tn*.ni*".tn,,",,t.'tfty)
vr vr Ysr rrlvr
- the laws of a possession of the united States.

g2 I I certity that the entity identified in part t:

' ls a holding company, treasury center, or captive finance company and substantially all ,cf the entity,s activities are functions
described in
Regulations section 1 .1 471 -5(e)(5)(iXC) through (E);

' ls a member of a nonfinancial group described in Regulations section .1a71 -5(e)(5)(i)(B); 1

' ls not a depository or custodial institution (other than for members of the entity's expanded affiliated group); and
' Does not function (or hold itself out) as an investment fund, such as a private equity fund, \/enture capital fund, leveraged buyout fund, or any
investment vehicle with an investment strategy to acquire or fund companies
and then hold interests in those companies as capital assets for
investment purposes.

3lit n r
r was".rtity
formed on (or, in the case of a new line of business, the date of board resolution
apprcving the new line of business)
(date must be less than 24 months prior to date of payment);

' ls not yet operating a business and has no prior operating history or is investing capital in assets with the inrent to operate a new line of
business other than that of a financial institution or passive NFFE;

' ls investing capital into assets with the intent to operate a business other
than that of a financial institution; and
fund, such as a private equity fund, venture capirar fund, reverased buyout fund,
;,:":::::1,:fl:l]::^9j"i:,,:^::,r.::rl^1,
M*lYeligle wlo-s.e pulPose is to l:y":y,"rl :: or any
ScquiJg"or lund
companles ana tren rrota interests in tnose i"rprrr.rl. .r;;,;i;;;;i;Y;ilr"ffi";; ;"dr:.:
Excepted Nonfinancial in Liquidation or Bank
34 ! I certity tnat tne entity ,Oentified in part l:

' Filed a plan of riquidation, filed a pran of reorganization, or fired for

bankruptc),on
' During the past 5 years has not been engaged in business as a financial institution
o.u.t"d ,r. , p".*. NFFE
' ls either liquidating or emerging from a reorganization or bankruptcy with
the intent to continue or recommence operations as a nonfinancial
entity; and

' Has' or will provide, documentary evidence such as a bankruptcy filing or other public documentation that supports its claim if it remains in
bankruptcy or liquidation for more than 3 years.

rorm W-8BEN-E llev 7-2otz)

V rNGGA
f
ORx r-,f
ruf Pnt-
*nF+na tri
t- nt1-t

i,.
 Form W-BBEN-E (Rev. T -2011)

35 ! t certity tnr, *
' Has been issued a determination letter from the IBS that is currently in effect concluding that the payee is a section 501(c) organization that
dated_ ; or
is

' Has provided a copy of an opinion from U.s. counsel certifying that the payee
is a section 501(c) organization (without regard to whether
payee is a foreign private foundation). the

UlcertifythattheentityidentifiedinPartlis,nonp.titorganizationtr,"t,""t.tr,"totto-,s*q
, residence
,,:,:._.-.:,1? excrusrvery ror rerigious, charrtabre, scientiric, qr
.: l['JXIj:::':t:'::l:: :1i1i::.
The entity is exempt from income tax in its country of residence;
artrstic,
iloL,u, uurrur
curturar or EUuuduUIlat
dr ur educationar purposes;

' The entity has no shareholders or members who have proprietary

a or beneficial interest in its income or assets;
' Neither the applicable laws of the entity's country of residence
nor the entily's.Jormation documents permit any income
or assets of the entity
to be distributed to' or applied for the benefit of, a private person
or noncharitabre entity, other than-pursuant to the conduct of the
of reasonable compensation for services rendered or pivment representins entity s
il?:l',?: ff ,,rrH""ffi:f3J:ent the fair market vatue of property

'
The applicable laws of the entity's country of t::i99ngg orthe.entity's
dissolution' all of its assets be dist;ibuted to in entity that is -g6r;",rent,
formation documents require that, upon the entitys liquidation
or
a tor"iin an integral part oii toreign government, a contiolled entity
:Jril#:?tJi,,,liilliXill;,?i1fl|:lfflrTgilization
that is describJd in ti,
pu,.t or escheats to ths.sovernmenr or the entity,s
country or

r r =YYY Yvr rvvr s'

check box gz. or gzL
g7a I lcertifythat:
r The entity identified in Part I is a foreign corporation
that is not a financial institution; and
' The stock of such corporation is regularly traded on one or more established securities meukets, including
(name one securities exchange upon which the stock
is regularly traded).
b n lcertifythat:
' The entity identified in Part I is a foreign corporation that is not
a financial institution;
' The entity identified in Part I is a member of the same expanded
affiliated group as an ,--ntity the stock of which is regularly traded
on an
established securities market;
o The name of the entity, the stock of which is regularly traded on an established
securities rnarket, is
o The name : and
of the securities market on which the stock is traded is
Territory NFFE
38 E certify that:
I

' The entity identified in Part I is an entity that is organized in a possession

of the United Stales:
. The entity identified in part l:
(i) Does not accept deposits in the ordinary course of a banking or similar
business;
(ii) Does not hold' as a substantial portion of its business, financial
assets for the account of others; or
(iii) ls not an insurance company (or the holding company
of an insuran<;e company) that issues or is obligated to make payments with
respect to a financial account; and
o All of the owners of the entity identified in Part I are bona fide residents of the possession
ir which the NFFE is organized or incorporated.

39 E lcertifythat:
' The entity identified in part I is a foreign entity that is not a financial institution;

' Less than 50% of such entity's gross income for the preceding
calendar year is passive income; and
assets that produce or are hetd ror rhe production or passive income (catcutated
;,::';^lji,"t:':!-'rli:::::-1"]l^lr-ti:l:itltv l. as a
#ll eE .rin.t,,r"iion-.t.,'i["
arterly)(see J#;,,on"or;""il"";:il""i
rJLr uuuur 15 r(rr U te uertrituon oI passtve lncome).

4oa nj::g?"Il:tt tom"'t@

NFFtr
NFFE, diraaf
direct r6^^dih^
reporting NltrtrE
NFFE, or^" sponsored direct repoiting NFFE
;nift i;;;;;;J: ;;,*. i;,";;iil?? ;1'*
Check box 40b or 4Oc, whichever applies.
b n further certify that the entity identified in Part I has no substantial U.S.
I
owners (or, if appl cable, no controlling U.s. persons); or
c E further cerlify that the entlty identified in Part I has provided the name, address,
t
and IN of each substantial U.s. owner (or, if applicable,
controlling U.S. person) of the NFFE in part XXIX.

rorm W-8BEN-E (Fev. 7-2012)

h\ bt
 Form W-8BEN-E (Rev. 7-20j7)

Excepted Inteffii6-FFT
4'l El"".tiryffi
. ls a member of an expanded affiliated group;

' Does not maintain financiar accounts (other than accounts maintained for members of its affiliated group);
' Does not make withhordabre payments to any person other than to members oiiia affiliated group;
o Does not hord an account (other
than depository accounts in the country in which "rorn
payments from any withhording agent other the errt is operating to pay for expenses) with or receive
than a member of its expanded affiriated group,;
' Has not agreed to repod under Regurations section 1.1471-4(d)(2xiD(c) or otherwise act as an for chapter 4 purposes on behalf of any financial
institution, including a member of its expanded
affiliated group.

NrFE (see instruEtionETt;Een thk;

42 Name of sponsoring entity:
43 nt that the entity identified in part I is a direct
NFFE that is the identified on line 42.

As required by Part )fivr, provide the name, address,

and rN of each substantirr u.i. o**r. ot tn" r Please see the instructions for a definition of
substantial U's' owner. lf providing the form to an FFI trealed
as a reporting Model 1 FFI or reportin,l 2 FFl, an NFFE may also use this part for
reporting its controlling U.S. persons under an applicable
lGA.

Name

under penalties of perjury, I declare that I have examined the information

on this form and to the best of my and belief it is true, correct, and complete.
certify under penalties of per.iury that: I further

' The entity identified on line 1 of this form is the beneficial owner
of all the income to which this form is using this form to certify its status for chapter 4
purposes, or is a merchant submitting this form for purposes
of section 605OW;
. The entity identified on line 1 of this form is not a U.S. person;
' The income to which this form relates is: (a) not effectively connected with the conduct oF a trade or in the United States, (b) elFectivety connected but is
not subject to tax under an income tax treaty, or (c) the partner's
share of a partnership,s effectivery connec income; and
'
For broker transactions or barter exchanges, the beneficial
owner is an exempt foreign person as defined in inslructions.
Furthermore, I authorize this form to be provided to any withholdf\
agent that has control, receipt, or custody of the of which the entity on tine 1 is the beneficial
owner or any withholding agent that can disburse or make p"yr{n\
of the income of which the entity on tjne .t is th€l
owner
I asree that I wirrsubmit a new form this form becomes incorrect'

f1x:":':lvi'on
Sisn Here
) Signature of
1 1 -03-201 9

Date (MM-DD-Yyyy)

E I certify that t have the capacity to sign Ior the entity identified
on rine 1 of thir;

Form W-8BEN-E (Rev'r-2017)