rom W-BBEN| Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals) (Per day 2017 > For use by individuals. Entities must use Form W-BBEN-E. Re daaleaicio geeetanraey > G0 to wri gov!FormWBBEN for instructions and the latest Information. Fibra Rrouetn > ive this form to the withholding agent or payer. Do nat send othe IRS. Do NOT use tis form i Instead, use Forme + You are NOT an nv Wena + You sre a US. clizn orother U.S. person, cluding a resident en indica hes ‘7 You sr 2 beneficial owner caiing tht income is ttecivey connected withthe conc of trade or business within the US. (other then person servess) a beng! * You area benecial owner who srecshing compensation for persona serves parermad nthe Unted States caso wa 1 You aoa person ating ae an intemediny ay Note: you aro resident ina FATOA periner jurisdiction (ie, a Mode 1 IGA jisdlcton wih recipi), carn tax account infomation may Be rowed to your jradction of rescence, [EWM _iaoniificaton of Beneficial Owner aoe HaImTORS) A Nar of rl e's he breton omer 2 cami a aaa Arturo Rene Acota Leon Venere 3 Prana eenee SWE SWOT Ao UT Oa De Totuse aI. Bor or ar OB U0 resiencal Lor Overs, Casa 10-01 ‘ity oF town, site cr province. nce pou Sod0 Were SPREDTTE County “Turmaro, Estado Aragua Codigo Postal 2115 Venezuela “4 Maing acess (faferent fom above) ‘iyo Town, ale or prowres-nSuda pana cade Whore SPORT Conny ‘5 U5. tnpayar Wanctionrambr SGN oF, raqared fee watson) Foreign Tax wenityng nariber (se stutor=) vooe729215 7 Reteresce rare) fees nerutons) Dat of bth ba OD-YWYW) foe accra) ‘iain of Tax Treaty Benefit (or chapter 3 purposes ony [noe RATRCTENS) 9 coy tal he bene ownein aia ‘ine mesnng he core ae tray between he Unted Sates and at com 10. Spectarates and eonaton apletieros sor) The bent owner cing te proven re nd paragraph of every enedon ne ahovetacam a” seat of witadng on apecty pe ol ron plan he adiional oonationsin Areal paragraph he baefcal owner meal Yo be elie forte rate of winholdag? [EMMI —certitcation ‘nae pertis cperay. cele at Ihave eared re Warman nls or aro The Dat ny Kawi ar bla Wun core Wa pe TRS etsy ioe’ perales obey ak + amine india tte beet wre am ashorze 1 fore nd the ene owe a encanto whch om iano mangina om fo document mentor rast uous, + Te poner named an nf ie sot US. pon, (art tect comeced wine concuc ofa rac business ita Une Ses, (tect connect bts at subject oak dean ape ncae ae ety of (the panne tare of patna’ ache connect neon, ‘+ Tee peson named one of his forms resin ote ety aunty ea one te em it any! win th mango Income tx bey between ented Sao ard at covny, rd ay + Frtrohrranacton or ata excarge, banc canie an exam org peo 8 sine inte nsinctions Furramor,| autores tom ob prove o ay wiicng age hal hs cont cto cusody fhe icame whch am te bent oune ot any witcing agar at can Gets r make payers oh come whens ha beneial owner agree tat see ee Re ae ‘Wary cerestion made on hu frm becomes coast on) Sign Here br hy te 03-20-2021, on ae oe ROTA Dale DO Pentre oar ‘Gacy wc ating Hom i ignea bene one) For Paperwork Reduction Act Notice, see separate lnstctons (at 250072 Foen WBBEN ex 72017