D Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status).

Transcription

1 *W-8BEN-E (Rev April 201 6) Departmet of the Treasury Iteral Reveue Service Do NOT use this form for: Gertificate of Status of Beeficial Ower for Uited States Tax Withholdig ad Reportig (Etities) > For use by etities Idividuals must use Form W-8BEN > Sectio refereces are to the Iteral Reveue Code" > f formatio about Form W-8BEN-E ad its separate istructios is at wwwirsgovlformwsbee > Give this form to the withholdig aget or payer Do ot sed to the lrs!_u Le _q4!-![4 pg, _9a-BA J-E_Yg 3 Name of disregarded etity receivig the paymet (if applicable, see istructios) OMB No Istead use Form: US etity or US citize or residet W-g o A foreig idividual W-SBEN (ldtvidual) or Form 8233 A foreig idividual or etity claimig that icome is effectively coected with the coduct of trade or busiess withi the US (uless claimig treaty beefits) Aforeigpartership,aforeigsimpletrust,oraforeiggratortrust(ulessclaimigtreatybeefits) (seeistructiosforexceptios) W-8lMY A foreig govermet, iteratioal orgaizatio, foreig cetral bak of issue, foreig tax-exempt orgaizatio, foreig private foudatio, or govermet of a US possessio claimig that icome is effectively coected US icome or that is claimig the applicability of sectio(s) 1 15(2), 501 (c), 892, 895, or 1443(b) (uless claimig treaty beefits) (see istructios for other exceptios) W-SECI or W-8EXp Ay perso actig as a itermediary " W-glMy ldetificatio of Beeficial Ower 1 Name of orgaizatio that is the beeficial ower 2 Coutry of icorporatio or orgaizatio Chapter 3 Status (etity type) (Must check oe box otyl: -----iz 6oh;;;; BOSNIA AND HERZEGOVINA E Disregarded etity Simple trust! Grator trust! Complex trust! Estate Cekal Bak of lssue Tax-exempt orgaizatio Private foudatio lteraiioal orgaizatio lf you etered disregarded etity, partership, simple trust, or grator trust above, is the etity a hybrid makig a treaty claim? lf "Yes" complete Part lll D 5 yes Chapter 4 Status (FATCA status) (See istructios for details ad complete the certificatio below for the etitys applicable status) I Noparticipatig FFI (icludig a limited FFI or a FFI related to a! Noreportig lca FFl Complete part Xil! V tr Beportig IGA FFI other tha a deemed-compliat FFl, participatig FFl, or exempt beeficial ower) Participatig FFl Reportig Model 1 FFl Reportig Model 2 FFl tr Sposored FFl Complete Part lv Certified deemed-compliat oregisterig local bak Complete Part V I CertitieO deemed-compliat FFt with oly low-value accouts Complete Part Vl I Certitied deemed-compliat sposored, closely held ivestmet vehicle Complete Part Vll C"titiO deemed-compliat Iimited life debt ivestmet etity, Comolete Part Vlll W-BECI Partership Govermet ruo Foreig govermet, govermet of a US possessio, or foreig cetral bak of issue Comolete Part Xlll Ll Iteratioal orgaizatio Complete Parl XlV Exempt retiremet plas complete part xv Etity whotty owed by exempt beeficial owers Complete parl XVI Registered deemed-compliat FFI (other tha a reportig Model 1 [ Teitory fiacial istitutio Complete part XVll FFl, sposored FFl, or oreportig IGA FFI covered i Part Xll) Nofiacial group etity Compleie part XVlll see istructios tr Excepted orifiacial start-up compay complete part XlX fl r^-^+l h^h+iacial etity i liquidatio or bakruptcy Complete Part XX 501(c) orgaizatio Complete Part XXl Noprofit orgaizatio Complete Part XXll Publicly traded NFFE or NFFE affiliate of a publicly traded corporatio Complete Part )C(lll Ll Excepted territory NFFE Complete Part XXIV! Active NFFE Complete Part XXV Passive NFFE Complete Part XXVI E CertitieO deemed-compliat ivestmet advisors ad ivestmet! Excepted iter-affiliate FFl Complete Part XXVll maagers Complete Pad lx Ll Direct reportig NFFE, fl Ower-documeted FFl Complete Part X Sposored direct reportig NFFE, Complete Part )fivlll Ll Restricted distributor Complete Part Xl E Accout that is ot a fiacial accout 6 Permaet residece address (skeet, apt or suite o, or rural route), Do ot use a PO box or i-care-of address (other tha a registered address), -q-4r-d_ z lr o--v-4-q City or tow, state or provice Iclude postal code where appropriate l-t-099 9ABAJEy9,_E_E_p_EBA:ItqN_-9_f pq-s-tr_ra_ 7 Mailig address (if differet from above) I - --f --Cil;il I City or tow, state or provice Iclude postal code where appropriate ; u i til;t;;;;;1ii;;ti;; ;; ;;; rr rui, r ijiiiiij - - t 9a GllN 10 Referece umbe(s) (see istructios) _p-qary_r-4-o-0_q-0q_me_,q7_0_ Note: Please complete remaider of the form icludiq siqiq the form i Part XXX For Paperwork Reductio Act Notice, see separate istructios Cat, No 59689N rorm W-8BEN-E (Rev ) { /*

2 Form W-8BEN-E (Rev ) Page2 Disregarded Etity or Brach Receivig Paymet (Complete oly if a disregarded etity with a GllN or a brach of a FFI i a coutrv other tha the FFIs coutrv of residece See istructios) 11 Chapter 4 Status (FATCA status) of disregarded etity or brach receivig paymet L-l Limited Brach (see istructios) Reportig Model 1 FFl Us Brach, -^ LJ Harllorpalrg Frr Reportig Model 2 FFl 12 Address of disregarded etity or brach (street, apt or suite o, or rural route) Do ot use a PO box or i-care-of address (other tha a registered address) City or tow, state or provice Iclude postal code where appropriate Coutry drrl,r-(ffiti 14 certify that (check all that apply): a f] Te beeficial ower is a residet of treaty betwee the Uited States ad that coutry b ffre beeficial ower derives the item (or items) of icome for which the treaty beefits are claimed, ad, if applicable, meets the requiremets of the treaty provisio dealig with limitatio o beefits The followig are types of Iimitatio o beefits provisios that may be icluded i a applicable tax treaty (check oly oe; see istructios): tr c Govermet LJ Compay that meets the owership ad base erosio test Tax exempt pesio trust or pesio fud Compay that meets the derivative beefits test withi the meaig of the icome tax Other tax exempt orgaizatio LJ Compay with a item of icome that meets active trade or busiess test Publiclv traded corporatio I Favorable discretioary determiatio by the US competet authority received Subsidiary of a publicly traded corporatio L-J Other (specify Article ad paragraph): The beeficial ower is claimig treaty beefits for US source divideds received from a foreig corporatio or iterest from a US trade or busiess of a foreig corporatio ad meets qualified residet status (see istructios) 15 Special rates ad coditios (if applicable-see istructios): The beeficial ower is claimig the provisios of Article ad paragraph of the treaty idetified o lie 14a above to claim a % rate of withholdig o (specify type of icome): Explai the additioal coditios i the Article the beeficial ower meets to be eligible for the rate of withholdig: FFI 16 Name of sposorig etity: GllN of sposorig etity: Gheck whichever box applies fl I certify that the etity idetified i Part l: ls a ivestmet etity; ls ot a Ql, WP, or WT; ad Has agreed with the etity idetified above (that is ot a oparticipatig FFI) to act as the sposorig etity for this etity I certify that the etity idetified i Part l: ls a cotrolled foreig corporatio as defied i sectio957(a); ls ot a Ql, WP, or WT; ls wholly owed, directly or idirectly, by the US fiacial istitutio idetified above that agrees to act as the sposorig etity for this etity; ad Shares a commo electroic accout system with the sposorig etity (idetified above) that eables the sposorig etity to idetify all accout holders ad payees of the etity ad to access all accout ad customer iformatio maitaied by the etity icludig, but ot limited to, customer idetificatio iformatio, customer documetatio, accout balace, ad all paymets made to accout holders or rorm W-8BEN-E (Rev4-2016) < -4)

3 Form W-8BEN-E (Rev ro ) eage 3,---, Operates ad is licesed solely as a bak or credii ulo (or similar cooperative credit orgaizatio operated without profit) i its coutry of icorporatio or orgaizatio; Egages primarily i the busiess of receivig deposits from ad makig loas to, with respect to a bak, retail customers urelated to such bak ad, with respect to a credit uio or similar cooperative credit orgaizatio, members, provided that o member has a greater tha five percet iterest i such credit uio or cooperative credit orgaizatio; Does ot solicit accout holders outside its coutry of orgaizatio; c Has o fixed place of busiess outside such coutry (for this purpose, a fixed place of busiess does ot iclude a locatio that is ot advertised to the public ad from which the FFI performs solely admiistrative support fuctios); Has o more tha $175 millio i assets o its balace sheet ad, if it is a member of a expaded affiliated group, the group has o more tha $500 millio i total assets o its cosolidated or combied balace sheets; ad Does ot have ay member of its expaded affiliated group that is a foreig fiacial istitutio, other tha a foreig fiacial istitutio that is icorporated or orgaized i the same coutry as the FFI idetified i Part I ad that meets the requiremets set forth i this Part V 19 Accouts LJ the FFI idetified i Part l: Is ot egaged primarily i the busiess of ivestig, reivestig, or tradig i securities, partership iterests, commodities, otioal priclpal cotracts, isurace or auity cotracts, or ay iterest (icludig a futures or forward cotract or optio) i such security, partership iterest, commodity, otioal pricipal cotract, isurace cotract or auity cotract; o No fiacial accout maitaied by the FFI or ay member of its expaded affiliated group, if ay, has a balace or value i excess of I certify that $50,000 (as determied after applyig applicable accout aggregatio rules); ad Neither the FFI or the etire expaded affiliated group, if ay, of the FFl, have more tha $50 millio i assets o its cosolidated or combied balace sheet as ofthe ed of its most recet accoutig year Held Ivestmet Name of sposorig etity: I certify that the etity idetified i Part l: ls a FFI solely because it is a ivestmet etity described i (eX4); o ls ot a Ql, WP, or WT; i Will have all of its due diligece, withholdig, ad reportig resposibilities (determied as if the FFI were a participatig FFI) fulfilled by the sposorig etity idetified o lie 20; ad Twety or fewer idividuals ow all of the debt ad equity iterests i the etity (disregardig debt iterests owed by US fiacrar istitutios, padicipatig FFls, registered deemed-compliat FFls, ad certified deemed-compliat FFls ad equity iterests owed by a etity if that etity ows 100 percet of the equity iterests i the FFI ad is itself a sposored FFt) 22 L-J lcertifythattheetityidetified i Part Was i existece as of Jauary 17,2013; l: lssued all classes of its debt or equity iterests to ivestors o or before Ja uary 17, 2013, pursuat to a trust ideture or similar agreemet; ad ls certified deemed-compliat because it satisfies the requiremets to be treated as a limited life debt ivestmet etity (such as the restrictios with respect to its assets ad other requiremets uder g S(0(Z)(iv)) 23 LJ lcertifythattheetityidetified i Partl: ls a fiacial istitutio solely because it is a ivestmet Does ot maitai fiacial accouts etity described i (e)(a)0(A), ad Note:ThisStatuSo yapp iesiftheu,sfiacia i"tii,tio,p treat the FFI as a ower-documeted FFI (see istructios for eligibility requiremets) I additio, the FFI must make the certificatios below 24a (All ower-documeted FFls check here) certify that the FFI idetified i Part l: Does ot act as a itermediary; Does ot accept deposits i the ordiary course of a bakig or similar busiess; Does ot hold, as a substatial portio of its busiess, fiacial assets for the accout of others; o ls ot a isurace compay (or the holdig compay of a isurace compay) that issues or is obligated to make paymets with respect to a fiacial accout; Is ot owed by or i a expaded affiliated group with a etity that accepts deposits i the ordiary course of a bakig or similar busiess, holds, as a substatial portio of its busiess, fiaeial assets for the accout of others, or is a isurace compay (or the holdig compay of a isurace compay) that issues or is obligated to make paymets with respect to a fiacial accout; a Does ot maitai a fiacial accout for ay oparticipatig FFI; ad o Does ot have ay specified US persos that ow a equity iterest or debt iterest (other tha a debt iterest that is ot a fiacial accout or that has a balace or value ot exceedig $50,000) i the FFI other tha those idetified o the FFI ower reportig statemet rorm tu W-8BEN-E (Bev )

4 tu Form W-8BEN-E tfev ) Page 4 Check box 24b or 24c, whichever applies b I certify that the FFI idetified i Part l: r Has provided, or will provide, a FFI ower reportig statemet that cotais: The ame, address, TIN (if ay), chapter 4 status, ad type of documetatio provided (if required) of every idividual ad specified US perso that ows a direct or idirect equity iterest i the ower-documeted FFI (lookig through all etities other tha specified US persos); The ame, address, TIN (if ay), ad chapter 4 status of every idividual ad specified US perso that ows a debt iterest i the owerdocumeted FFI (icludig ay idirect debt iterest, which icludes debt iterests i ay etity that directly or idirectly ows the payee or ay direct or idirect equity iterest i a debt holder of the payee) that costitutes a fiacial accout i excess of $50,000 (disregardig all such debt iterests owed by participatig FFls, registered deemed-compliat FFls, certified deemed-compliat FFls, excepted NFFEs, exempt beeficial owers, or US persos other tha specified US persos); ad Ay additioal iformatio the withholdig aget requests i order to fulfill its obligatios with respect to the etity o Has provided, or will provide, valid documetatio meetig the requiremets of $ (dX6Xiii) for each perso idetified i the FFI ower reportig statemet c t certify that the FFI idetified i Part I has provided, or will provide, a auditors letter, siged withi four years of the date of paymet, from a idepedet accoutig firm or legal represetative with a locatio i the Uited States statig that the firm or represetative has reviewed the FFIs documetatio with respect to all of its owers ad debt holders idetified i (d)(0)(ivXAXZ), ad that the FFI meets all the requiremets to be a ower-documeted FFl The FFI idetified i Part I has also provided, or will provide, a FFI ower reportig statemet of its owers that are specified US persos ad Form(s) W-9, with applicable waivers Check box 24d if applicable (optioal, see istructios) U f certify that the etity idetified o lie 1 is a trust that does ot have ay cotiget beeficiaries or desigated classes with uidetifled beeficiaries EEEjE RestrictedDistrihutor 25a L-J (All restricted distributors check here) certify that the etitv idetified i Part l: Operates as a distributor with respect to debt or equity iterests of the restricted fud with respect to which this form is furished; Provides ivestmet services to at least 30 customers urelated to each other ad less tha half of its customers are related to each other; ls required to perform AML due diligece procedures uder the ati-moey lauderig laws of its coutry of orgaizatio (which is a FATFcompliat jurisdictio); Operates solely i its coutry of icorporatio or orgaizatio, has o fixed place of busiess outside of that coutry, ad has the same coutry of icorporatio or orgaizatio as all members of its affiliated group, if ay; Does ot solicit customers outside its coutry of icorporatio or orgaizatio; Has o more tha $175 millio i total assets uder maagemet ad o more tha $7 mitlio i gross reveue o its icome statemet for the most recet accoutig year; ls ot a member of a expaded affiliated group that has more tha $500 millio i total assets uder maagemet or more tha $20 millio i gross reveue for its most recet accoutig year o a combied or cosolidated icome statemet; ad Does ot distribute ay debt or securitjes of the restricted fud to specified US persos, passive NFFEs with oe or more substatial US owers, or oparticipatig FFls Check box 25b or 25c, whichever applies FFI I fudher certify that with respect to all sales of debt or equity iterests i the restricted fud with respect to which this form is furlshed that are made after December 31, 2011, the etity idetified i Part l: b Has bee boud by a distributio agreemet that cotaied a geeral prohibitio o the sale of debt or securities to US etities ad US residet idividuals ad is curretly boud by a distributio agreemet that cotais a prohibitio of the sale of debt or securities to ay specified US perso, passive NFFE with oe or more substatial US owers, or oparticipatig FFl c ts curretly boud by a distributio agreemet that cotais a prohibitio o the sale of debt or securities to ay specified US perso, passive NFFE with oe or more substatial US owers, or oparticipatig FFI ad, for all sales made prior to the time that such a restrictio was icluded i its distributio agreemet, has reviewed all accouts related to such sales i accordace with the proceoures idetified i $ (c) applicable to preexistig accouts ad has redeemed or retired ay, or caused the restricted fud to trasfer the securities to a distributor that is a participatig FFI or reportig Model 1 FFI securities which were sold to specified US persos, passive NFFEs with oe or more substatial US owers, or oparticipatig FFls rorm W-8BEN-E (Rev )

5 Form W-8BEN-E (Rev ) Page 5 IGA FFI 26 L-J I certify that the etity idetified i Part l: lvleets the requiremets to be cosidered a oreportig fiacial istitutio pursuai to a applicable IGA betwee the Uited States ad is treated as a (if appticabre, "";-i;i;;;1i;;;); " The applicable IGA is a! Model 1 IGA or a Modet 2 IGA; ad uder the provisios of the applicable IGA or Treasury regulatios o lf you are a trustee documeted trust or a sposored etity, provide the ame of the trustee or sposor whose GllN is provided o lie 9a (if ay) _- ; ad your GllN (if issued to you) 27[] type egaged i by a isurace compay, custodial istitutio, or depository istitutio with respect to the paymets, accouts, or obligatios for which this form is submitted (except as permitted i (h)(2)) Oheck box 28a or 28b, whichever applies 28a f] certify that the etity idetified i Part I is a iteratioal orgaizatio described i sectio 7701(aX18) b I certify that the etity idetified i Part l: ls comprised primarily of foreig govermets; ls recogized as a itergovermetal or supraatioal orgaizatio uder a foreig law similar to the Iteratioal Orgaizatios lmmuities Act or that has i effect a headquarters agreemet with a foreig govermet; o The beefit of the etitys icome does ot iure to ay private perso; ls the beeficial ower of the paymet ad is ot egaged i commercial fiacial activities of a type egaged i by a isurace compay, custodial istitutio, or depository istitutio with respect to the paymets, accouts, or obligatios for which this form is submitted (excepr as permitted i (h)(2)) Retiremet Plas Check box 29a, b, c, d, e, or f, whichever applies 2ga! certify that the etity idetified i Part l: ls established i a coutry with which the Uited States has a icome tax treaty i force (see Part lll if claimig treaiy beefits); ls operated pricipally to admiister or provide pesio or retiremet beefits; ad ls etitled to treaty beefits o icome that the fud derives from US sources (or would be etjtled to beefits if it derived ay such icome) as a residet of the other coutry which satisfies ay applicable limitatio o beefits requiremet b Ll I certify that the etity idetified i Part l: ls orgaized for the provisio of retiremet, disability, or death beefits (or ay combiatio thereof) employees of oe or more employers i cosideratio for services redered; No sigle beeficiary has a right to more tha 5% of the FFIs assets; ls subject to govermet regulatio ad provides aual iformatio reportig about its beeficiaries to coutry i which the fud is established or operated; ad Is geerally exempt from tax o ivestmet icome uder the laws of the coutry i which it is established or operates due to its status as a retiremet or pesio pla; o Receives at least 50% of its total cotributios from sposorig employers (disregardig trasfers of assets from other plas described i this part, retiremet ad pesio accouts described i a applicable Model 1 or Model 2 lga, other retiremet fuds described i a applicable Model 1 or Model 2 lca, or accouts described i g (b)(2)(i)(A)); o Either does ot permit or pealizes distributios or withdrawals made before the occurrece of specified evets related to retiremet, disability, or death (except rollover distributios to accouts described i $11a71-5(b)(2)(iXA) (refeig to retiremet ad pesio accouts), to retiremet ad pesio accouts described i a applicable Model 1 or Model 2 lga, orto other retiremet fuds described i this parl or i a applicable Model 1 or Model 2 IGA); or o Limits cotributios by employees to the fud by referece to eared icome of the employee or may ot exceed $50,000 aually c t certify that the etity idetified i Part l: ls orgaized for the provisio of retiremet, disability, or death beefits (or ay combiatio thereof) to beeficiaries that are former employees of oe or more employers i cosideratio for services redered; o Has fewer tha 50 padicipats; ls sposored by oe or more employers each of which is ot a ivestmet etity or passive NFFE; Employee ad employer cotributios to the fud (disregardig trasfers of assets from other plas described i this part, retiremet ad pesio accouts described i a applicable Model 1 or Model 2 lga, or accouts described i 911a71-5(b)(2)(i)(A)) are limited by referece to eared icome ad compesatio of the employee, respectively; Participats that are ot residets of the coutry i which the fud is established or operated are ot etitled to more tha 20 percet of the fuds assets; ad ls subject to govermet regulatio ad provides aual iformatio reportig about its beeficiaries to the relevat tax authorities i the coutry i which the fud is established or operates to beeficiaries that are former the relevat tax authorities i the rorm W-8BEN-E (Rev ) a-

6 Form W-8BEN-E (Rev ) Page 6 30 d Ll I certify that the etity idetified i Part I is formed pursuat to a pesio pla that would meet the requiremets of sectio 401(a), other tha the requiremet that the pla be fuded by a trust created or orgaized i the Uited States e I certify that the etity idetified i Part I is established exclusively to ear icome for the beefit of oe or more retiremet fuds described i this part or i a applicable Model 1 or Model 2lGA, accouts described i $11471-s(b)(2XiXA) (referrig to retiremet ad pesio accouts), or retiremet ad pesio accouts described i a applicable Model 1 or Model 2 lga f [ certify that the etity idetified i Part l: ls established ad sposored by a foreig govermet, iteratioal orgaizatio, cetral bak of issue, or govermet of a US possessio (each as defied i ) or a exempt beeficial ower described i a applicable Model 1 or Model 2 IGA to provide retiremet, disability, or death beefits to beeficiaries or participats that are curret or former employees of the sposor (or persos desigated by such employees); or Is established ad sposored by a foreig govermet, iteratioal orgaizatio, cetral bak of issue, or govermet of a US possessio (each as defied i ) or a exempt beeficial ower described i a applicable Model 1 or Model 2IGA to provide retiremet, disability, or death beefits to beeficiaries or participats that are ot curret or former employees of such sposor, but are i cosideratio of persoal seryices performed for the sposor Beeficial Owers L-J I certify that the etity idetified i Part l: ls a FFI solely because it is a ivestmet etity; Each direct holder of a equity iterest i the ivestmet etity is a exempt beeficial ower described i or i a applicable Model 1 or Model 2 IGA; Each direct holder of a debt iterest i the ivestmet etity is either a depository istitutio (with respect to a loa made to such etity) or a exempt beeficial ower described i gl or a applicable Model 1 or Model 2 lga Has provided a ower reportig statemet that cotais the ame, address, TIN (if ay), chapter 4 status, ad a descriptio of the type of documetatio provided to the withholdig aget for every perso that ows a debt iterest costitutig a fiacial accout or direct equity iterest i the etity; ad Has provided documetatio establishig that every ower of the etity is a etity described i $ (b), (c), (d), (e), (f) ad/or (g) without regard to whether such owers are beeficial owers, T Fiacial 31 I certify that the etity idetified i Part I is a fiacial istitutio (other tha a ivestmet etity) that is icorporated or orgaized uder the laws of a Excepted Nofiacial of the Uited States 32 L-l I certify that the etity idetified i Part l: o ls a holdig compay, treasury ceter, or captive fiace compay ad substatially all of the etitys activities are fuctios described i $1 1 a71-5(e)(5)(i)(c) throush (E); ls a member of a ofiacial group described i g (eX5)(iXB); ls ot a depository or custodial istitutio (other tha for members of the etitys expaded affiliated group); ad o Does ot fuctio (or hold itself out) as a ivestmet fud, such as a private equity fud, veture capital fud, leveraged buyout fud, or ay ivestmet vehicle with a ivestmet strategy to acquire or fud compaies ad the hold iterests i those compaies as capital assets for ivestmet purposes 33 Ll I certify that the etity idetified i Part l: Was formed o (or, i the case of a ew lie of busiess, the date of board resolutio approvig the ew lie of busiess) (date must be less tha 24 moths prior to date of paymet); ls ot yet operatig a busiess ad has o prior operatig history or is ivestig capital i assets with the itet to operate a ew lie of busiess other tha that of a fiacial istitutio or passive NFFE; ls ivestig capital ito assets with the itet to operate a busiess other tha that of a fiacial istitutio; ad Does ot fuctio (or hold itself out) as a Ivestmet fud, such as a private equity fud, veture capital fud, leveraged buyout fud, or ay ivestmet vehicle whose purpose is to acquire or fud compaies ad the hold iterests i those compaies as capital assets for ivestmet purposes Nofiacial l or 34 LJ I certify that the etity idetified i Part l: c Filed a pla of liquidatio, filed a pla of reorgaizatio, or filed for bakruptcy o Durig the past 5 years has ot bee egaged i busiess as a fiacial istitutio or acted as a passive NFFE; ls either liquidatig or emergig from a reorgaizatio or bakruptcy with the itet to cotiue or recommece operatios as a ofiacial etity; ad Has, or will provide, documetary evidece such as a bakruptcy filig or other public documetatio that suppos its claim if it remais i bakruptcy or liquidatio for more tha three years rorm W-8BEN-E (Bev )

7 Form W-8BEN-E (Rev4-2016) eage "" Has bee issued a determiatio letter from the IRS that is curretly i effect cocludig that the payee is a sectio 501(c) orgaizatio that is dated-_--_- - -_-_- ; or Has provided a copy of a opiio from US cousel certifyig that the payee is a sectio 501(c) orgaizatio (without regard to whether the payee is a foreig private foudatio) T"*iliii 36-6rGitill6 r The etity is established ad maitaied i its coutry of residece exclusively for religious, charitable, scietific, aistic, cultural or educatioal purposes; The etity is exempt from icome tax i its coutry of residece; The etity has o shareholders or members who have a proprietary or beeficial iterest i its icome or assers; Neither the applicable laws of the etitys coutry of residece or the etitys formatio documets permit ay icome or assets of the etity to be distributed to, or applied for the beefit of, a private perso or o-charitable etity other tha pursuat to the coduct of the etity,s charitable activities or as paymet of reasoable compesatio for services redered or paymei represetig the fair market value of propedy which the etity has purchased; ad The applicable laws of the etitys coutry of residece or the etitys formatio documets require that, upo the etitys liquidatio or dissolutio, all of its assets be distributed to a etity that is a foreig govermet, a itegral part of a foreig govermet, acotiolled etity of a foreig govermet, or aother orgaizatio that is described i this Part XXll or escheats to the govermet of the etitys coutry of residece or ay political subdivisio thereof Gheck box 37a or 37b, whichever applies" g7a lcertifythat: Traded NFFE or ofa Traded The etity idetified i Part I is a foreig corporatio that is ot a fiacial istltutio; ad o The stock of such corporatio is regularly traded o oe or more esiablished securities markets, icludig (ame oe securities exchage upo which the stock is regularly traded) b E I certifythat: The etity idetified i Part I is a foreig corporatio that is ot a fiacial istitutio; The etity idetified i Part I is a member of the same expaded affiliated group as established securities market: The ame of the etity, the stock of which is regularly traded o a established securities market, is The ame of the securities market o which the stock is reorrlarlv traclecl is a etity the siock of which is regularly traded o a : ad 38 l certifythat: o The etity idetified i Part I is a etity that is orgaized i a possessio of the Uited States; The etity idetified i Part l: Does ot accept deposits i the ordiary course of a bakig or similar busiess, o Does ot hold, as a substatial portio of its busiess, fiacial assets for the accout of others, or o ls ot a isurace compay (or the holdig compay of a isurace compay) that issues or is obligated to make paymets with respect to a fiacial accout; ad o All of the owers of the etity idetified i Part I are boa fide residets of the possessio i which the NFFE is orgaized or icorporated Active NFFE 39! certifythat: The etity idetified i Part I is a foreig etity that is ot a fiacial istitutio; Less tha 50% of such etitys gross icome for the precedig caledar year is passive icome; ad o Less tha 50% of the assets held by such etity are assets that produce or are held for ihe productio of passive icome (calculated as a _weighted average of the percetage of passive assets measured quarterly) (see istructios for the defiitio of passive icome) 4oalcertifythattheetityidetifiediPart isaforeigetitythatisotafiacia istitutio(otherthauiry possessio of the Uited States) ad is ot certifyig its status as a publicly kaded NFFE (or affiliate), excepted territory NFFE, active NFFE, direct reportig NFFE, or sposored direct reportig NFFE Check box 40b or 40c, whichever applies b I furlher certify that the etity idetified i Part I has o substatial US owers (or, if applicable, o cotrollig US persos), or " I I further certify that the etity idetified i Part I has provided the ame, address, ad TIN of each substatial US ower (or, if applicabie, cotrollig US perso) of the NFFE i Part XXIX rorm W-8BEN-E (Rev )

8 Form W-8BEN-E (Rev ) Page 8 41 Iter-Atfiliate FFI LJ I certify that the etity idetified i Part l: ls a member of a expaded affiliated group; Does ot maitai fiacial accouts (other tha accouts maitaied for members of its expaded affiliated group); Does ot make withholdable paymets to ay perso other tha to members of its expaded affiliated group that are ot limited FFls or limited braches; Does ot hold a accout (other tha a depository accout i the coutry i which the etity is operatig to pay for expeses) with or receive paymets from ay withholdig aget other tha a member of its expaded affiliated group; ad Has ot agreed to report uder (dX2Xii)(C) or otherwise act as a aget for chapter 4 purposes o behalf of ay fiacial istitutio, icludig a member of its expaded affiliated group 42 Name of sposorig etity: GllN of sposorig etity: 43 r that the idetified i Part I is a direct NFFE that is sposored by the idetified o lie 42 Owers As required by Part XXVI, provide the ame, address, ad TIN of each substatial US ower of the NFFE Please see istructios for defiitio of substatial US ower lf providig the form to a FFI treated as a reportig Model 1 FFI or reportig Model 2 FFl, a NFFE may also use this Part for reportig its cotrollig US persos uder a applicable lga Certificatio Uder pealties of perjury, I declare that I have examied the iformatio o thls form ad to the best of my kowledge ad belief it is true, correct, ad complete, I further certify uder pealties of perjury that: The etity idetified o lie 1 of this form is the beeficial ower of all the icome lo which this form relates, is usig this form lo cefti{y its status for chapter 4 purposes, or is a merchat submittig this form for purposes of sectio 6050W, The etity idetifiod o lie 1 of this form is ot a US perso, The icome to which this form relates is: (a) ot effectively coected with the coduct of a trade or busiess i the Uited States, (b) effectively coected but is ot subject to tax uder a icome tax treaty, or (c) the paders share of a parterships effectively coected icome, ad o For broker trasactios or barter exchages, the beeficial ower is a exempt foreig porso as defied i the istructios Fudhermore, I authorize this form to be provided to ay withholdig aget thal has cotrol, receipt, or custody of the icome of which the etity o lie 1 is tho beeficial ower or ay withholdig aget that ca disburse or make paymets of the icome of which the etity o li6 1 is the beeficial ower I agree that I will submit a ew form withi Sis Here ) fle au, itrsz 08a4-2o4 6 Prit Name Date (MM-DD-YYYY) M I certify that I have the capacity to sig for the etity idetified o lie 1 of this form, rorm W-8BEN-E (Rev4-2016)