Tax Information Intervie

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4/18/2019 Tax Information Interview

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Reference Id: A04470656TJEZR7SSC37

Certificate of Foreign Status of


Beneficial Owner for United
States Tax Withholding and Reporting
Form W-8BEN (Individuals) SUBSTITUTE (July 2017)

Do NOT use this form if: Instead, use Form:

You are NOT an individual W-8BEN-E

You are a U.S. citizen or other U.S. person, including a resident alien individual W-9

You are a beneficial owner claiming that income is effectively connected with the conduct of W-8ECI
trade or business within the U.S. (other than personal services)

You are a beneficial owner who is receiving compensation for personal services performed in the 8233 or W-4
United States

A person acting as an intermediary W-8IMY

Part I Identification of Beneficial Owner


1 Name of individual who is the beneficial owner

Lamberto Raymond Taylo Jr

2 Country of citizenship

Philippines

3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

11C Tower 1 East Bay Residences Km 21 East Service rd. Sucat

City or town, state or province. Include postal code where appropriate.

Muntinlupa City 1770

Country

Philippines

4 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate.

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4/18/2019 Tax Information Interview

Country

5 U.S. taxpayer identification number (SSN or ITIN), if required (see


instructions)

6 Foreign tax identifying number (see instructions)


212275362000

Part II Claim of Tax Treaty Benefits


9 I certify that the beneficial owner is a resident of within the meaning of the income tax treaty between the United States
and that country.

10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of     of the
treaty identified on line 9 above to claim a   %   rate of withholding on (specify type of income):    

Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of
withholding:

Part III Certification


Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it
is true, correct, and complete. I further certify under penalties of perjury that:

1. I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the
income to which this form relates or am using this form to document myself for chapter 4 purposes,
2. The person named on line 1 of this form is not a U.S. person,
3. The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United
States, (b) effectively connected but is not subject to tax under an income tax treaty, or (c) the partner's share of a partnership's
effectively connected income,
4. The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the
meaning of the income tax treaty between the United States and that country, and
5. For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of
which I am the beneficial owner or any withholding agent that can disburse or make payments of the income of which I am the
beneficial owner. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

Lamberto Raymond Taylo Jr 04-18-2019


Sign Here
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)

Capacity in which acting

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