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    Mariano P Padernilla Philippines: Brgy. Malag It Grande

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    Lain Padernilla
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    Mariano P Padernilla Philippines: Brgy. Malag It Grande

    Uploaded by

    Lain Padernilla
    11 views1 page
    ddd

    Original Title

    W8-BEN-SERVICES_2021-05-29_PREVIEW_DOC

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    ddd

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    Download as pdf or txt
    11 views1 page

    Mariano P Padernilla Philippines: Brgy. Malag It Grande

    Uploaded by

    Lain Padernilla
    ddd

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United

    States Tax Withholding and Reporting (Individuals)


    Substitute Form ▶ For use by individuals. Entities must use Form W-8BEN-E. OMB No. 1545-1621

    Department of the Treasury Go to www.irs.gov/FormW8BEN for instructions and the latest information.
    ▶

    Internal Revenue Service ▶ Give this form to the withholding agent or payer. Do not send to the IRS.

    Note: a) If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), a certain tax account information may be provided
    to your jurisdiction of residence.
    b) This form can be used by a non-U.S. individual to certify tax status for payments made under section 1441.
    c) The number of the questions in this substitute form matches the official IRS form so that the signer can cross reference the official IRS instructions.
    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 trade or business within the U.S.
    (other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
    • You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4
    • You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY

    Part I Identification of Beneficial Owner (see instructions)


    1 Name of individual who is the beneficial owner 2 Country of citizenship
    Mariano P Padernilla 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.
    Brgy. Malag it Grande
    City or town, state or province. Include postal code where appropriate. Country
    Passi City 5037 Philippines
    4 Mailing address (if different from above)

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

    5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
    •••••••-157
    7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)

    Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
    9 I certify that the beneficial owner is a resident of PH 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 Article and paragraph
    article 8 paragraph 1 of the treaty identified on line 9 above to claim a 0 % rate of withholding on (specify type of income):
    Services .
    Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
    As a tax resident of Philippines, Mariano P Padernilla meets required terms of the treaty, doesn't have a permanent establishment in the US, and doesn't perform independent personal
    services in the US from a fixed base in the US; or the right or property in respect of which royalties are paid isn't effectively connected with a permanent establishment or fixed base

    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:
    • 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,
    • The person named 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 business in the United States,
    (b) effectively connected but is not subject to tax under an applicable income tax treaty, or
    (c) the partner’s share of a partnership's effectively connected income,

    • 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
    • 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.
    The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to establish your status as a non-
    U.S. person, establish your Chapter 4 status (if required), and, if applicable, obtain a reduced rate of withholding.
    ▲

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

    Print name of signer Capacity in which acting (if form is not signed by beneficial owner)
    For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)

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