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7

FormW-8BEN-E(February 2014)

Department 01 the Treasury

Internal Revenue Service

Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)~ For useby e':llilies. Individuals musl use FormW-8BEN. ~ Seclion relerences are lo lhe Inlemal RevenueCode.

•. Intormallon about Form W-8BEN-E and ils separale inslruclions is al www.irs.govlformw8bene.•. Give lhis torm lo lhe wilhholding agent or payer. Do nol send lo lhe IRS.

OMB No. 1545-1621

Do NOT use this fonn for: Instead use Form

W-8ECW-8IMY

W-8ECI or W-8EXP

. W-8IMY

. W-

W-8BEN (Individual

2 Country of incorporation or organization

• U.S. entity or U.S. citizen or resident

• A foreign individual

• A foreign individual or entity claiming that income is effectively connected with the conduct of trade or business within the U.S.

(unless claiming treaty benefits).• A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits) (see instructions for exceptions)

• A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private

foundation, or government of a U.S. possession claiming that income is effectively connected U.S. income or that is claiming

the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (unless claiming treaty benefits) (see instructions)

• Any person acting as an interrnediary .

Identification of Beneficial Owner

Name of organization that is the beneficial owner

3 Name of disregarded entity receiving the payment (if applicable)

4 Chapter 3 Status (entity type) (Must check one box only): O Corporation O Disregarded entity O Partnership

O Simple trust O Grantor trust O Complex trust O Estate O Government

O Central Bank of Issue O Tax-exempt organization O Private foundation

lf you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty

claim? If "Yes" complete Part 1 1 1 . O Ves O No

5 Chapter 4 Status (FATCA status) (Must check one box only unless otherwise indicated). (See instructions for details and complete the

certification below for the entity's applicable status).

O Nonparticipating FFI (including a Iimited FFI or an FFI related to a O Nonreporting IGA FFI (including an FFI treated as a registered

Reporting IGA FFI other than a registered deemed-compliant FFI deemed-compliant FFI under an applicable Model 2 IGA).

or participating FFI). Complete Part XII.

O Participating FFI. O Foreign government, government of a U.S. possession, or foreign

O Reporting Model 1 FFI. central bank of issue. Complete Part XIII.

O Reporting Model 2 FFI. O International organization. Complete Part XIV.

O Registered deemed-compliant FFI (other than a reporting Model 1 O Exempt retirement plans. Complete Part XV.

FFI or sponsored FFI that has not obtained a GIIN). O Entity wholly owned by exempt beneficial owners. Complete Part XVI

O Sponsored FFI that has not obtained a GIIN. Complete Part IV. O Territory financial institution. Complete Part XVII.

O Certified deemed-compliant nonregistering local bank. Complete O Nonfinancial group entity. Complete Part XVIII.Part V. O Excepted nonfinancial start-up company. Complete Part XIX.

O Certified deemed-compliant FFI with only low-value accounts. O Excepted nonfinancial entity in liquidation or bankruptcy.

Complete Part VI. Complete Part x x .

O Certified deemed-compliant sponsored, closely held investment O 501(c) organization. Complete Part XXI.

vehicle. Complete Part VII. O Nonprofit organization. Complete Part XXII.

O Certified deemed-compliant Iimited Iife debt investment entity. O Publicly traded NFFE or NFFE affiliate of a publicly traded

Complete Part VIII. corporation. Complete Part XXIII.

O Certified deemed-compliant investment advisors and investment O Excepted territory NFFE. Complete Part XXIV.

managers. Complete Part IX. O Active NFFE. Complete Part XXV.

O Owner-documented FFI. Complete Part X. O Passive NFFE. Complete Part XXVI.

O Restricted distributor. Complete Part XI. O Excepted inter:affiliate FFI. Complete Part XXVII.

O Direct reporting NFFE.

O Sponsored direct reporting NFFE. Complete Part XXVIII.

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

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

7 Mailing address (if different from above)

Note. Please complete remainder of the form including signing the form in Par! XXIX.

For Paperwork Reduction Act Notice, see separate instructions. Cal.No.59689N

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

8 U.S.taxpayeridentificationnumber (T IN ), if required 9a O GIIN b O Foreign TIN

Country

Referencenumber(s)(see instructions

Form W-8BEN-E (2-2014

http://www.irs.govlformw8bene./

http://www.irs.govlformw8bene./

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lIPDATED INFORMATION FOR USERS OF FORM W-8BEN-E --

USE f)F FORM W-8BEN (REVISION DATE FEBRUARY 2006)

BEFORE JANUARY 1, 2015

The Form W-SBEN-E reflects changes made by the Foreign Account Tax Compliance Act

(FATCA) and is for use by beneficial owners that are entities. Entities also may use the

Form W-SBEN (revision date February 2006) through December 31,2014.

For purposes of chapter 3 of the Internal Revenue Code, a Form W-SBEN (revision date

February 2006) provided to a withholding agent by an entity before January 1, 2015 will

remain val id until the form's validity expires under Treasury Regulations section 1.1441-1 (e)

(4)(ii).

For purposes of chapter 4 of the Internal Revenue Code, a Form W-SBEN (revision date

February 2006) provided to a withholding agent by an entity before January 1, 2015 is and

will remain valid to the extent permitted in Treasury Regulations section 1.1471-3(d)(1)

(describing the allowance for use of a "pre-FATCA Form W-S"). See also Treasury

Regulations section 1.1471-2T(a)(4)(ii) (describing a transitional exception to withholding for

certain payments made with respect to a preexisting obligation).

A withholding agent may request that you provide a Form W-SBEN (revision date February

2006) before January 1, 2015. The Form W-SBEN (revision date February 2006) can be

found on irs.gov in the Forms and Publications section, under the "Prior Year Forms" tab, by

searching the cumulative list of forms posted there for the term "Form W-S". It does not

reflect the changes made by FATCA.

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15

FormW.8BEN-E (2-2014) Paga

lmII Disregarded Entity or Branch Receiving Payment. (Complete only if disregarded entity or branch of an

FFI in a country other than the FFI's country of residence.)

11 Chapter 4 Status (FATCA status) 01 disregarded entity or branch receiving payment

O Limited Branch. O Reporting Model 1 FFI. O U.S. Branch.

O Participating FFI. O Reporting Model 2 FFI.

12 Address 01 disregarded entity or branch (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than registered address).

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

Country

13 GIIN (il any)

1DIIIIIr---:C::":I'-a--im-o-f'""T-o-a-x-=T-re-a-ty-B--e-n-e-f-it-s-(--if-a-p-p-li-c-a-b-Ie-).-(-F-o-r -ch-a-p-t-e-r-3-p-u-r-p-o-se-s-o-n-ly-)-------------

14 1certily that (check all that apply):

a O The benelicial owner is a resident 01 • •• ._ ••• within the meaning 01 the income tax

treaty between the United States and that country.

b O The benelicial owner derives the item (or items) 01 income lor which the treaty benelits are claimed, and, il applicable, meets th

requirements 01 the treaty provision dealing with Iimitation on benelits (see instructions).

c O The benelicial owner is claiming treaty benelits lor dividends received lrom a loreign corporation or interest Irom a U.S. trade or busines

01 a loreign corporation and meets qualilied resident status (see instructions).

Special rates and conditions (if applicable-see instructions): The benelicial owner is claiming the provisions of Article----- --- -------------------

of the treaty identilied on line 14a aboye to c1aima • ••• % rate of withholding on (specify type 01 income): .

Explain the reasons the benelicial owner meets the terms 01 the treaty article:

Sponsored FFI That Has Not Obtai ned a GIIN

16 Name of sponsoring entity: _

17 Check whichever box applies.

O I certily that the entity identified in Part 1:

• Is an FFI solely because it is an investment entity;

• Is not a 01, WP, or WT; and

• Has agreed with the entity identilied aboye (that is not a nonparticipating FFI)to act as the sponsoring entity lor this entity.

O 1certify that the entity identilied in Part 1:

• Is a controlled loreign corporation as delined in section 957(a);

• Is not a 01, WP, or WT;• Is wholly owned, directly or indirectly, by the U.S. financial institution identilied aboye that agrees to act as the sponsoring entity for thi

entity; and

• Shares a common electronic account system with the sponsoring entity (identified aboye) that enables the sponsoring entity to identify a

account holders and payees 01 the entity and to access all account and customer inlormation maintained by the entity including, but no

Iimited to, customer identification information, customer documentation, account balance, and all payments made to account holders o

payees.

l : iZ m I!I Certified Deemed-Compliant Nonregistering Local Bank

18 O 1certify that the FFI identilied in Part 1:

• Operates and is licensed solely as a bank or credit union (or similar cooperative credit organization operated without protil) in its country 0

incorporation or organization;

• Engages primarily in the business 01 receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to suc

bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than fiv

percent interest in such credit union or cooperative credit organization;

• Does not solicit account holders outside its country 01 organization;

• Has no lixed place of business outside such country (Ior this purpose, a fixed place 01 business does not include a location that is no

advertised to the public and lrom which the FFI performs solely administrative support lunctions);

• Has no more than $175 million in assets on its balance sheet and, il it is a member 01 an expanded alliliated group, the group has no mor

than $500 million in total assets on its consolidated or combined balance sheets; and

• Does not have any member 01 its expanded affiliated group that is a loreign linancial institution, other than a loreign linancial institution tha

is incorporated or organized in lhe same country as the FFI identilied in Part 1and that meets the requiremenls set lorth in this Part V.

FormW-8BEN-E (2-201

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Form W-8BEN-E (2-2014) Page3

limII!lI Certified Deemed-Compliant FFI with Only Low-Value Aeeounts

19 D 1 certily lhal lhe FFI identilied in Part 1 :

• 1 5 nol engaged primarily in the business 01 investing, reinvesling, or trading in securities. partnership interesls. commodities, noliona

principal contracts. insurance or annuity contracts, or any inlerest (including a lutures or lorward contracl or oplion) in such securily

partnership interes!, commodity. notional principal contract, insurance contract or annuity contract:

• No linancial account mainlained by the FFI or any member 01 its expanded affiliated group, il any, has a balance or value in excess 0

$50.000 (as determined alter applying applicable account aggregation rules);and

• Nellher lhe FFI nor lhe enlire expanded affiliated group, il any, 01 lhe FFI, have more lhan $50 million in assels on ItS consolidaled o

combined balance sheel as 01 lhe end 01 ils most recenl accounling year.

Certified Deemed-Compliant Sponsored, Closely Held Investment Vehiele

20 Name 01 sponsoring enlity:

21 D I certily lhal the enlily idenlilied in Part 1 :

• 1 5 an FFt solely because il is an inveslmenl entily descríbed in 91.1471-5(e)(4);

• 15 nol a 01. WP. or WT;

• Has a contraclual relalionship with lhe above identified sponsoring enlily that agrees to lulfill all due diligence, wlthholdlng, and reporting

responsibililies 01 a participaling FFIon behall 0 1 this entity; and

• Twenly or lewer individuals own all 01 lhe debt and equily inleresls in the enlily (disregarding debl inleresls owned by U.S. linancia

inslilulions. participaling FFls. regislered deemed-complianl FFls. and certified deemed-complianl FFls and equity Inleresls owned by a

enlily il lhal enlily owns 100 percenl 01 the equily interesls in lhe FFI and is itself a sponsored FFI).

lDI!mI Certified Deemed-Compliant limited life Debt Investment Entity

22 D 1 certify that lhe enlily idenlified in Part 1 :

• Was in exislence as 01 January 17, 2013;• Issuedall class.es01 ils debt or equily inleresls lo inveslors on or beforeJanuary 17,2013, pursuanl lo a lrusl indenlure or similar agreement;and

• 1 5 certilied deemed-complianl because il salisfies the requiremenls lo be treated as a limited lile debt inveslment entily (such as the

reslnclions with respect lo its assels and other requiremenls under 9 1.1471-5(f)(2)(iv)).

lm!:I Certified Deemed-Compliant Investment Advisors and Investment Managers

23 D I certily lhal lhe enlily idenlilied in Part 1 :

• 1 5 ¡¡ linancial inslitution solely because il is an investmenl enlily described in 91,1471-5(e)(4)(i)(A};and

• Does nol mainlain linancial accounls.

lau Owner-Doeumented FFI

Note. This slalus only applies if the U.S. financial inslilulion or participaling FFIlo which lhis lorm is given has agreed lhal il wlll lreal lhe FFIas an

owner-documenled FFI (see inslruclions lor eligibilily requirements). In addilion, lhe FFI must make lhe certilicalions below.

24a D(AIIowner-documenled FFlscheck here) I certify lhat the FFI idenlilied in Part 1:

• Does nol acl as an inlermediary:

• Does nol accepl deposils in lhe ordinary course of a banking or similar business;

• Does nol hold. as a subslanlial portion of ils business, linancial assels lor lhe accounl 01 olhers;

• 1 5 1101 an insurance company (or lhe holding company 01 an insurance company) lhal issuesor is obligaled lo make paymenls wilh respecl to

a linancial accounl;

• 1 5 nol owned by or in an expanded affilialed group with an enlily thal accepts deposits in the ordinary course of a banking or simila

business, holds. as a substantial portion 01 ils business, linancial assets for the account 01 olhers. or is an insurance company (or the holding

company 01 an insurance company) thal issues or is obligated to make payments with respecl lo a linancial accounl: and

• Does not mainlain a linancial accounl for any nonparticípaling FFI.

Form W-8BEN-E (2-2014

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Form W-8BEN-E (2-2014) Page

lim IE I Owner-Documented FFI (continued)

Check box 24b or 24c, whichever applies.

b D. I certily that the FFI identilied in Part 1:

• Has provided, or will provide, an FFI owner reporting statement that contains:

• The name, address, TIN (il any), chapter 4 status, and type 01 documentation provided (il required) 01 every individual and specilied U.

person that owns a direct or indirect equity interest in the owner-documented FFI (Iooking through all entities other than specilied U.

persons);

• The name, address, TIN (il any), chapter 4 status, and type 01 documentation provided (il required) 01 every individual and specilied U.Sperson that owns a debt interest in the owner-documented FFI (including any indirect debt interest, which includes debt interests in an

entity that directly or indirectly owns the payee or any direct or indirect equity interest in a debt holder 01 the payee) that constitutes

linancial account in excess 01 $50,000 (disregarding all such debt interests owned by participating FFls, registered deemed-compliant FFl

certilied deemed-complianl FFls, excepted NFFEs, exempt benelicial owners, or U.S. persons other than specilied U.S. persons); and

• Any additional inlormation the withholding agent requests in order to lulfill its obligations with respect to the entity.

cOI certify that the FFI identilied in Part I has provided, or will provide, an auditor's letter, signed within lour years 01 the date 01 payment,

Irom an independent accounting lirm or legal representative with a location in the United States stating that the lirm or representative h

reviewed the FFI's documentation with respect to all 01 its owners and debt holders identilied in S1.1471-3(d)(6)(iv)(A)(2), and that the F

meets all the requirements to be an owner-documented FFI. The FFI identilied in Part I has also provided, or will provide, an FFI own

reporting statement 01 its owners that are specilied U.S. persons and Form(s) W-9, with applicable waivers.

Check box 24d if applicable.

d O I certify that the entity identilied in line 1 is a trust that does not have any contingent beneliciaries or designated classes with unidentilie

beneliciaries.

lim I E !I Restricted Distributor 25a O (AIIrestricted distributors check here) I certily that the entity identilied in Part 1:

• Operates as a distributor with respect to debt or equity interests 01 the restricted lund with respect to which this lorm is lurnished;

• Provides investmenl services to at least 30 customers unrelated to each other and less than hall 01 its customers are related to each other;

• 15required to perform AML due diligence procedures under the anti-money laundering laws 01 its country 01 organization (which is an FAT

compliant jurisdiction);

• Operates solely in its country 01 incorporation or organization, has no lixed place 01 business outside 01 that country, and has the sam

country 01 incorporation or organization as all members 01 its affiliated group, il any;

• Does not solicit customers outside its country 01 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 l

the most recent accounting year;

• 15not a member 01 an expanded affiliated group that has more than $500 million in total assets under management or more than $20 milli

in gross revenue lor its most recent accounting year on a combined or consolidated income statement; and

• Does not distribute any debt or securities 01 the restricted lund to specilied U.S. persons, passive NFFEs with one or more substantial Uowners, or nonparticipating FFls.


I lurther certify that with respect to all sales 01 debt or equity interests in the restricted lund with respect to which this lorm is lurnished that are made

after December 31, 2011, the entity identilied in Part 1:

b O Has been bound by a distribution agreement that contained a general prohibition on the sale 01 debt or securities to U.S. entities and U.S

resident individuals and is currently bound by a distribution agreement that contains a prohibition 01 the sale 01 debt or securities to any

specilied U.S. person, passive NFFE with one or more substantial U.S. owners, or nonparticipating FFI.

c O 15currently bound by a distribution agreement that contains a prohibition on the sale 01 debt or securities to any specilied U.S. person,

passive NFFEwith one or more substantial U.S. owners, or nonparticipating FFI and, lor 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

identilied in S1.1471-4(c) applicable to preexisting accounts and has redeemed or retired any, or caused the restricted lund to transler th

securities to a distributor that is a participating FFI or reporting Model1 FFI securities which were sold to specilied U.S. persons, passive

NFFEs with one or more substantial U.S. owners, or nonparticipating FFls.

li m lE U I Nonreporting IGA FFI26 DI certily that the entity identilied in Part 1:

• Meets the requirements to be considered a nonreporting linancial institution pursuanl lo an applicable IGA between lhe United Slales and

• 15lreated as a under the provisions 01 the applicable IGA (see instructions); and

• 1Iyou are an FFI lreated as a regislered deemed-complianl FFI under an applicable Model 2 IGA, provide your GIIN:Form W-8BEN-E (2-20

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Forrn W-8BEN-E (2-2014) Page5

IDE!III Foreign Government, Government 01 a U.S. Possession, or Foreign Central Bank 01 Issue

27 DI certily Ihal Ihe enlily idenlilied in Part I is Ihe beneficial owner of Ihe paymenl and is nol engaged in commercial flnanclal aclivilies of a

Iype engaged in by an insurance company, cuslodial inslilulion, or deposilory inslilulion with respecl lo Ihe paymenls, accounls, o

obligallons lor which Ihis lorm is submitted (excepl as permitted in 91.1471-6(h)(2)).

~ International Organization

Check box 28a or 28b, whichever applies.

28a DI certily Ihal Ihe entlly idenlilied in Part I is an inlernalional organizalion described in seclion 7701(a)(18).

bOl certily thal Ihe enlily idenlilied in Part 1 :

• Is comprised primarily 01 loreign governments;

• Is recognized as an inlergovernmenlal or supranalional organizalion under a foreign law similar to the Inlernalional Organlzalions Immunilies

Acl;

• The benelit 01 the entity's income does not inure lo any privale person;

• Is the beneficial owner 01 Ihe paymenl and is not engaged in commercial linancial activilies 01 a type engaged in by an insurance company

custodial inslitulion. or depository instilulion with respect lo the payments. accounts. or obligalions lor which this lorm ISsubmitted (excepl a

permitted in 91.1471-6(h)(2)).

lZ lE i!I Exempt Retirement Plans

Check box 29a, b, c, d, e, or f, whichever applies.

29a O I certily thal Ihe enlily idenlilied in Part 1:

• Is eslablished In a counlry wilh which Ihe Uniled States has an income lax treaty in lorce (seePart 111il claiming treaty benelils);

• Is operaled principally lo adminisler or provide pension or reliremenl benelits; and

• Is enlllled lo Irealy benefils on income Ihal the lund derives lrom U.S. sources (or would be enlilled lo benelils il il denved any such income

as a residenl 01 Ihe other country which salislies any applicable limitalion on benelits requiremenl.bOl certily Ihal Ihe enlity idenlified in Part 1:

• Is organized for Ihe provision 01 relirement, disability. or dealh benelils (or any combinalion Ihereof) to beneficlanes that are forme

employees 01 one or more employers in consideration for services rendered;

• No single beneficiary has a right to more than 5% of Ihe FFI's assets;

• Is subject to government regulation and provides annual informalion reporting aboul ils beneliciaries lo the relevant tax aulhorities in the

counlry in which the fund is established or operaled; and

• Is generally exempt Irom lax on investment income under Ihe laws 01 Ihe counlry in which It is established or operates due to its slatus a

a retirement or pension plan;

• Receives at leasl 50% of ils lotal conlributions from sponsoring employers (disregarding translers 01 assets lrom other plans described i

Ihis part, retirement and pension accounts described in an applicable Model 1 or Model 2 IGA. olher relirement funds descnbed in a

applicable Model 1 or Model 2 IGA. or accounls described in 91.1471-5(b)(2)(i)(A));

• Either does not permil or penalizes distribulions or withdrawals made before Ihe occurrence 01 specilied events related lo retiremen

disability. or death (except rollover distributions to accounls described in 91.1471-5(b)(2)(i)(A)(relerring to relirement and pension accounls)

lo reliremenl and pension accounls described in an applicable Model 1 or Model 2 IGA, or lo olher reliremenl lunds described in Ihis part o

in an applicable Model 1 or Model 2 IGA);or

• Limils conlributions by employees lo Ihe lund by reference lo earned income of the employee or may nol exceed $50.000 annually.

cOI certily Ihat Ihe entity idenlilied in Part 1:

• Is organized lor the provision 01 retiremenl, disabilily. or dealh benelils (or any combination Ihereof) lo beneficianes thal are forme

employees 01 one or more employers in consideralion for services rendered;

• Has fewer than 50 participanls;

• Is sponsored by one or more employers each 01 which is nol an inveslmenl enlily or passive NFFE;

• Employee and employer conlributions lo Ihe lund (disregarding lranslers of assels lrom olher plans described in this parto retirement an

pension accounts described in an applicable Model 1 or Model 2 IGA. or accounls described in 91.1471-5(b)(2)(i)(A))are limlted by reference t

earned income and compensalion 01 Ihe employee, respeclively;

• Partlcipants Ihal are nol residenls 01 Ihe counlry in which Ihe lund is eslablished or operated are not enlitled lo more than 20 percenl of Ih

lund's assets; and

• Is subjecl lo government regulation and provides annual inlormation reporting aboul its beneficiaries lo the relevant tax authonlies in Ihcounlry in which the lund is eslablished or operales.

d DI certily that the enlily idenlilied in Part I is lormed pursuanl lo a pension plan Ihal would meet the requiremenls 01 sectlon 401(a).olher

than tlle requiremenl thal Ihe plan be lunded by a Irust crealed or organized in Ihe Uniled Slales.

e O I certily Ihal the entity idenlified in Part I is eslablished exclusively lo earn income lor the benefil 01 one or more relirement lunds

described in Ihis part or in an applicable Model 1 or Model 2 IGA. accounls described in 91.1471-5(b)(2)(i)(A)(refernng to retirement an

pension accounls), or reliremenl and pension accounls described in an applicable Model 1 or Model 2 IGA.

Forrn W-8BEN-E (2-2014

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FormW-8BEN-E (2-2014) Paga

li m I E fI Exempt Retirement P!ans (Continued)

O I eertify that the entity identified in Part 1 :

• Is established and sponsored by a foreign government, inlernalional organizalion, central bank of issue, or government of a U.S. possession

(eaeh as defined in 91.1471-6) or an exempt benefieial owner deseribed in an applieable Model 1 or Model 2 IGA lo provide reliremenl,

disabilily, or death benefits to benefieiaries or partieipanls lhat are eurrent or former employees of the sponsor (or persons designated by sueh

employees); or

• Is established and sponsored by a foreign government. inlernalional organization, central bank of issue, or government of a U.S. possession

(eaeh as defined in 91.1471-6) or an exempl benefieial owner deseribed in an applieable Model 1 or Model 2 IGA lo provide retiremenl.disabilily, or dealh benefils to benefieiaries or partieipanls that are nol eurrenl or former employees of sueh sponsor, but are in eonsideralion

of personal serviees performed for lhe sponsor.

lD E i!D Entity Wholly Owned by Exempt Beneficia! Owners

30 O 1 eertify lhal lhe entily idenlified in Part 1 :

• Is an FFI solely beeause il is an investmenl enlily;

• Eaeh direet holder of an equity inleresl in lhe investment entity is an exempt benefieial owner deseribed in 91.1471-6 or in an applieab

Model 1 or Model 2 IGA;

• Eaeh direel holder of a debl interesl in lhe inveslmenl entily is eilher a depository inslitution (with respeel lo a loan made lo sueh entity) or

exempl benefieial owner deseribed in 91.1471-6 or an applieable Model 1 or Model 2 IGA.

• Has provided an owner reporting slatemenl lhat eonlains lhe name, address, TIN (if any), ehapler 4 status, and a deseription of lhe lype

doeumenlation provided lo lhe withholding agent for every person that owns a debl interest eonstituting a finaneial aeeounl or direel equ

interest in the entily; and

• Has provided doeumenlalion establishing lhat every owner of lhe enlity is an enlity deseribed in 91.1471-6(b), (e), (d), (e), (f) and/or (g) witho

regard lo whelher sueh owners are benefieial owners.

lDEfm Territory Financial Institution31 O 1 eertify lhat the enlity idenlified in Part 1 is a finaneial inslilulion (olher lhan an investmenl enlity) lhal is ineorporated or organized under

the laws of a possession of lhe United States.

l : i m Im II J Excepted Nonfinaneial Group Entity

32 O 1 eertify lhal lhe enlily identified in Part 1 :

• Is a holding eompany, lreasury eenter, or eaptive finanee eompany and subslanlially all of lhe enlity's aetivities are funelions deseribed

91.1471-5(e)(5)(i)(C)lhrough (E);

• Is a member of a nonfinaneial group deseribed in 91.1471-5(e)(5)(i)(B);

• Is not a deposilory or eustodial inslitution (other lhan for members of the enlily's expanded affiliated group); and

• Ooes nol funetion (or hold itself oul) as an inveslmenl fund, sueh as a private equily fund, venlure capital fund, leveraged buyoul fund, or a

inveslment vehiele wilh an inveslment slralegy to aequire or fund eompanies and then hold inlerests in lhose eompanies as capital assels

inveslmenl purposes.

lDE!f3 Exeepted Nonfinaneia! Start-Up Company33 O 1 eertify thal the enlity idenlified in Part 1 :

• Was formed on (or, in the case of a new line of business, lhe dale of board resolution approving the new line of business)-------- ------- --------

(dale musl be less lhan 24 months prior to date of paymenl);

• Is nol yet operaling a business and has no prior operating history or is investing capital in assels with lhe inlent lo operale a new line

business other lhan thal of a finaneial inslitution or passive NFFE;

• Is investing eapilal into assels with lhe inlenl lo operale a business olher lhan lhal of a finaneial inslilution; and

• Ooes nol funetion (or hold itself out) as an inveslment fund, sueh as a private equily fund, venture capital fund, leveraged buyoul fund, or a

inveslmenl vehielewhose purpose is lo aequireor fund eompaniesand then hold interests in those eompanies as capital assets for investmenl purpose

lDEf3I Exeepted Nonfinaneia! Entity in Liquidation or Bankruptey

34 O 1 eertify that lhe enlity idenlified in Part 1 :

• Filed a plan of liquidation, filed a plan of reorganizalion, or filed for bankrupley on

• Ouring lhe past 5 years has nol been engaged in business as a finaneial inslitution or aeted as a passive NFFE;

• Is eilher liquidaling or emerging from a reorganizalion or bankruptey with the intenl lo eontinue or reeommenee operalions as a nonfinane

enlity; and

• Has, or will provide, doeumenlary evidenee sueh as a bankruptey filing or other publie doeumenlalion that supports its elaim if il remains

bankrupley or liquidation for more lhan lhree years.

m m E £ D 501(el Organization35 O I eertify lhat lhe enlily identified in Part I is a 501(e) organizalion lhat:

• Has been issued a delerminalion lelter from lhe IRS lhat is eurrenlly in effeel eoneluding lhal lhe payee is a seetion 501(e)organizalion lha

dated ; or

• Has provided a eopy of an opinion from U.S. eounsel eertifying lhal lhe payee is a seetion 501(e)organizalion (withoul regard to whelher

payee is a foreign private foundation).

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Form W-8BEN-E (2-2014) Page

lDE£m Non-Profit Organization

36 O I certily that the entity identilied in Part I is a non-protil organization that meets the lollowing requirements:

• Theentity is establishedand maintainedin its country 01residenceexclusivelylor religious.charitable.scientilic. artistic. culturalor educationalpurpose

• The entity is exempt Irom income tax in its country 01residence:

• The entity has no shareholders or members who have a proprietary or benelicial interest in its income or assets;

• Neither the applicable laws 01the entity's country 01residence nor the entity's lormation documents permit any income or assets 01the enti

to be distributed to. or applied lor the benelit 01. a private person or non-charitable entity other than pursuant to the conduct 01the entity

charitable activities or as payment 01reasonable compensation lor services rendered or payment representing the lair market value 01propert

which the entity has purchased: and

• The applicable laws 01 the entity's country 01 residence or the entity's lormation documents require that. upon the entity's liquidation

dissolution. all 01its assets be distributed to an entity that ís a loreign government, an integral part 01a loreign government. a controlled enti

01a loreign government. or another organization that is described in this Part XXII or escheats to the government 01the entity's country

residence or any political subdivision thereof.

~ Pu bl ic ly Tr ad ed NFFE o r NFFE A ff il iat e of a Pu bl ic ly Tr ad ed Co rp or at io n

Check box 37a or 37b, whichever applies.

37a O I certily tha!:

• The entity identilied in Part I is a loreign corporation that is not a linancial institution: and

• The stock of such corporation is regularly traded on one or more established securities markets. including

(name one securitles exchange upon whlch the stock is regularly traded).

bOl certily tha!:

• The entity identilied in Part I is a loreign corporation that is not a linancial institution:

• The entity identilied in Part I is a member 01the same expanded affiliated group as an entity the stock 01which is regularly traded on a

establlshed securities market;• The name 01the entity. the stock 01which is regularly traded on an established securities market. is

• The name 01the securities market on which the stock is regularly traded is

~ Excepted Territory NFFE

38 O I c erti ly tha!:

• The entity identilied in Part I ís an entity that is organized in a possession 01the United States;

• The entity identilied in Part 1:

• Does not accept deposits in the ordinary course 01a banking or similar business.

• Does not hold. as a substantial portion 01its business, linancial assets lor the account 01others. or

• Is not an insurance company (or the holding company 01an insurance company) that issues or is obligated to make payrnents wlth respe

to a linanclal account; and

• AII 01the owners 01the entity identilied in Part I are bona lide residents 01the possession in which the NFFE is organized or incorporated.

m m : E m Active NFFE

39 O I c erti ly that:

• The entity identilied in Part I is a loreign entity that is not a linancial institution:

• Less than 50% 01such entity's gross income lor the preceding calendar year is passive income: and

• Less than 50% 01 the assets held by such entity are assets that produce or are held lor the production 01passlve Income (calculated as

weighted average 01the percentage 01passive assets measured quarterly) (see instructions lor the delinition 01passive incorne).

lDImJ Passive NFFE

40a O I certily that the entity identilied in Part I is a loreign enlity that is not a linancial institution (other than an investment entlty organized in a

possession 01 the United States) and is not certilying its status as a publicly traded NFFE (or affiliate). excepted terntory NFFE, activ

NFFE. direct reporting NFFE. or sponsored direct reporting NFFE.


bOl lurther certlly that the entity identilied in Part I has no substantial U.S. owners, or

O I further certif that the entit identilied in Part I has rovided the name.address. and TIN01each substantial U.S.owner of the NFFEin PartXXX.

Excepted Inter-Affiliate FFI

41 I certify that the entity identilied in Part 1:

• Is a rnernber01anexpanded affiliatedgroup:

• Does not maintain financial accounts (other than accounts maintained for members 01 its expanded affiliated group);

• Does not make withholdable payrnents to any person other than to members 01 its expanded affiliated group that are not lirnited FFls

limited branches:

• Does not hold an account (other than a depository account in the country in which the entity is operating to pay lar expenses) with or receiv

payments Irorn any withholding agent other than a member 01 its expanded affiliated group: and

• Has not agreed to report under S1.1471-4(d)(2)(ii)(C)or otherwiseact as an agent for chapter 4 purposeson behall 01any flnanclal Institution. includi

a member 01its expandedaffiliatedgroup.

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Form W-8BEN-E (2-2014)

~ Sponsored Direct Reporting NFFE

42 Name 01sponsoring entity:

43 O I certify that the entity identilied in Part I is a direct reporting NFFE that is sponsored by the entity identilied in line 42.

l D E £ n 3 CertificationUnder penalties 01 perjury, I declare that I have examined the inlormation on this lorm and to the best 01 my knowledge and beliel it is true, correct, and complete. I lurther

certify under penalties 01 perjury that:

• The entity identilied on line 1 01 this lorm is the benelicial owner 01 all the income to which this lorm relates, is using this lorm to certify its status lor chapter

purposes, or is a merchant submitling this lorm lor purposes 01section B050W,

• The entity identilied on line 1 01 this lorm is not a U.S. person,

• The income to which this lorm relates is: (a) not eHectively connected with the conduct of a trade or business in the United States, (b) eHectively connected but

not subject to tax under an income tax treaty, or (c) the partner's share of a partnership's eHectively connected income, 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 the entity on line 1 is the beneficial

owner or any withholding agent that can disburse or make payments of the income of which the entity on line 1 is the beneficial owner.

I agree that I will submit a new form within 30 days if any certification on this form beco mes incorrecto

Sign Here~ ---- _•• ---- ------_. ----- ---' --- ----- -----__o-----__-_••• ••• _----- -.

Signature of individual authorized to sign for beneficial owner Print Name Date (MM-DD-YYYY)

o I certify that I have the capacity to sign for the entity identified on line 1 of this formo

Substantial U.S. Owners of Passive NFFE

As required by Part XXVI, provide the name, address, and TIN 01each substantial U.S. owner 01the NFFE. Please see instructions lor delinition 01

substantial U.S. owner.

Name Address TIN

Form W-8BEN-E (2.201

Documents

2015-05-29 (9) (1).pdf