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    W-8BEN: Donald Christoph

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    paul
    This document is the Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides instructions for individuals to identify themselves and claim tax treaty benefits. It certifies that the individual is the beneficial owner of the income to which the form relates, is a resident of the country listed, and authorizes the form to be provided to withholding agents.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    W-8BEN: Donald Christoph

    Uploaded by

    paul
    140 views1 page
    This document is the Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides instructions for individuals to identify themselves and claim tax treaty benefits. It certifies that the individual is the beneficial owner of the income to which the form relates, is a resident of the country listed, and authorizes the form to be provided to withholding agents.

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    This document is the Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides instructions for individuals to identify themselves and claim tax treaty benefits. It certifies that the individual is the beneficial owner of the income to which the form relates, is a resident of the country listed, and authorizes the form to be provided to withholding agents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    140 views1 page

    W-8BEN: Donald Christoph

    Uploaded by

    paul
    This document is the Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides instructions for individuals to identify themselves and claim tax treaty benefits. It certifies that the individual is the beneficial owner of the income to which the form relates, is a resident of the country listed, and authorizes the form to be provided to withholding agents.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United

    States Tax Withholding and Reporting (Individuals)


    (Rev. July 2017) ▶ 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.

    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
    Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be
    provided to your jurisdiction of residence.

    Part I Identification of Beneficial Owner (see instructions)


    1 Name of individual who is the beneficial owner 2 Country of citizenship
    Donald Christoph Canada
    3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
    2400 Matheson Blvd East
    City or town, state or province. Include postal code where appropriate. Country
    Mississanga, Ontario L4W 5G9 Canada
    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)
    988529637 988529637
    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 Canada 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 XVIII, Paragraph 4 of the treaty identified on line 9 above to claim a 30 % rate of withholding on (specify type of income):
    Interest on Bond .
    Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
    He Receives a stated sum paid periodically at stated times during life or during a specified number of years.

    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.

    Donald Christoph
    ▲

    Digitally signed by Donald Christoph


    Sign Here DN: cn=Donald Christoph, o, ou, [email protected],
    c=US
    Date: 2021.07.06 13:50:35 +03'00'

    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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