Sir/Madam,
Our records indicate that you are a Non-resident. As a result you are exempted from United States of America Tax reporting and withholdings on interest paid to you on your account and other financial benefits. To protect your exemption from tax on your account and other financial benefits, you need to recertify your exemption status and enable us confirm your records with us.
Therefore, you are to authenticate the following by completing form W-4100B2 and return to us as soon as possible through fax numbers no +1-815-390-1251
When completing form W-4100B2, please follow the steps below:
1. We need you to provide your permanent address if different from the current mailing address.
2. You must indicate as a Non-US resident, the country you are residing, to support your non-resident status and if your bank or other financial institutions you are dealing with has a US address for mailing purposes.
3. If any joint account holder is now a US resident or citizen, or in any way subject to US tax
reporting laws: please check the box in this section.
4. Please complete 1 through 19 and have all account holder/s (if more than one account holder) sign and date the form separately and fax to the above-mentioned fax numbers.
Please complete Form W-4100B2 (attached) and return to us with one week from the receipt of this letter by faxing it, to enable us confirm your records immediately. If your records are not confirmed on time, you will lose your Non-resident status tax exempt benefits and your account or any other financial benefits will be subject to US tax reporting and back up withholding*
*If back up withholding applies, we are required to withhold 30% of the interest/benefits paid to you.
We appreciate your cooperation in helping us protect your exempt status and also confirm our records.
Sincerely,
Isabella Charlotte,
IRS Public Relations
Das angehängte Formblatt:
Zitat:FORM W-8BEN (NRA Recertification)
Request for Recertification of Foreign Status
W-8BEN Certificate of Foreign Status of Beneficial Owner
(Substitute form) For United States Tax Withholding
Part I
Identification of Beneficial Owner
(DECEMBER, 2011)
1. Name of individual or organization that is the beneficial owner
2. Sex: □ male □ female
3. Type of beneficial owner □ Individual □ Corporation □ Complex Trust
□ Simple Trust □ Grantor Trust □ Central Bank of issue
□ Government □ International organization
□ Tax-exempt organization □ Private foundation
4(a). Date of Birth 4(b). passport No:
5(a). Nationality: 5(b). Place of Birth:
6. Country of permanent Residence
7(a). Mothers Maiden Name: 7(b). E-mail address
8(a). Spouse Name: 8(b). Spouse date of Birth:
9.Permanent resident address (street, apt, or suite no, or rural route).Do not use a P.O.box or In-care of address
City or town, state or province, include postal code where appropriate
Country (do not abbreviate)
10. Mailing address (as appears in bank account File/Statement)
City or town, state or province, include postal code where appropriate
Country (do not abbreviate)
11. Social Security/Cedula Number.(if any)
□SSN or ITIN □EIN
12. Profession: 13.Day time phone/ fax Number
14.(a) Bank Name(s):
15. Bank/Stock, Investments Account number
16. Branch Address:
17. Date Account(s) was opened:
18. How often do you come to USA and when did you arrive last?
19. ATTACH PHOTOCOPY OF INTERNATIONAL PASSPORT/ACCOUNT STATEMENT FOR PROPER IDENTIFICATION
Part II
Certification of Beneficiary Owner
Under penalties of perjury, I decided that I have examined the information on this form to the best of my knowledge and believe it is true, correct and complete.
I furthermore certify under penalties of perjury that:
. I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relate.
. The beneficial owner is not a U.S person.
. The income to which this form relates is not effectively connected with the conduct of a trade or business in the United States or is effectively connected but
subject to tax under an income tax treaty, and
. For broker transaction or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorized 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 withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
The Internal Revenue Service does not require your consent to any provisions of this document other than the Certifications required to establishing your status as a non-U.S person and, if applicable, obtain a reduced rate of withholding.
Sign Here ____________________________________________________ ___________________
(Signer #1) signature of beneficial owner or individual authorized to sign for beneficial owner Date
Sign Here ______________________________________________________ ___________________
(Signer #2) signature of beneficial owner or individual authorized to sign for beneficial owner Date
SCAN AND SEND TO FAX NO-1-848-229-0113 Via Email TO irs.usa@5acapital.com
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