在美国课税与申报⽬的下之最终受益⼈⾝分证明（实体）
U.S. entity or U.S. citizen or r esident………………………………………………………...………………………………………………………………….W-9 美國實體、美國公民或美國居民，適⽤W-9
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A foreign individual ………………………………………………………………………………………...…………………W-8BEN (Individual) or Form 8233 外籍(⾮美國籍)⼈⼠，適⽤W-8BEN (個⼈)或8233表格
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)……………..…........................................................................................................................................................................................W-8ECI 主張其收⼊與在美國境內之交易或業務有實際關聯的外國個⼈或實體(除⾮主張其享有租稅協定利
益)，適⽤W-8ECI
A foreign partnership, a foreign simple trust, or a foreign grantor trust (unless claiming treaty benefits)(e instructions for exceptions).........W-8IMY 外國合夥制企業，外國單純信託或外國贈與⼈信託 (除⾮主張其享有租稅協定利益)(請參閱例外說明)，適⽤W-8IMY
A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or
government of a U.S. posssion claiming that income is effectively connected U.S. income or that is claiming the applicability of ction(s) 115(2), 501(c), 892, 895, or 1443(b)(unless claiming treaty benefits)(e instructions for other exceptions )…………………………………..W-8ECI or W-8EXP 外國政府、國際組織、外國中央銀⾏、外國免受扣繳組織、外國私⼈基⾦會，或美國屬地政府聲稱所得為有效關聯美國所得或主張其適⽤第115 (2) 節，501(c)節, 892節, 895節或1443(b)節規範之美國屬地政府(除⾮主張其享有租稅協定利益) (請參閱例外說明)，適⽤W-8ECI 或W-8EXP
Any person acting as an intermediary (including a qualified intermediary acting as a qualified derivatives dealer)………………………………W-8IMY 4 Chapter 3 Status (entity type) ( Must check one box only) 第三章⾝分狀態(組織類型)(僅可勾選⼀種⾝分) □ Corporation 公司□ Disregarded
entity ⾮企業實體
□ Partnership 合夥制企業□ Simple Trust 單純信託□ Grantor trust 贈與⼈信託□ Complex trust 複雜信託□ Estate 遺產□Government 政府□ Central Bank of Issue 中央銀⾏□ Tax-exempt organization 免稅組織□ Private foundation 私⼈基⾦會□ International organization 國際組織
If you entered disregarded entity, partnership, simple trust, or grantor trust above, is the entity a hybrid making a treaty claim?□ Yes □ No 倘勾選上列⾮企業實體、合夥制企業、單純信託或贈與⼈信託時，該組織是否主張租稅協定利益？□是□否
If “Yes ” complete Part III. 倘勾選「是」，請完成第三部分。
方造句5 Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity’s applic able status).
第四章⾝分狀態(請參閱詳細說明並依實體適⽤之⾝分狀態完成後續聲明事項) 。
□ Nonparticipating FFI (including an FFI related to a
Reporting IGA FFI other than a deemed-compliant FFI,
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participating FFI, or exempt beneficial owner)
未簽署協議的外國⾦融機構 (包含與在跨政府協議下應申報的外國⾦融
機構相關之外國⾦融機構，但該機構並⾮視同合規的的外國⾦融機構、有
簽署協議的外國⾦融機構、或免受扣繳的最終受益⼈)。
□ Participating FFI 有簽署協議的外國⾦融機構。
□ Reporting Model 1 FFI 在模式⼀下應申報的外國⾦融機構。□ Reporting Model 2 FFI 在模式⼆下應申報的外國⾦融機構。□ Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XII). See instructions. 註冊視同合規的外國⾦融機構 (排除在模式⼀下應申報的外國⾦融機構、受贊助的外國⾦融機構，或第⼗⼆部分所涵蓋的在跨政府協議下免申報的外國⾦融機構) 詳⾒說明。□ Sponsored FFI. Complete Part IV. 受贊助的外國⾦融機構。完成第四部分。□ Certified deemed-compliant nonregistering local bank. Complete Part
V 公認視同合規的⾮註冊本地銀⾏。完成第五部分。□ Certified deemed-compliant FFI with only low-value accounts. Complete Part VI. 公認視同合規的僅具低價值帳⼾外國⾦融機構。完成第六部分。
□ Certified deemed-compliant sponsored, cloly held investment vehicle. Complete Part VII. 公認視同合規的受贊助且被緊密持有的投資⼯具。完成第七部分。□ Certified deemed-compliant limited life debt investment entity. Complete Part VIII.
公認視同合規的暫時性的債權投資實體。完成第⼋部分。□ Certain investment entities that do not maintain financial accounts. Complete Part IX. 未維護⾦融帳⼾之若⼲投資實體。請完成第九部分。□ Owner-documented FFI. Complete Part X. 已提供所有⼈資訊之外國⾦融機構。請完成第⼗部分。□ Restricted distributor. Complete Part XI. 受限制的通路商。請完成第⼗⼀部分。□ Nonreporting IGA FFI. Complete Part XII. 在跨政府協議下⽏須申報的外國⾦融機構。完成第⼗⼆部分。□Foreign government, government of a U.S. posssion, or foreign central bank of issue. Complete Part XIII. 外國政府、美國屬地政府或發⾏貨幣的外國中央銀⾏。完成第⼗三部分。□ International organization. Complete Part XIV. 國際組織。完成第⼗四部分。□ Exempt retirement plans. Complete Part XV.
豁免的退休計畫。完成第⼗五部分。
□ Entity wholly owned by exempt beneficial owners. Complete Part XVI.
由免受扣繳的最終受益⼈完全持有的實體。完成第⼗六部分
□ Territory financial institution. Complete Part XVII. 美國屬地⾦融機構。完成第⼗七部分。□ Excepted nonfinancial group entity . Complete Part XVIII. 免受扣繳的⾮⾦融集團實體。完成第⼗⼋部分。□ Excepted nonfinancial start-up company . Complete Part XIX. 免受扣繳的⾮⾦融新創公司。完成第⼗九部分。□ Excepted nonfinancial entity in liquidation or bankruptcy . Complete Part XX. 免受扣繳的清算中或破產的⾮⾦融實體。完成第⼆⼗部分。□ 501(c)Organization. Complete Part XXI. 符合第501(c)節規範的組織。完成第⼆⼗⼀部分。□ Nonprofit organization. Complete Part XXII. ⾮營利組織。完成第⼆⼗⼆部分。
□ Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIII. 股票在證券市場正常交易的⾮⾦融外國實體或其關係企業。完成第⼆⼗三部分。□ Excepted territory NFFE. Complete Part XXIV. 免受扣繳的美國屬地⾮⾦融外國實體。完成第⼆⼗四部分。
□ Active NFFE. Complete Part XXV.
積極的⾮⾦融外國實體。請完成第⼆⼗五部分。
□ Passive NFFE. Complete Part XXVI
消極的⾮⾦融外國實體。完成第⼆⼗六部分。
□ Excepted inter-affiliate FFI. Complete Part XXVII.
免受扣繳的關係企業間的外國⾦融機構。完成第⼆⼗七部分。
□Sponsored direct reporting NFFE. Complete Part XXVIII.
受贊助的直接申報的⾮⾦融外國實體。完成第⼆⼗⼋部分。
□Account that is not a financial account. ⾮⾦融帳⼾之帳⼾
6 Permanent residence address (street, apt. or suite no., or rural route). Do not u a P.O. box or in-care-of address. (other than a registered
address)永久居住地址(含街道、公寓或房間號碼，或郵件投遞路線)。請勿使⽤郵政信箱或轉信地址。(除註冊地地址之外之地址)
收取款項的⾮企業實體之第四章⾝分狀態(FATCA⾝分)
□Branch treated as nonparticipating FFI. 視為未簽屬協議的外國⾦融機構的分⽀機構
□Reporting Model 1 FFI.在模式1下應申報的外國⾦融機構□U.S. Branch 美國分⽀機構
□Participating FFI.有簽屬協議的外國⾦融機構□Reporting Model 2 FFI 在模式2下應申報的外國⾦融機構
12 Address of disregarded entity or branch (street, apt, or suite no., or rural route). Do not u a P.O. box or in-care-of address (other than a
registered address). 永久居住地址(含街道、公寓或房間號碼，或郵件投遞路線)。請勿使⽤郵政信箱或轉信地址(排除註冊的地址)。
City or town, state or province, Include postal code where appropriate. 城市或鄉鎮、州或省，及郵遞區號
Country國家
a□The beneficial owner is a resident of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ within the meaning of the income tax treaty between the United States and that country. 最終受益⼈係與美國簽訂租稅協定國家_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _之居民。
b□The beneficial owner derives the item (or items) of income for which the treaty benefits are claimed, and , if applicable,meets the requirements of the treaty provision dealing with limitation on benefits The following are types of limitation on benefits provisions that may be included in an applicable tax treaty (check only one; e instructions)：最終受益⼈取得適⽤租稅協定利益的收⼊項⽬，並符合租稅協定條款對該利益之限制，以下為在適⽤之租稅協定下所涵蓋之利益限制條款類型（請擇⼀勾選；詳⾒說明）：
□Government□Company that meets the ownership and ba erosion test
政府公司符合所有權及稅基侵蝕測試
□Tax exempt pension trust or pension fund □Company that meets the derivative benefits test
免稅之退休⾦信託或退休基⾦公司符合衍⽣利益測試
□Other tax exempt organization □Company with an item of income that meets active trade or business test 其他免稅組織公司之收益項⽬符合積極的貿易或業務測試
□Publicly traded corporation□Favorable discretionary determination by the U.S. competent authority received 股票在證券市場正常交易的公司⾃美國主管機關取得之優惠裁量決定
□Subsidiary of a publicly traded corporation□Other (specify Article and paragraph)：_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ 股票在證券市場正常交易的公司之⼦公司其他(詳述條號及段落)：_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _春游活动
c□The beneficial owner is claiming treaty benefits for U.S. source dividends received from a foreign corporation or interest from a U.S. trade or business of a foreign corporation and meets qualified resident status (e instructions).
最終受益⼈係主張⾃外國公司取得之美國來源所得股息或⾃從事美國貿易或業務之外國公司取得之利息係適⽤租稅協定利益，且為符合資格的居民⾝分。（詳⾒說明）
15 Special rates and conditions ( if applicable – e instructions) : The beneficial owner is claiming t
he provisions of Article and paragraph _ _ _ _
_ _ _ _ _ _of the treaty identified on line14a above to claim a _ _ _ _ _ _ _ _ _ _ _ _ % rate of withholding on (specify type of income): _ _ _ _ _ _ .
Explain the additional conditions in the Article the beneficial owner meets to be eligible for the rate of withholding: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 特別稅率與條件(如適⽤，詳⾒說明) : 最終受益⼈主張依上述第14a點之協議_ _ _ _ _ _ _ 條號及段落規定，要求以_ _ _ _ _ _ _% 稅率扣繳(詳述收⼊類型) _ _ _ _ _ _ _。
16 Name of sponsoring entity: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
贊助實體名稱: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
17 Check whichever box applies.依適⽤條件勾選
呼吸疼痛
□I certify that the entity identified in Part I: 本⼈聲明第⼀部分列⽰之實體:
Is an investment entity；為⼀投資實體;
Is not a QI, WP (except to the extent permitted in the withholding foreign partnership agreement), or WT; and⾮合格中間機構、外國扣繳合夥企業（外國扣繳合夥企業協議內⽂允許者除外）或外國扣繳信託；且
Has agreed with the entity identified above (that is not a nonparticipating FFI) to act as the sponsoring entity for this entity.
同意前述辨識出的實體(且⾮屬未簽屬協議的外國⾦融機構)成為本實體之贊助實體。
□I certify that the entity identified in Part I: 本⼈聲明第⼀部分列⽰之實體:
Is a controlled foreign corporation as defined in ction 957(a); 係⼀符合第957(a)節描述的受控制的外國公司
Is not a QI, WP, or WT; ⾮合格中間機構、外國扣繳合夥企業或外國扣繳信託
Is wholly owned, directly or indirectly, by the U.S. financial institution identified above that agrees to act as the sponsoring entity for this entity; and 由前述之美國⾦融機構直接或間接完全持有，並同意擔任本實體之贊助實體；且
Shares a common electronic account system with the sponsoring entity (identified above) that enables the sponsoring entity to identify all account holders and payees of the entity and to access all account and customer information maintained by the entity including, but not limited to, customer identification information, customer documentation, account balance, and all payments made to account holders or payees.
與前述贊助實體共⽤⼀個電⼦帳⼾系統，⽽此系統可讓贊助實體辨識出所有本實體的帳⼾持有⼈及受款⼈，並有權限進⼊本實體所維護之所
Operates and is licend solely as a bank or credit union (or similar cooperative credit organization operated without profit) in its country of incorporation or organization；在其成⽴國僅被授權經營銀⾏或信⽤合作社(或類似的⾮營利信⽤合作組織)；
Engages primarily in the business of receiving deposits from and making loans to, with respect to a bank, retail customers unrelated to such bank and, with respect to a credit union or similar cooperative credit organization, members, provided that no member has a greater than 5% interest in such credit union or cooperative credit organization;
銀⾏主要業務為向銀⾏無關聯散⼾之收取存款及發放貸款；信⽤合作社或類似的信⽤合作組織部分主要業務為向會員收取存款及發放貸款，且其會員於該信⽤合作社或信⽤合作組織未擁有5%以上權益。
Does not solicit account holders outside its country of organization；未於成⽴國以外之地區招攬帳⼾持有⼈；
Has no fixed place of business outside such country (for this purpo, a fixed place of business does not include a location that is not advertid to the public and from which the FFI performs solely administrative support functions);
品质管理培训在該國家之外沒有固定營運場所(此處之固定營運場所不包含：未公開宣傳並作為⾏政⽀援功能的地點)
Has no more than $175 million in asts on its balance sheet and, if it is a member of an expanded affiliated group, the
group has no more than $500 million in total asts on its consolidated or combined balance sheets；and
資產負債表上之資產不超過1.75億美元；若屬為某擴增附屬集團成員，該集團合併資產負債表上之總資產不超過5億美元；且?Does not have any member of its expanded affiliated group that is a foreign financial institution, other than a foreign financial institution that is incorporated or organized in the same country as the FFI identified in Part I and that meets the requirements t forth in this Part.
擴增附屬集團無任何其他成員為外國⾦融機構，但與第⼀部分所列之外國⾦融機構成⽴於同⼀國家，並符合第五部分所載規定之外國⾦融機
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Is not engaged primarily in the business of investing, reinvesting, or trading in curities, partnership interests, commodities, notional principal contracts, insurance or annuity contracts, or any interest (including a futures or forward contract or option) in such curity,
partnership interest, commodity, notional principal contract, insurance contract or annuity contract；
不以從事投資、再投資、或交易證券、合夥制企業利益、商品、名⽬本⾦契約、保險契約或年⾦契約、或任何與證券、合夥制企業利益、商品、名⽬本⾦契約、保險或年⾦契約相關之利益(包括期貨、遠期契約或選擇權)為主要業務；
No financial account maintained by the FFI or any member of its expanded affiliated group, if any, has a balance or value in excess of $50,000 (as determined after applying applicable account aggregation rules)；and
該外國⾦融機構或同擴增附屬集團任何成員(若有)所維護的⾦融帳⼾餘額或價值均未超過5萬美元(該⾦額係依適⽤的帳⼾加總規則決定)；
且
wps邮件
Neither the FFI nor the entire expanded affiliated group, if any, of the FFI, have more than $50 million in asts on its consolidated or combined balance sheet as of the end of its most recent accounting year.
贊助實體名稱：_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
21 □I certify that the entity identified in Part I: 本⼈聲明第⼀部分列⽰之實體:
Is an FFI solely becau it is an investment entity described in Regulation ction 1.1471-5(e)(4);
係因符合財政部法規1.1471-5(e)(4)節所述之投資實體⽽成為⼀外國⾦融機構;
Is not a QI, WP, or WT; ⾮合格中間機構、外國扣繳合夥企業或外國扣繳信託
Will have all of its due diligence, withholding, and reporting responsibilities (determined as if the FFI were a participating FFI) fulfilled by the sponsoring entity identified on line 20; and
將由第20點的贊助實體為其擔負所有盡職調查、扣繳及申報責任(如同該外國⾦融機構是⼀個有簽署協議的外國⾦融機構)；及?20 or fewer individuals own all of the debt and equity interests in the entity (disregarding debt interests owned by U.S. financial institutions, participating FFIs, registered deemed-compliant FFIs, and certified deemed-compliant FFIs and equity interests owned by an entity if that entity owns 100%of the equity interests in the FFI and is itlf a sponsored FFI).
20⼈或以下的個⼈們擁有此實體的所有債權或股權利益(不含由美國⾦融機構、有簽署協議之外國⾦融機構、註冊視同合規之外國⾦融機構及
Form W-8BEN-E (7-2017) Page 4 22 □I certify that the entity identified in Part I: 本⼈聲明第⼀部分列⽰之實體:
Was in existence as of January 17, 2013; 於2013年1⽉17⽇時已存在;
Issued all class of its debt or equity interests to investors on or before January 17, 2013, pursuant to a trust indenture or similar agreement; and 依據信託契約或類似合約，於2013年1⽉17⽇當⽇或之前發⾏所有類型的債權或股權利益給投資⼈; 且Is certified deemed-compliant becau it satisfies the requirements to be treated as a limited life debt investment entity
