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<!--************************ Heading ************************-->
<table id="t1">
<tr>
<td id="t1c1">
<table><tr><td>Form <span>W-8BEN</span></td></tr>
<tr><td>(Rev. February 2006)</td></tr>
<tr><td><p>Department of the Treasury Internal Revenue Service</p></td></tr>
</table>
</td>
<td id="t1c2">
<h1>Certificate of Foreign Status of Beneficial Owner<br />
for United States Tax Withholding</h1>
<p><b><img src="images/triangle.svg" />
Section references are to the Internal Revenue Code.
<img src="images/triangle.svg" />
See separate instructions.</b></p>
<p><b><img src="images/triangle.svg" />
Give this form to the withholding agent or payer. Do not send to the IRS.</b></p>
</td>
<td id="t1c3">
OMB No. 1545-1621
</td>
</tr>
</table>
<!--List of Notes-->
<table id="t2">
<tr><td style="padding-top: 2pt;">
<table><tr>
<td><b>Do not use this form for:</b></td>
<td style="text-align: right;"><b>Instead, use Form:</b></td>
</tr></table></td>
</tr>
<tr><td><table><tr>
<td class="svgCell"><img src="images/circle.svg" /></td>
<td id="leader1">A U.S. citizen or other U.S. person, including a resident alien individual</td>
</tr></table>
</td>
</tr>
<tr><td><table><tr>
<td class="svgCell"><img src="images/circle.svg" /></td>
<td id="leader2">A Person claiming that income is effectively connected with the conduct<br />
of a trade or business in the United States</td>
</tr></table></td>
</tr>
<tr><td><table><tr>
<td class="svgCell"><img src="images/circle.svg" /></td>
<td id="leader3">A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions)</td>
</tr></table></td>
</tr>
<tr><td><table><tr>
<td class="svgCell"><img src="images/circle.svg" /></td>
<td id="leader4">A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization,<br />
foreign private foundation, or government of a U.S. possession that received effectively connected income or that is<br />
claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions)</td>
</tr></table></td>
</tr>
<tr><td><div id="t2note">
<b>Note:</b><i>These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only to claim they are a foreign
person exempt from backup withholding.</i></div>
</td>
</tr>
<tr><td><table><tr>
<td class="svgCell"><img src="images/circle.svg" /></td>
<td id="leader5">A person acting as an intermediary</td>
</tr></table></td>
</tr>
<tr>
<td style="padding-bottom: 4pt;"><b>Note:</b><i>See instructions for additional exceptions.</i></td>
</tr>
</table>
<!--************************ Part 1 ************************-->
<table id="t3">
<tr class="partHeading"><td><table><tr>
<td >Part I</td>
<td><b>Identification of Beneficial Owner</b> (See instructions.)</td>
</tr></table></td>
</tr>
<tr class="t3body">
<td><table>
<tr>
<td style="width: 5in;"><b class="formCounter">1</b>
Name of individual or organization that is the beneficial owner</td>
<td class="t3bodyCol2" style="width: 214px;"><b class="formCounter">2</b>
Country of incorporation or organization</td>
</tr>
<tr>
<td><input type="text"/></td>
<td class="t3bodyCol2"><input type="text"/></td>
</tr>
</table></td>
</tr>
<tr class="t3body"><td>
<table>
<tr>
<td rowspan="3" class="formCounter" style="width: 1em">3</td>
<td>Type of beneficial owner:</td>
<td class="t33r1"><input type="checkbox" /><span class="t3valign">Individual</span></td>
<td class="t33r1"><input type="checkbox" /><span class="t3valign">Corporation</span></td>
<td class="t33r1"><input type="checkbox" /><span class="t3valign">Disregarded entity</span></td>
<td class="t33r1"><input type="checkbox" /><span class="t3valign">Partnership</span></td>
<td class="t33r1"><input type="checkbox" /><span class="t3valign">Simple trust</span></td>
</tr>
<tr>
<td class="t33r2"><input type="checkbox" /><span class="t3valign">Grantor trust</span></td>
<td class="t33r2"><input type="checkbox" /><span class="t3valign">Complex trust</span></td>
<td class="t33r2"><input type="checkbox" /><span class="t3valign">Estate</span></td>
<td class="t33r2"><input type="checkbox" /><span class="t3valign">Government</span></td>
<td colspan="2" class="t33r2"><input type="checkbox" /><span class="t3valign">International organization</span></td>
</tr>
<tr>
<td><input type="checkbox" /><span class="t3valign">Central bank of issue</span></td>
<td><input type="checkbox" /><span class="t3valign">Tax-exempt organization</span></td>
<td colspan="4"><input type="checkbox" /><span class="t3valign">Private foundation</span></td>
</tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table>
<tr><td><b class="formCounter">4</b>
Permanent residence address (street, apt. or suite no., or rural route).
<b>Do not use a P.O. box or in-care-of address.</b></td>
</tr>
<tr><td><input type="text" /></td></tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table><tr>
<td style="width: 5.59in; padding-left: 20pt;">City or town, state or province. Include postal code where appropriate.</td>
<td class="t3bodyCol2" style="padding-left: 1em;">Country (do not abbreviate)</td>
</tr>
<tr>
<td><input type="text" /></td>
<td class="t3bodyCol2"><input type="text" /></td>
</tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table>
<tr>
<td><b class="formCounter">5</b>
Mailing address (if different from above)</td>
</tr>
<tr><td><input type="text" /></td></tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table>
<tr>
<td style="width: 5.59in; padding-left: 20pt;">City or town, state or province. Include postal code where appropriate.</td>
<td class="t3bodyCol2" style="padding-left: 1em;">Country (do not abbreviate)</td>
</tr>
<tr><td><input type="text" /></td>
<td class="t3bodyCol2"><input type="text" /></td>
</tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table>
<tr>
<td style="width: 4.7in;"><b class="formCounter">6</b>
U.S. taxpayer identification number, if required (see instructions)</td>
<td class="t3bodyCol2"><b class="formCounter">7</b>
Foreign tax identifying number, if any (optional)</td>
</tr>
<tr><td><input type="text" style="width: 8cm"/>
<input type="checkbox" /><span style="vertical-align:bottom;"> SSN or ITIN</span>
<input type="checkbox" style="margin-left: 8pt" /><span style="vertical-align:bottom;"> EIN</span>
</td>
<td class="t3bodyCol2"><input type="text" /></td>
</tr>
</table>
</td>
</tr>
<tr class="t3body"><td>
<table>
<tr>
<td><b class="formCounter">8</b>
Reference number(s) (see instructions)</td>
</tr>
<tr>
<td><input type="text" /></td>
</tr>
</table>
</td>
</tr>
</table>
<!--************************ Part 2 ************************-->
<table id="t4">
<tr class="partHeading">
<td ><table><tr>
<td >Part II</td>
<td><b>Claim of Tax Treaty Benefits</b> (if applicable)</td>
</tr></table></td>
</tr>
<tr>
<td class="t4body" style="padding-top: 5pt;"><table>
<tr>
<td class="formCounter">9</td>
<td style="padding-bottom: 2pt;">
<b>I certify that (check all that apply):</b><br />
</td>
</tr>
<tr>
<td class="col1" style="padding-bottom: 2pt; padding-top: 2pt;"><b>a </b></td>
<td><table class="t4list">
<tr>
<td class="col2" ><input type="checkbox" /></td><td style="font-size: 6.4pt; vertical-align: top; padding-bottom: -3pt; padding-top: 3pt;">
The beneficial owner is a resident of
<input type="text" id="t4i1" />within the meaning of the income tax treaty between the United States and that country.
</td>
</tr></table>
</td>
</tr>
<tr>
<td class="col1"><b>b </b></td>
<td><table class="t4list">
<tr>
<td class="col2"><input type="checkbox" /></td><td>If required, the U.S. taxpayer identification number is stated on line 6 (see instructions).</td>
</tr></table>
</td>
</tr>
<tr>
<td class="col1"><b>c </b></td>
<td><table class="t4list"><tr>
<td class="col2"><input type="checkbox" /></td><td> The beneficial owner is not an individual, 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 (see instructions).</td>
</tr></table>
</td>
</tr>
<tr>
<td class="col1"><b>d </b></td>
<td><table class="t4list"><tr>
<td class="col2"><input type="checkbox" /></td><td> The beneficial owner is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest
from a U.S. trade or business of a foreign corporation, and meets qualified resident status (see instructions).</td>
</tr></table>
</td>
</tr>
<tr>
<td class="col1"><b>e </b></td>
<td><table class="t4list"><tr>
<td class="col2"><input type="checkbox" /></td><td> The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file
Form 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000.</td>
</tr></table>
</td>
</tr>
<tr id="t4r2">
<td class="formCounter">10</td>
<td><b>Special rates and conditions</b> (if applicable - see instructions): The beneficial owner is claiming the provisions
of Article <input type="text" id="t4i2"/> of the treaty identified on line 9a above to claim a <input type="text" id="t4li3"/>%
rate of withholding on (specify type of income):<input type="text" id="t4li4"/> .
<br />
Explain the reasons the beneficial owner meets the terms of the treaty article:
<input type="text" id="t4li4a"/>
<input type="text" id="t4li5"/>
<input type="text" id="t4li6" style="border-bottom: none;"/>
</td>
</tr>
</table></td>
</tr>
</table>
<!--************************ Part 3 ************************-->
<table id="t5" style="margin-top: 2px;">
<tr class="partHeading"><td><table>
<tr>
<td>Part III</td>
<td><b>Notional Principal Contracts</b></td>
</tr></table></td>
</tr>
<tr><td style="padding-top: 2pt; padding-bottom: 2pt;"><table>
<tr>
<td style="vertical-align: top"><b style="font-size: 8pt; padding-left: 8pt; padding-right: 6.75pt;">11</b></td>
<td style="vertical-align: top"><input type="checkbox" /></td>
<td><p>I have provided or will provide a statement that identifies those notional principal contracts from which the income is <b>not</b> effectively
connected with the conduct of a trade or business in the United States. I agree to update this statement as required.</p></td>
</tr></table>
</td>
</tr>
</table>
<!--************************ Part 4 ************************-->
<table id="t6">
<tr class="partHeading"><td>
<table><tr>
<td>Part IV</td>
<td><b>Certification</b></td>
</tr></table></td>
</tr>
<tr class="t6body"><td style="padding-top: 2pt;"><p>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:</p>
<p><b>1 </b>I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,</p>
<p><b>2 </b>The beneficial owner is not a U.S. person,</p>
<p><b>3 </b>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 income tax treaty, (c) the partner's share of a partnership's effectively connected income, <b>and</b></p>
<p><b>4 </b>For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.</p>
<p>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.</p></td>
</tr>
</table>
<!--************************ Sign Here ************************-->
<table id="t7">
<tr><td id="t7c1">
<table>
<tr>
<td id="signHere"><table id="t7svg">
<tr><td style="padding-bottom: 2pt;">Sign Here </td>
<td style="padding-left: 4pt;"><svg width="12px" height="24px" version="1.1">
<polygon points="0,0 0,24 12,12" style="fill:#000000;"/>
</svg></td>
</tr></table>
</td>
<td><table>
<tr>
<td id="sigCell"><span id="sig"></span></td>
<td><input type="text" style="text-align: center; width: 1.2in;"/></td>
<td><input type="text" style="text-align: center; width: 1.2in;"/></td>
</tr>
<tr>
<td style="width: 58%;"><span id="t7dashed1">Signature of beneficial owner (or individual authorized to sign for beneficial owner)</span></td>
<td style="width: 21%;"><span id="t7dashed2">Date (MM-DD-YYYY)</span></td>
<td style="width: 21%;"><span id="t7dashed3">Capacity in which acting</span></td>
</tr>
</table></td>
</tr>
</table>
</td>
</tr>
<tr><td><table>
<tr>
<td style="font-size: 8pt; width: 57%"><b>For Paperwork Reduction Act Notice, see separate instructions.</b></td>
<td style="width: 23%;">Cat. No. 25047Z</td>
<td style="text-align: right; width:20%;">Form <b style="font-size:150%;">W-8BEN</b> (Rev. 2-2006)</td>
</tr></table></td>
</tr>
</table>
</body>
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