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This document is an IRS Form W-8BEN, which is used by non-U.S. individuals to certify their foreign status for tax withholding purposes. It provides instructions on who should and should not use the form. The form collects identification information about the beneficial owner including name, address, tax identification numbers, and date of birth. It certifies that the beneficial owner is a resident of a foreign country with which the U.S. has a tax treaty and is eligible for reduced tax rates under that treaty.

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Mariella Giuliani
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71 views

Taxform Clickfunnels

This document is an IRS Form W-8BEN, which is used by non-U.S. individuals to certify their foreign status for tax withholding purposes. It provides instructions on who should and should not use the form. The form collects identification information about the beneficial owner including name, address, tax identification numbers, and date of birth. It certifies that the beneficial owner is a resident of a foreign country with which the U.S. has a tax treaty and is eligible for reduced tax rates under that treaty.

Uploaded by

Mariella Giuliani
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United

States Tax Withholding and Reporting (Individuals)


(Rev. February 2014) ▶ For use by individuals. Entities must use Form W-8BEN-E. OMB No. 1545-1621
▶ Information about Form W-8BEN and its separate instructions is at www.irs.gov/formw8ben.
Department of the Treasury
▶ Give this form to the withholding agent or payer. Do not send to the IRS.
Internal Revenue Service

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
• A person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY

Part I Identification of Beneficial Owner (see instructions)


1 Name of individual who is the beneficial owner 2 Country of citizenship
Barbara Crespi Italy
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
Via Giotto, Res. Lago 442
City or town, state or province. Include postal code where appropriate. Country
Basiglio, Milano, 20080 Italy
4 Mailing address (if different from above)
[email protected]
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)
CRSBBR65D50F257N
7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)
1845253 04-10-1965
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 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
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income):
.
Explain the reasons the beneficial owner meets the terms of the treaty article:

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 as an individual that is an owner or account holder of a foreign financial institution,
• 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.
▲

Sign Here 07/24/2019


Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
Barbara Crespi
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. 2-2014)
P4BBD8J3I38S3CRKPM9DBC

Barbara Crespi
Party ID: 6X7SUJIEW2WRJIK9MPPAGV
IP Address: 2.41.12.91
VERIFIED EMAIL: [email protected]

Multi-Factor
Digital Fingerprint Checksum c838b4de9fff18221ec7e276183bf64618c83dec

Timestamp Audit
2019-07-23 23:21:09 -0700 All parties have signed document. Signed copies sent to: Klayton Fletcher and
Barbara Crespi.
2019-07-23 23:21:09 -0700 Document signed by Barbara Crespi ([email protected]) with drawn
signature. - 2.41.12.91
2019-07-23 23:21:08 -0700 Barbara Crespi verified email address '[email protected]'. - 2.41.12.91
2019-07-23 23:19:47 -0700 Generated Document from Online Form W-8BEN (W-8BEN-2bd595). - 2.41.12.91
2019-07-23 23:12:23 -0700 Online Form viewed by Barbara Crespi ([email protected]). - 2.41.12.91

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