Foreign Status Certification is required. Click Certify … · unless the address is in Kuwait or Saudi Arabia. Do not provide an address in-care-of a financial institution, an employer

Select CERTIFY YOUR ACOUNT to begin.

Foreign Status Certification is required. Click Certify your account for foreign status and answer all the questions.

It will take approximately 5–10 minutes to complete.

Screenshot is for illustrative purposes only.

You have the option to take advantage of the E-SIGN Act. The act allows you to avoid printing, signing and mailing your tax document to us and instead, digitally sign your form by accepting the terms and conditions of the E-SIGN act. The choices are:

• Yes, I wish to digitally sign my tax form • No, I will print, manually sign and mail

my tax form.

Please review and acknowledge your understanding and acceptance of the Federal Electronic Signature to Global and National Commerce Act (E-SIGN).

A translated version of the E-SIGN agreement is available for you to review before acknowledging.

Once you have read the E-SIGN agreement, all four (4) boxes must be checked to be able to continue.

Type your Full Name in the box provided and click SUBMIT once finished.



You must provide the required information:

• Employee Name • Mailing Country • Permanent Country • Citizenship Country

Click NEXT to continue.


You will now be guided through the Tax Certification Interview Process. The process will take approximately ten minutes.

To get started you need the following information:

• Address Information • U.S. Taxpayer Identification (if required) • Foreign Tax Identification Number (if available)

Click NEXT to continue


Form Selection

This section will guide you through the Form Selection Process.

To begin, please indicate which type of individual or entity is going to submit this tax form.

• U.S. Citizen (including a dual citizen) • U.S. Resident Alien • Non U.S. Person

Please note, it is most likely that you will be choosing Non U.S. Person.



Form Selection

This screen describes the form you are about to complete based on what you choose on the prior screen.



This confirms you have selected the correct form to complete.



W-8 BEN Question 1

Are you a beneficial owner of income paid to the account?

• Yes, I am an individual beneficial owner and directly receive the income generated from this account.

• No, but I am completing this form on behalf of an individual that is the beneficial owner.

• Other

Click NEXT once you have made your selection.


W-8 BEN Question 2

Was the individual born in the United States?

• Yes • No



W-8 BEN Question 3

What is the full legal name of the individual?

• First/Given Name (required) • Middle Name(s)/Initial • Last/Family Name (required)

Click NEXT once you have completed the information.


W-8 BEN Question 4

What is the Individual’s country of citizenship?

• Select one country from the following menu of countries. (select from drop down box)



W-8 BEN Question 5

What is the Individual’s permanent residence address?

Do not provide a post office or P.O. Box number unless the address is in Kuwait or Saudi Arabia. Do not provide an address in-care-of a financial institution, an employer or another person that is used solely for mailing purposes.

Click NEXT once you have completed the required information.


W-8 BEN Question 6

What is the Individual’s permanent address include a post office or P.O. Box number?

• Yes • No



W-8 BEN Question 7

What is the Individual’s permanent address include an In Care of address?

• Yes • No



W-8 BEN Question 8

If the individual has a mailing address in a different country, please provide it in the following spaces:

Click NEXT once you have filled in the necessary information.


W-8 BEN Question 9

Does the individual have a U.S. taxpayer identification number (a “TIN”)?

• Yes

If yes, please specific the type of TIN from the following list:

o Social Security Number (SSN) o Individual Taxpayer Identification

Number (ITIN) o Employer Identification Number (EIN) o Please provide the number in the

space provided. • No


W-8 BEN Question 10

Does the individual have an identifying number that was issued for tax purposes by a foreign country in which he/she is considered resident (e.g. Canadian Social insurance number)?

• Yes. If so, please provide the number in the space provided.

• No


W-8 BEN Question 11

Is the individual resident in a country that has a tax treaty country with the United States?

• Yes, please select the name of the treaty country from the drop down list provided.

• No


W-8 BEN Question 12

Is the individual taxed as a resident of the selected treaty country?

• Yes • No


Summary

Please take the opportunity to review the answers to the questions you previously answered.

If you need to make any changes, click the EDIT button to go back to that question.

Click NEXT once you have reviewed the information on this screen.


Form Review

This is a confirmation of how the W-8BEN form will look once it is submitted with the information you provided.

Click NEXT to move forward to the final screen.

This confirms you have completed and reviewed the content that you wish to be included on the appropriate Form W-8 or W-9.

Click NEXT to move forward to the final screen.


Penalties of Perjury – Certification

Do you make and declare all of the following statements under penalties of perjury? Please mark the box for each statement you are able to declare.

Under the penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and believe it is true, correct and complete. I further 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 relates.

• The beneficial owner 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 to the United States, (b) effectively connected but is not subject to tax under an income tax treaty or (c) the partner’s share of a partnership’s effectively connected income.

• 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.

To sign your tax form under penalties of perjury, please enter your PIN and press the SUBMIT button.

• Your PIN is your date of birth (ddmmyyy)


Fidelity Stock Plan Services, LLC

Thank you

This is a copy of your completed W-8BEN form for your records.

• You can print the document using the print button found on the Adobe Acrobat menu.

• If you have any questions with electronic forms, please contact a Fidelity Stock Plan Services representative at 800-544-0275.


E-SIGN ACCEPTANCE (The text inside the scrollbar)

Under applicable United States law (Federal Electronic

Signatures in Global and National Commerce Act), before we

can process your executed tax forms and related documents

electronically and your consent to the electronic delivery of

all such forms and related materials for your account, we

must provide you with the following information and you

must affirmatively consent and thereafter not withdraw such

consent.

By completing the check boxes below and clicking the

"submit" button you indicate your informed consent to

electronic delivery to you and submission from you to us of

your Form W-8 or W-9 and all related communications,

notices, information and related documents. By signing the

tax form and the certifications therein, you are instructing us

to accept your entries and to treat the signature as a valid

digital signature on your Form W-8 or W-9 as described here.

Additionally, you are consenting to our maintaining and your

receiving electronic records of your tax form and all related

materials. You understand that you may withdraw your

consent to such electronic records at any time by notifying us

in the preferences section of this application by selecting the

E-Sign Options link and acknowledging your revocation of

the E-Sign Act. After revoking the E-Sign Act, you will be

required to complete the paper version of these Forms and

related documents until you reaffirm your consent to the E-

Sign Act.

You understand and agree that no special hardware and

software requirements are needed for access to or retention

of your electronic records other than those required to access

the Internet and www.netbenefits.com, as well as the ability

to register for your unique and secure user name and

password. In addition to print the recommended copy(s) of

the tax form for your official records, you will have access to

printers and required materials as well as a program to

access, read and reproduce such documents in ".PDF" format.

Should any technological change or upgrade be made that

will affect your ability to access your Forms, we will notify

you by e-mail and remind you of your right to withdraw your

consent to receive electronic records.

705936.1.0

https://login.fidelity.com/ftgw/Fas/Fidelity/IspCust/Login/Init

Documents

Foreign Status Certification is required. Click Certify … · unless the address is in Kuwait or Saudi Arabia. Do not provide an address in-care-of a financial institution, an employer