Department of Treasury Internal Revenue Service.

www.irs.gov
 
Application for a not ordinary resident (non-resident) saver to receive interest without tax taken off or deducted.
 
ATTN ;
 
Our records indicate that you are a non-resident alien. As a result, you are exempted from United States of America Tax reporting and withholdings, on interest paid you on your account and other financial dealing to protect your exemption from tax on your account and other financial benefit in rectifying your exemption status.
Therefore, you are to authenticate the following by completing W-8BEN FORM, and return to us as soon as possible via fax number enclosed on W-8BEN FORM.
 
If you are a USA Citizen and resident, this W-8BEN FORM is not meant for you, please indicate “USA Citizen/Resident” on the form and return it to us. We shall then send you a form W9095.
 
When completing W-8BEN FORM, please follow the steps below
 
1. We need you to provide your permanent address if different from the current mailing address on your W-8BEN FORM , you must indicate if a non-USA resident, your country of origin to support your non-resident status (if your bank account or other financial dealing has a USA address for mailing purpose).
2. If any joint account holder are now USA residents or Citizen, or in any way subject to USA tax reporting laws, Please check the box in this section.
3. Please have all account holders sign and date the form separately and fax it to the above-mentioned number.
 
Please, complete W-8BEN FORM attached” and return to us within 1 (one) week from the receipt of this letter by faxing it, to enable us update your records immediately if your account or any other financial benefits are not rectified in a timely manner, it will be subject to USA tax reporting and back up withholding (if back up withholding applies, we are required to withhold 30% of the interest paid to you).
 
What you need to do
Print out the attached notification and complete the attached W-8BEN FORM and Fax same along with a copy of your international passport to fax number on the form within 7 working days.

List of required documents:

1. A copy of filled W-8BEN FORM.
2. A photocopy of the photo page of your international passport.
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Keep this notice for your records. If you need assistance, please do not hesitate to contact us. If you should receive multiple notifications, it means previous filled form was not properly filled and as such, we need you to refill needed column and re-fax to us