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Click here to open Form W-8 BEN instructions from the IRS web site in a new window.

Part 1: Identification of Beneficial Owner (See instructions.)

1 User Name * : (Account that log in AVOP)

2 Name of individual or organization that is the beneficial owner * :

3 Country of incorporation or organization * :

4 Type of beneficial owner:

5 Permanent residence address. Do not use a P.O. Box.

Street Address * :
City * :
State, province or region:
Zip or postal code, if appropriate:
Country * :

6 Mailing address (if different from above)

Street Address:
City:
State, province or region::
Zip or postal code, if appropriate::
Country:

7 U.S. Taxpayer Identification Number (required - see instructions) *

! If you do not complete this section, AVOP is required to withhold 30% of your earnings to be paid to the IRS. Learn more

SSN or ITIN EIN

8 Foreign Tax Identifying Number, if any (optional)

9 Reference number(s) (see instructions)

Part 2: Claim of Tax Treaty Benefits (if applicable)

! If you do not complete this section, AVOP is required to withhold 30% of your earnings to be paid to the IRS. Learn more

10 I certify that (check all that apply):

a	The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country.
b	If required, the U.S. taxpayer identification number is stated on line 6 (see instructions).
c	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).
d	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).
e	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.

11 Special rates and conditions (if applicable--see instructions): The beneficial owner is claiming the provisions of Article

of the treaty identified on line 9a 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 3: Notional Principal Contracts

12 I have provided or will provide a statement that identifies those notional principal contracts from which the income is not effectively connected with the conduct of a trade or business in the United States. I agree to update this statement as required. (not applicable for this AVOP program)

Part 4: 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 beneficial owner (or I 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 not effectively connected with the conduct of a trade or business in the United States or is effectively connected but is not subject to tax under an income tax treaty, 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.

Signature of beneficial owner (or individual authorized to sign for the beneficial owner) (Typing in your name acts as your signature) * :	Capacity in which acting * :

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