Your statusChapter 3 status(Required)Choose a Chapter 3 statusQI (including a QDD)Nonqualified intermediaryWithholding foreign partnershipWithholding foreign trustNonwitholding foreign partnershipNonwithholding foreign simple trustNonwithholding foreign grantor trustTerritory financial institutionU.S. branchChapter 4 status(Required)Choose a Chapter 4 statusSponsored direct reporting NFFEDirect reporting NFFEActive NFFEExcepted territory NFFEPublicly traded NFFE or NFFE affiliate of a publicly traded corporationExcepted nonfinancial entity in liquidation or bankruptcyExcepted nonfinancial start-up companyExcepted nonfinancial group entityExempt retirement plansNonreporting IGA FFIForeign central bank of issueRestricted distributorOwner-documented FFICertain investment entities that do not maintain financial accountsCertified deemed-compliant limited life debt investment entityCertified deemed-compliant sponsored, closely held investment vehicleCertified deemed-compliant FFI with only low-value accountsCertified deemed-compliant nonregistering local bankSponsored FFITerritory financial institutionRegistered deemed-compliant FFIReporting Model 2 FFIReporting Model 1 FFIParticipating FFINonparticipating FFIPassive NFFE Qualified intermediariesDo you assume primary withholding responsibility?(Required) Yes No Do you use rate pool accounts at ?(Required) Yes No Non-qualified intermediariesDo you disclose clients ?(Required) Yes No Are you using the Alternative Procedure?(Required) Yes No Would you like to produce an Alternative Withholding Statement?(Required) Yes No Do you use an omnibus account with disclosed sub-accounts?(Required) Yes No ConsentConsent(Required) has asked us to collect information from you and use it to create a withholding statement We will pass this information to once you electronically sign your withholding statement. We will send you a copy by email, for your records. We will not store, process or share any information about you other than with and as authorised by them. may be required to process and/or share information about your business and any clients that you disclose with third parties for regulatory, compliance or other authorised purposes. Please contact directly if you would like more information. I agreeConsent(Required)TBC I agree
