Free Form W-8ECI (Rev. February 2006) - Federal

Form

W-8ECI

(Rev. February 2006) Department of the Treasury Internal Revenue Service

Certificate of Foreign Person's Claim That Income Is Effectively Connected With the Conduct of a Trade or Business in the United States
Section references are to the Internal Revenue Code. See separate instructions. Give this form to the withholding agent or payer. Do not send to the IRS.

OMB No. 1545-1621

Note: Persons submitting this form must file an annual U.S. income tax return to report income claimed to be effectively connected with a U.S. trade or business (see instructions).
Do not use this form for: A beneficial owner solely claiming foreign status or treaty benefits A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) Instead, use Form: W-8BEN W-8EXP

Note: These entities should use Form W-8ECI if they received effectively connected income (e.g., income from commercial activities). A foreign partnership or a foreign trust (unless claiming an exemption from U.S. withholding on income effectively W-8BEN or W-8IMY connected with the conduct of a trade or business in the United States) W-8IMY A person acting as an intermediary Note: See instructions for additional exceptions.

Part I
1 3

Identification of Beneficial Owner (See instructions.)
2 Country of incorporation or organization

Name of individual or organization that is the beneficial owner Type of entity (check the appropriate box): Partnership Government Private foundation Individual

Simple trust Grantor trust International organization

Corporation Complex trust Central bank of issue

Disregarded entity Estate Tax-exempt organization

4

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box. City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)

5

Business address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box. City or town, state, and ZIP code

6 8

U.S. taxpayer identification number (required--see instructions) SSN or ITIN Reference number(s) (see instructions)

7 EIN

Foreign tax identifying number, if any (optional)

9

Specify each item of income that is, or is expected to be, received from the payer that is effectively connected with the conduct of a trade or business in the United States (attach statement if necessary)

Part II

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 amounts for which this certification is provided are effectively connected with the conduct of a trade or business in the United States and are includible in my gross income (or the beneficial owner's gross income) for the taxable year, and The beneficial owner is not a U.S. person. 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.

Sign Here

Signature of beneficial owner (or individual authorized to sign for the beneficial owner)

Date (MM-DD-YYYY) Cat. No. 25045D

Capacity in which acting Form

For Paperwork Reduction Act Notice, see separate instructions.

W-8ECI

(Rev. 2-2006)