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Tax Interview

The document is a Form W-8BEN, which certifies the foreign status of an individual for U.S. tax withholding and reporting purposes. It identifies Ashil A Shetty from India as the beneficial owner, claiming a 15% withholding rate on copyright royalties under the U.S.-India tax treaty. The form includes sections for identification, tax treaty benefits, and certification of the information provided.

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2 views

Tax Interview

The document is a Form W-8BEN, which certifies the foreign status of an individual for U.S. tax withholding and reporting purposes. It identifies Ashil A Shetty from India as the beneficial owner, claiming a 15% withholding rate on copyright royalties under the U.S.-India tax treaty. The form includes sections for identification, tax treaty benefits, and certification of the information provided.

Uploaded by

shetty.ashil003
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Reference Id: A0115406164COG4AQU7CE

Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United


States Tax Withholding and Reporting (Individuals)
SUBSTITUTE
(Rev. October 2021)

Do NOT use this form if: Instead, use Form:


• You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E
• You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9
• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the United States
(other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
• You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4
• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY

Part I Identification of Beneficial Owner


1 Name of individual who is the beneficial owner 2 Country of citizenship
ASHIL A SHETTY India
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.

City or town, state or province. Include postal code where appropriate. Country
Mangalore KA 575001 India
4 Mailing address (if different from above)

City or town, state or province. Include postal code where appropriate. Country
Mangalore Karnataka 575001 India
5 U.S. taxpayer identification number (SSN or ITIN), if required

6 Foreign tax identifying number

XXXXXX378J
Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only)
I certify that the beneficial owner is a resident of
India within the meaning of the income tax
treaty between the United States and that country.
Special rates and conditions (if applicable): The beneficial owner is claiming the provisions of Article and paragraph
Article and paragraph 12(2)
of the treaty identified on line 7 above to claim a 15.0 % rate of withholding on (specify type of income):
Copyright Royalties .

Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:

Part III 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 individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income or proceeds to which this form
relates or am using this form to document myself for chapter 4 purposes;
• The person named on line 1 of this form is not a U.S. person;
• This form relates to:
(a) income not effectively connected with the conduct of a trade or business in the United States;
(b) income effectively connected with the conduct of a trade or business in the United States but is not subject to tax under an applicable income tax treaty;
(c) the partner’s share of a partnership’s effectively connected taxable income; or
(d) the partner’s amount realized from the transfer of a partnership interest subject to withholding under section 1446(f);
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United States and that country; 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. I agree that I will submit a new form within 30 days if any certification made on this form becomes incorrect.

T e I ter Reve e Serv ce oe ot re re o r co e t to rov o o t oc e t ot er t t e cert c t o re re to e t b o r t t o U.S. v


c b e obt re ce r te o t o .

✔ I certify that I have the capacity to sign for the person identified on line 1 of this form.
Sign Here
Ashil A Shetty 01-06-2025
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)

Ashil A Shetty
Print name of signer

Form W- BE

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