EFTA00317450.pdf

Withholding Statement Information Required fr om Intermediaries with Non-Qualified Intermediary Status Name of Intermediary: Intermediary US EIN (if available): Type of Intermediary Entity Box Checked on WS-IMY: N(N, NonWitbbolding Foreign Partnership. NonWithholding Foreign Simple Trust. NonWithbokling Foreign Grantor Trion BO Entitled BO Pre-S4 BO Pre-S4 BO Portfolio BO Portfolio BNYM Beneficial Owner (BO) Name US Tax ID of BO Tax Status BO Dividend BO Div. Tax Doe. BO Country of BO Recipient to Treaty Interest Interest Interest Interest Account and BO INRA. US Exempt. Withholding Exemption Provided for BO Residence Code' Rate. Withholding Exemption Withholding Exemption Number Address Of mailable/ US Non-Exempt) Rate Code" tYtN) Rate Code" Rate Code" The Intermediary hereby nide:mull -s the Bank against any tax. 'tent or penalty winch ma result as a resul of the mance tance of any one of the account structures sel vied above. Signature: Date: BNYNI Notes: - If answer is not available/applicable. please wide in -N/A". Please refer to IRS websoe (wwwars.gov) for applicable rociptent and exemption codes as found on the IRS blank 1042-S form. 'Applicable for NRA beneficiaries only. "Applicable for NRA beneficiaries only. receiving a reduced withholding rate. EFTA00317450