Written statement


Requirements for written statements [§1.1471-3(c)(4)]

A written statement is a statement by the payee, or other person receiving the payment, that provides the person’s chapter 4 status and any other information reasonably requested by the withholding agent to fulfill its obligations under chapter 4 with respect to the payment, such as whether the person is receiving the payment as a beneficial owner, intermediary, or flow-through entity.

A written statement is valid only if it is provided by a person with respect to an offshore obligation, contains the name of the person, the person’s address, the certifications relevant to the person’s chapter 4 status (as contained on a withholding certificate), any additional information required with respect to the chapter 4 status claimed as provided under paragraph (d) of this section (for example, a GIIN), and a signed and dated certification that the information provided on the form is accurate and will be updated by the individual within 30 days of a change in circumstances that causes the form to become incorrect. A written statement may be submitted in any form that is acceptable to the withholding agent, including a statement made as part of the account opening documentation. A written statement may be used in lieu of a withholding certificate only to the extent provided under §1.1471-3(d), as applicable to the chapter 4 status claimed.

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