FORM W-8BEN
Certificate of foreign status, individuals
1PART I IDENTIFICATION
Name: Ines Duarte
Country of citizenship: Portugal
2TAX IDENTIFICATION NUMBER
Foreign TIN: 123 456 789
US TIN: none
3ADDRESS
Permanent residence: Rua das Flores 12, Lisbon, Portugal
Mailing address: same
4DATE OF BIRTH
Date of birth: 14 March 1988
5TREATY CLAIM
Claim of treaty benefits: Portugal
Line 9 reference as per the instructions
6CERTIFICATION
Signed under penalties of perjury
Date: 06 Oct 2026
7PAYER RECORD
Valid until 31 Dec 2029
Filed with vendor record V-8812
Sample for illustration. Company names, numbers, tax registrations and bank details are fictional.