Lux Management Group

W-8 BEN Form

Certificate of Foreign Status of Beneficial Owner

This form is required for foreign nationals or entities receiving U.S. income.

Full Legal Name *

Country of Citizenship *

Foreign Tax ID Number

Date of Birth *

Permanent Residence Address *

Mailing Address (if different)

U.S. Tax ID (if any)

Reference Number(s)

Treaty Country *

Treaty Article *

Rate of Withholding *

Type of Income *

Conditions *

I certify under penalties of perjury that I am the beneficial owner of the income to which this form relates and the withholding certificate is correct.

Signature (Type Your Name) *

Date *

✓

Your form has been submitted successfully. A member of our team will be in touch if needed.