Withholding Statement

Withholding Statement Information Required from 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 BNYM Account Number Beneficial Owner (BO) Name and Address US Tax ID of BO Of mailable/ Tax Doe. Provided for BO BO Country of Residence BO Tax Status INRA. US Exempt. US Non-Exempt) BO Recipient Code' BO Entitled to Treaty Rate. tYtN) BO Dividend Withholding Rate BO Div. Exemption Code" BO Pre-S4 Interest Withholding Rate BO Pre-S4 Interest Exemption Code" BO Portfolio Interest Withholding Rate BO Portfolio Interest Exemption 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