Page 1 of 1 AMTD 835 F 11/20
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Regular Mail:
PO Box 2760, Omaha, NE 68103-2760
Overnight Mail:
200 South 108th Avenue
Omaha, NE 68154-2631
Fax: 866-468-6268
Letter of Explanation
for U.S. Mailing Address/
Phone Number for Form W-8
I,
_____________________________________________________
, certify that I am a non-U.S. person as dened for U.S. tax purposes. I have a U.S. address/U.S.
phone number for one of the below reason(s):
Claiming a Treaty
I certify that I am treated as a resident of ______________________________ for purposes of the income tax treaty between it and the U.S. and am not treated
as a U.S. resident or citizen for purposes of that income tax treaty.
*AMTD835*
Please complete one of the three sections below.
If you claimed a treaty on your W-8BEN, you will also need to certify your claim in the Treaty section below.
Account #: __________________________________________
First Name: _________________________________________ Middle Name: ____________________________
Last Name: _________________________________________
Note: The mailing address on your account may not belong to a Registered Investment
or Financial Advisor.
Residing in the U.S.
I certify that I am one of the following:
CC
() A student at a U.S. educational institution and hold the appropriate visa.
CC
() A teacher, trainee, or intern at a U.S. educational institution or a participant
in an educational or cultural exchange visitor program and hold the
appropriate visa.
CC
() A foreign individual assigned to a diplomatic post or a position in a consulate,
embassy, or international organization in the U.S.
CC
() A spouse -or- unmarried child of one of the persons described in (), (), or ().
Temporarily in the U.S.
I certify that I do not qualify as a U.S. resident under the substantial presence test.
Based on the substantial presence test calculation for the current year and the
previous two years, I have been in the U.S for ___________ days.
Closer Connection to a Foreign Country
I certify that I meet the closer connection exception to
the substantial presence test because I meet all of the
following criteria:
• I have been present in the United States for fewer than
183 days in the current year;
• I maintain a tax home in the country of___________________
____________________ during the current year; and
• I have a closer connection during the current year
to the above foreign (non-U.S.) country because
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
TD Ameritrade, Inc., member FINRA/SIPC, a subsidiary of The Charles Schwab Corporation. TD Ameritrade is a trademark jointly owned by
TD Ameritrade IP Company, Inc. and The Toronto-Dominion Bank. © Charles Schwab & Co. Inc. All rights reserved.
Investment Products: Not FDIC Insured * No Bank Guarantee * May Lose Value
I have provided, or will provide, TD Ameritrade, Inc. with any other documentation requested to support my claim of non-U.S. status and/or tax
treaty benets and will refresh such documentation upon request. I also acknowledge that: (1) I must advise TD Ameritrade, Inc. if I become a U.S.
citizen, U.S. resident, or other U.S. person for U.S. tax law purposes; and (2) such change in my U.S. tax status will impact on the U.S. tax treatment
of my income from U.S. investments, which are held by TD Ameritrade, Inc.
Note: Each account owner must complete and sign a separate form.
X
Signature: Date
Printed Name: Title:
Sign Here
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