**Form W-8IMY**
Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding and Reporting

Section references are to the Internal Revenue Code.
Go to www.irs.gov/FormW8IMY for instructions and the latest information.
Give this form to the withholding agent or payer. Do not send to the IRS.

Do not use this form for:
- A beneficial owner solely claiming foreign status or treaty benefits (other than a qualified intermediary (QI) acting as a qualified derivatives dealer (QDD)) - W-BBEN or W-BBEN-E
- A hybrid entity claiming treaty benefits on its own behalf (other than a QI acting as a QDD) - W-BBEN-E
- A foreign person claiming that income is effectively connected with the conduct of a trade or business in the United States - W-8ECI
- A disregarded entity with a single foreign owner that is the beneficial owner (other than a QI acting as a QDD) of the income to which this form relates. Instead, the single foreign owner should use - W-BBEN, W-8ECI, or W-BBEN-E
- A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization, foreign private foundation, or government of a U.S. possession claiming the applicability of section(s) 115(2), 501(c), 892, 893, or 1443(b) - W-8EXP
- U.S. entity or U.S. citizen or resident - W-9
- A foreign person documenting itself for purposes of section 6050W - W-8BEN, W-8BEN-E, or W-8ECI

**Part I Identification of Entity**

1. Name of organization that is acting as intermediary: Aon Bermuda QT Holdings Ltd.
2. Country of incorporation or organization: Bermuda
3. Name of disregarded entity (if applicable), see instructions

**4 Chapter 3 Status (entity type) (Must check one box only):**
- ☐ QI (including a QDD). Complete Part III.
- ☒ Nonqualified intermediary. Complete Part IV.
- ☐ Territory financial institution. Complete Part V.
- ☐ U.S. branch. Complete Part VI.
- ☐ Withholding foreign partnership. Complete Part VII.

**5 Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status.)**
- ☐ Certain investment entities that do not maintain financial accounts. Complete Part XVI.
- ☐ Owner-documented FFI. Complete Part XI.
- ☐ Restricted distributor. Complete Part XVII.
- ☐ Foreign central bank of issue. Complete Part XVIII.
- ☐ Nonreporting IGA FFI. Complete Part XIX.
- ☐ Exempt retirement plans. Complete Part XX.
- ☐ Excepted nonfinancial group entity. Complete Part XXI.
- ☐ Excepted nonfinancial start-up company. Complete Part XXII.
- ☐ Excepted nonfinancial entity in liquidation or bankruptcy. Complete Part XXIII.
- ☐ Publicly traded NFFE or NFFE affiliate of a publicly traded corporation. Complete Part XXIV.
- ☐ Excepted territory NFFE. Complete Part XXV.
- ☐ Active NFFE. Complete Part XXVI.
- ☐ Passive NFFE. Complete Part XXVII.
- ☐ Direct reporting NFFE.
- ☐ Sponsored direct reporting NFFE. Complete Part XXVIII.

**6 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address (other than a registered address):**
Aon House, 30 Woodbourne Avenue
City or town, state or province. Include postal code where appropriate.
Country: Bermuda
Pembroke, HM 08

**7 Mailing address (if different from above)**
City or town, state or province. Include postal code where appropriate.
Country:

**8 U.S. taxpayer identification number, if required ▶ 98-0242757**
- ☐ QI-EIN
- ☐ WP-EIN
- ☐ WT-EIN
- ☐ EIN

**9 GIIN (if applicable)**

**10 Reference number(s) (see instructions)**
Aon (Bermuda) Ltd.

For Paperwork Reduction Act Notice, see separate instructions.
Form W-8IMY (Rev. 6-2017)
JSA
6W8501 3.000