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

(Rev. June 2017)
Department of the Treasury
Internal Revenue Service

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)).
- A hybrid entity claiming treaty benefits on its own behalf (other than a QI acting as a QDD).
- A foreign person claiming that income is effectively connected with the conduct of a trade or business in the United States.
- 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:
- 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, 865, or 1443(b).
- U.S. entity or U.S. citizen or resident.
- A foreign person documenting itself for purposes of section 6050W.

Instead, use Form:
- W-8BEN or W-8BEN-E
- W-8BEN-E
- W-8ECI
- W-8EXP
- W-9
- W-8BEN, W-8BEN-E, or W-8ECI

**Part I Identification of Entity**

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

**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.

**Chapter 4 Status (FATCA status) (See instructions for details and complete the certification below for the entity's applicable status.) (Must check one box only):**
- Nonparticipating foreign financial institution (FFI) (including an FFI related to a Reporting IGA FFI other than a deemed compliant FFI, participating FFI, or exempt beneficial owner). Complete Part IX (if applicable).
- Participating FFI.
- Reporting Model 1 FFI.
- Reporting Model 2 FFI.
- Registered deemed-compliant FFI (other than a reporting Model 1 FFI, sponsored FFI, or nonreporting IGA FFI covered in Part XIX).
- Territory financial institution. Complete Part V.
- Sponsored FFI (other than a certified deemed-compliant sponsored, closely held investment vehicle). Complete Part X.
- Certified deemed-compliant nonregistering local bank. Complete Part XII.
- Certified deemed-compliant FFI with only low-value accounts. Complete Part XIII.
- Certified deemed-compliant sponsored, closely held investment vehicle. Complete Part XIV.
- Certified deemed-compliant limited life debt investment entity. Complete Part XV.
- 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 NFEE or NFEE affiliate of a publicly traded corporation. Complete Part XXIV.
- Excepted territory NFEE. Complete Part XXV.
- Active NFEE. Complete Part XXVI.
- Passive NFEE. Complete Part XXVII.
- Direct reporting NFEE. Complete Part XXVIII.
- Sponsored direct reporting NFEE. 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. Pembroke, HM 08
Country Bermuda

**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 [X]
- 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-BIMY (Rev. 6-2017)
JSA
GWBS01 3.000