**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 (QD)) - W-8BEN or W-8BEN-E
- A hybrid entity claiming treaty benefits on its own behalf (other than a QI acting as a QD) - W-8BEN-E
- A disregarded entity with a single foreign owner that is the beneficial owner (other than a QI acting as a QD) of the income to which this form relates. Instead, the single foreign owner should use - W-8BEN, W-8BEN-E, or W-8BEN-I
- 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, 895, 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 6039W - W-8BEN, W-8BEN-E, or W-8BEN-I

**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:

**Chapter 3 Status (entity type) (Must check one box only):**
- ☐ QI (Including a QD), 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.)**
- ☐ 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.
- ☐ 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.

**8 U.S. taxpayer identification number, if required > 98-0242757**
QIN
WP-IN
WT-EIN
EIN

**9 GIN (if applicable)**

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

For Paperwork Reduction Act Notice, see separate Instructions.
Form W-8IMY (Rev. 5-2017)
JSA
5W8501.3.000