**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

OMB No. 1545-1621

Go to www.irs.gov/FormW8IMY for instructions on the latest information.
Give this form to the withholding agent or payer. Do not send it 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-8BEN or W-8BEN-E
- A hybrid entity claiming treaty benefits on its own behalf (other than a QI acting as a QDD) - W-8BEN-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-8BEN, W-8ECI, or W-8BEN-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, 695, or 1443(i) - 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 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.)**
- ☐ 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.
- ☑️ Publicly traded NFEE or NFEE 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.

**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

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

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

**GIIN (if applicable)**

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

For Paperwork Reduction Act Notice, see separate instructions.
Form W-8IMY (Rev. 6-2017)
JSA
SW8501 3.000