# Form W-8IMY

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

**Department of the Treasury Internal Revenue Service**
**OMB No. 1545-1621**

**Instructions:**
- Section references are to the Internal Revenue Code.
- Information about Form W-8IMY and its separate instructions is at www.irs.gov/formw8imy.
- 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.
- A hybrid entity claiming treaty benefits on its own behalf.
- 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 of the income to which this form relates.
- 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).
- A U.S. entity or U.S. citizen or resident.
- A foreign person documenting itself for purposes of section 6050W.

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

**Part I Identification of Entity**

1. Name of individual or 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): Qualified intermediary. Complete Part III.
5. Chapter 4 Status (FATCA status): Nonparticipating FFI (including a limited FFI or 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).

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
7. Mailing address (if different from above)
8. U.S. taxpayer identification number, if required: 98-0242757
9. GIIN (if applicable)
10. Reference number(s) (see instructions): Aon (Bermuda) Ltd.

**For Paperwork Reduction Act Notice, see separate instructions.**