Appendix D-Federal Forms and Instructions Explanation of Codes (continued) 20 Passive NFFE with no Substantial U.S. Owners 10 Trust other than Withholding Foreign Trust 21 Publicly Traded NFFE or Affiliate of Publicly Traded NFFE 11 12 Withholding Foreign Trust Qualified Intermediary 13 14 15 Qualified Securities Lender-Qualified Intermediary Qualified Securities Lender-Other Corporation 22 23 24 Active NFFE Individual Section 501(c) Entities 25 Excepted Territory NFFE 26 Excepted NFFE-Other 16 17 18 Individual Estate Private Foundation 27 Exempt Beneficial Owner 28 29 Entity Wholly Owned by Exempt Beneficial Owners Unknown Recipient 19 International Organization 20 Tax Exempt Organization (Section 501(c) entities) 21 22 Unknown Recipient Artist or Athlete 30 31 32 33 Recalcitrant Account Holder Nonreporting IGA FFI Direct reporting NFFE U.S. reportable account 34 35 36 Nonconsenting U.S. account Sponsored direct reporting NFFE Excepted Inter-affiliate FFI 37 38 39 Undocumented Preexisting Obligation U.S. Branch-ECI presumption applied Account Holder of Excluded Financial Account10 23 Pension 24 Foreign Central Bank of Issue 25 Nonqualified Intermediary 26 Hybrid entity making Treaty Claim 35 Qualified Derivatives Dealer 36 Foreign Government-Integral Part 37 Foreign Government-Controlled Entity Pooled Reporting Codes9 27 Withholding Rate Pool-General 28 Withholding Rate Pool-Exempt Organization 29 PAI Withholding Rate Pool-General 30 PAI Withholding Rate Pool-Exempt Organization 31 Agency Withholding Rate Pool-General 32 Agency Withholding Rate Pool-Exempt Organization Chapter 4 Status Codes 01 U.S. Withholding Agent-FI 9 02 03 04 05 06 07 08 09 U.S. Withholding Agent-Other Territory FI-not treated as U.S. Person Territory FI-treated as U.S. Person Participating FFI-Other Participating FFI-Reporting Model 2 FFI Registered Deemed-Compliant FFI-Reporting Model 1 FFI Registered Deemed-Compliant FFI-Sponsored Entity Registered Deemed-Compliant FFI-Other 10 Certified Deemed-Compliant FFI-Other 11 Certified Deemed-Compliant FFI-FFI with Low Value Accounts 12 Certified Deemed-Compliant FFI-Nonregistering Local Bank 13 Certified Deemed-Compliant FFI-Sponsored Entity 14 40 Passive NFFE reported by FFI11 41 NFFE subject to 1472 withholding 50 U.S. Withholding Agent-Foreign branch of FI Pooled Reporting Codes 42 Recalcitrant Pool-No U.S. Indicia 43 Recalcitrant Pool-U.S. Indicia 44 Recalcitrant Pool-Dormant Account 45 Recalcitrant Pool-U.S. Persons 46 Recalcitrant Pool-Passive NFFEs 47 Nonparticipating FFI Pool 48 U.S. Payees Pool 49 QI-Recalcitrant Pool-GeneraI12 Box 13j. LOB Code (enter the code that best describes the applicable limitation on benefits (LOB) category that qualifies the taxpayer for the requested treaty benefits). LOB Code LOB Treaty Category 02 Government - contracting state/political subdivision/local authority 03 04 05 06 Tax exempt pension trust/Pension fund Tax exempt/Charitable organization Publicly traded corporation Subsidiary of publicly traded corporation 07 08 Company that meets the ownership and base erosion test Company that meets the derivative benefits test Certified Deemed-Compliant FFI-Investment Entity that does not maintain financial accounts 09 Company with an item of income that meets the active trade or business test 15 16 17 Nonparticipating FFI Owner-Documented FFI U.S. Branch-treated as U.S. person 10 11 Discretionary determination Other 18 U.S. Branch-not treated as U.S. person (reporting under section 1471) 19 Passive NFFE identifying Substantial U.S. Owners Codes 27 through 32 should only be used by a QI, QSL, WP, or WT. A QI acting as a QDD may use code 27 or 28. 10 This code should only be used if income is paid to an account that is excluded from the definition of financial account under Regulations section 1.1471-5(b)(2) or under Annex II of the applicable Model 1 IGA or Model 2 IGA. 11 This code should only be used when the withholding agent has received a certification on the FFI withholding statement of a participating FFI or registered deemedcompliant FFI that maintains the account that the FFI has reported the account held by the passive NFFE as a U.S. account (or U.S. reportable account) under its FATCA requirements. The withholding agent must report the name and GIIN of such FFI in boxes 15d and 15e. 12 This code should only be used by a withholding agent that is reporting a payment (or portion of a payment) made to a QI with respect to the QI's recalcitrant account holders. D-77