Form
W-8BEN
Rev. October 2021
Requested By WeQuote Inc.
1
Name and Address
2
Tax Information
3
Certification
Name and Citizenship
Name of individual who is the beneficial owner
The beneficial owner is generally the person required to include the payment on a tax return.
Country of citizenship
Address
Permanent residence address
Include your street and apartment or street number. Do not use a P.O. box or in-care-of address
City or town
State or province
(optional)
Postal code
(optional)
Country of residence
Do you have a different mailing address?
Yes
No
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