This document is Form W-8BEN, which is used by individuals to certify their foreign status for U.S. tax withholding and reporting purposes. The form provides instructions for individuals to identify themselves and claim tax treaty benefits. It specifies the type of income the form relates to, such as income not effectively connected to a U.S. trade or business. By signing the form, the individual certifies their foreign status and authorizes the form to be provided to withholding agents responsible for income related to the individual.