Revised 1/26/2016
VIACOM INTERNATIONAL NETWORKS SUPPLIER SETUP AND EXTENSION FORM
***IMPORTANT: SECTION 3 OF THIS FORM MUST BE SIGNED AND DATED TO AVOID REJECTION OF THE SETUP REQUEST*** Section 1 - General Supplier Data Information Please remember to complete all required fields. Full Company Name
Freelancer Spain/Portugal Freelancers-- Provide the date you started activities as a freelancer Are you a Channel 5 Foreign Talent Vendor (Subject to Withholding Tax)?
Yes No Yes No
Full Address
City Country Postal Code
Contact Name Phone Number
Email Address (required) Please Select Language
Company Registration Number EU VAT Registration Number Additional EU VAT Number
Other/Local Tax (VAT) Number If VAT is not required, an explanation must be provided
Expected Withholding Tax Percentages on Invoice Payments - (Spain, Portugal, and Italy)
Do you have any relationshop with an employee of Viacom Media If yes, please describe: Networks/Viacom International? (required)
Yes No Please describe in details the goods/services being provided by the vendor to Viacom: (required)
Section 2 - US Tax Reporting Considerations Please remember to complete all required fields. Vendors doing business with the Viacom entities below may be subject to US tax reporting obligations. MTV Networks Europe, Viacom Holding Limited, BET International and VIVA Media GMGH 1) Are you a US entity (i.e. corporation, partnership, LLC) or person? Yes No If Yes, please provide a U.S tax ID number and a Form W-9 (available at http://www.irs.gov/pub/irs-pdf/fw9.pdf?portlet=103 )
2) Are you a non-US entity/person and are you receiving payments for any of the following:
a.Services to be performed in the US? Yes No
b. Royalties or License fees for intangibles to be exploited in the US? Yes No
c. Rents for property located in the US or for Equipment used in the US? Yes No
d. Satellite/Transponder, Cloud, Software related, telecommunications, other similar payments? Yes No
If you answer Yes to any of the questions under part 3, you will be sent an email with information/login credentials to certify your W8 online from [email protected] once the vendor extension form request has been reviewed.
Section 3 - Certification and Required Signature: Print and Sign Please remember to complete all required fields. Please note: Based on the nature of your business, we may be obliged to deduct a local withholding tax from your payment. If your payments are for services, please state on every invoice where those services were provided, either entirely inside the US or entirely outside the US. If services were performed both within and outside the US, please provide a breakdown. If your payments are for royalties or license fees, please list the territories in which the content will be exploited on your invoices. If you wish to claim the benefits of a double tax treaty, please provide a certificate of resident. There may be additional required documents, depending on your country of residence.
I confirm the above details, and also that I have read and understood: - Terms of Use: http://signup.viacom.com/theswim/Pages/TermsOfUse.aspx - Privacy Policy: http://signup.viacom.com/theswim/Pages/PrivacyStatement.aspx - Supplier Compliance Policy: http://signup.viacom.com/theswim/pages/suppliercompliancepolicy.aspx
This form must be signed and date prior to submission.
Signature Date Name (print) Revised 1/26/2016 Section 4 - Supplier Banking Details ** Please note: communicate future changes to the banking details to [email protected] to prevent payment delays. Bank Name
Bank Address
Account Name Account Number
Sort Code/ABA/BSB SWIFT Code
BankGIRO/PLUSGIRO (Sweden) Creditor ID (Denmark)
IBAN Number Invoicing Currency Section 5 - Tax Residency Certificate
Based on local Law, we may have to impose a withholding tax on your fees. The withholding tax might be reduced or even fully eliminated under an applicable Tax Treaty, but only if we have a valid Tax Certificate on file. To avoid the unreduced withholding tax rate being applied to your account, please include an electronic version along with a copy of this form. The original form should be mailed back to the local office of the Viacom entity you are doing business with. Please note: If a valid Tax Certificate is not received prior to your invoice due date, we will apply the local unreduced withholding rate.
For Internal Use by Viacom Staff
This portion of the form MUST be completed by VIMN/MTV Networks staff only, NOT suppliers. NO SUPPLIER will be reviewed unless the form is completed in full. Fields noted with an * are mandatory.
Date* Requested By*
Phone Number*
Please select the type of supplier*
Please select the type of request*
If extension, must include vendor number*
Please provide the Viacom entity that the supplier is doing Business with*
If extension, must include requested company codes*
UK ONLY: Please provide entity
NON UK: Please indicate which company codes/entities the vendor needs to be extended to
Please describe in details the goods/services being provided by the vendor to Viacom*
Check here if Barter Vendor Payment terms (Europe)* Payment terms (Australia)* Reduction of terms from default Net 30/45 days require a contract and finance head Net 60 approval. Please include the approval and contract copy when submitting this form. Net 30 Other Net 45 Other
To avoid rejection of this form, please confirm the supplier section is signed and dated along with all required fields being completed.