Note: (a) This form has to be completed in triplicate by the beneficial owner of the interest and/or royalties derived in the Portuguese territory or by the legal representative in Portugal. After each copy is duly certified by the competent tax authority of the beneficial owners’ State of residence, it must be sent to the entity indicated at the right bottom.
The form is issued in three copies, being the fourth page the reverse side/second page of each copy, so that the fourth page has to be printed out in triplicate.