This is a declaration form for non-Israeli residents and Israeli brokers to substantiate eligibility for exemption from Israeli withholding tax on shares of Mobileye N.V. It includes sections for identification, shareholder type, and contact details.
doj/DataSet10/EFTA01380280.pdf
{"title":"Declaration of Status for Israeli Income Tax Purposes","document_type":"correspondence","key_locations":["Israel"],"document_subtype":"tax declaration form","key_organizations":["Mobileye N.V."],"reference_numbers":["DB-SDNY-0078648","SDNY_GM_00224832","EFTA01380280"]}