Form Uh Wh-1 - Wh-1 Statement Of Citizenship And Federal Tax Status - University Of Hawaii
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1
2UH WH-1 Revised Jan. 2007
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UNIVERSITY OF HAWAII
WH-1 STATEMENT OF CITIZENSHIP AND FEDERAL TAX STATUS
In order to comply with applicable tax provisions of the Internal Revenue Service (IRS), the information requested on this
PURPOSE:
form is required. The University will use this information to determine the appropriate federal tax withholding. Your
submission of this form is required each calendar year.
:
UNITED STATES (US) CITIZENS
1. Complete Section A and Section E only
DIRECTIONS:
:
PERMANENT RESIDENT ALIEN
1. Complete Section A and Section E only
2. Attach a photocopy (front and back) of your Alien Registration Card
:
Submit applicable IRS Form as instructed
ALL OTHERS
1. Complete Sections A, B, C, and E
4.
5. For J-1 visaholders, submit copy of DS-2019
2. Complete Section D if applicable
6. For B visaholders (B1,B2, WB, WT), submit
3. Submit copy (front and back) of your I-94,
Passport ID Page, and VISA page.
FMIS-45
Section A. PERSONAL INFORMATION
(1) General Information
Last Name
First
Middle
Social Security Number or ITIN Number
Country of Citizenship
Country of Residence for Tax Purpose
E-Mail Address
Business Name (if applicable)
Federal ID Number (if applicable)
My business is a [
] Sole Proprietorship
[
] Corporation
[
] Tax Exempt Organization
[
] Government Agency
[
] Partnership
(2 ) U.S. Residence Address
Number and Street
City or Province
State or Country
Postal Code
(3) Foreign Residence Address
Number and Street
City or Province
State or Country
Postal Code
Section B. U.S. IMMIGRATION ACTIVITY
(1) Current Visa Status
Date of U. S. Entry
Expiration Date of Current Visa
Intended Length of Stay
Anticipated Departure Date
Current Visa Type
:
What is the primary purpose of the visit?
(check appropriate box)
(check appropriate box)
[
] F-1 Student
[
] Studying/Training/Research in a Degree Program
[
] J-1 Student
[
] Studying/Training/Research in a Non-Degree Program
[
] J-1 Visitor (Non-Student)
[
] Training/Research as a Post-Doctoral Fellow
[
] B-1/WB Visitor For Business
[
] Providing Services as an Independent Contractor (i.e., Consulting,
[
] B-2/WT Visitor For Pleasure (Tourist)
Conducting a Workshop, etc.)
[
] Other INS Classification (list status):
[
] Other:
Is this the first time you have entered the United States?
Circle:
YES
NO
(2)
(3) Past Visa History
Provide the requested information to detail the number of days you were physically present in the United States during the calendar years
listed below.
Note: Calendar year refers to the period January 1 through December 31.
Enter Visa Type/INS
Have you taken
classification held
Are you leaving
any Treaty
while present in the
Enter Period(s) when you were physically present in the
Number of
the U.S. this
Benefits during
U. S. during the
US during the listed calendar year. (List the dates below,
days present
year? (Circle
the listed year?
listed calendar year.
for example, 01/01/99 – 12/31/99)
in the U. S.
answer)
(Circle answer)
Yes
No
Yes
No
2010
Yes
No
2009
Yes
No
2008
Yes
No
2007
Yes
No
2006
Yes
No
2005
Yes
No
2004
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