Exemption From Withholding On Compensation For Independent Personal Services Of A Nonresident Alien Student

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CLEAR FORM
Attachment to IRS Form 8233
Residents of Canada
Exemption From Withholding On Compensation For Independent Personal Services Of A Nonresident
Alien Student
===========================================================================
Name:
Social Security Number:
Permanent Address:
Local Address:
==========================================================================
1) I was a resident of Canada on the date of my arrival in the United States. I am not a U.S. citizen. I
have not been lawfully accorded the privilege of residing permanently in the United States as an
immigrant.
2) I am present in the United States soley for the purpose of my education or training.
3) I will receive compensation for personal services performed in the United States. This compensation
qualifies for exemption from withholding of federal income tax under the Tax Treaty between the United
States and Canada in an amount not in excess of $10,000 for any tax year.
4) I arrived in The United States on ___________________(insert the date of your last arrival in the
United States before beginning study or training). I am claiming this exemption only for such period of
time as is reasonably necessary to complete the education or training.
===========================================================================
Under penalties of perjury, I declare that I have examined these statements and, to the best of my
knowledge and belief, they are true, correct, and complete.
_________________________________________
___________________
Signature of Nonresident Alien Individual
Date
_________________________________________
___________________
Signature of Witness
Date

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