Form W-8 - Certificate Of Non-U.s. Status

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IEEE Vendor Add Form and Substitute Form W-8
CERTIFICATE OF NON-U.S. STATUS
Part I – General Information
Individual
Company
Services are only provided outside of the U.S. Complete Part I only.
Name
U.S. Taxpayer Identification Number
(if any)
Permanent address (include apt. or suite no.)
City and province or state
Postal code and country
Current mailing address (if different from permanent address)
City and province or state
Postal code and country
Part II – Information and questions regarding your residence status
Country of Citizenship:
Individuals complete (1), (2), and (3) below:
Questions to determine if you are a U.S. resident under U.S. tax rules:
(1) - Were you a lawful permanent resident of the U.S. at any time during the calendar year, that is;
held an immigrant visa (a green card)?
Yes
No
(2) - Were you physically present in the U.S. at least 31 days during the current calendar year?
Yes
No
If “yes,” How many days:
___________
(3) - If you answered “yes” to Question (2), do the total days you were present in the U.S. during the
current year (shown above), plus one-third of the days you were present in the prior year, plus one-
sixth of the days you were present in the second prior year equal or exceed 183 days?
Yes
No
If you answered yes to either Question #(1) or #(3) above, the individual must provide a U.S.
Taxpayer Identification Number or U.S. Federal Employer Identification Number.
Companies complete (4) and (5) below.
(4) - Are you a company based or located in the United States?
Yes
No
(5) - If you answered no to (4), are the payments you receive from us for services performed within
the United States? Yes
No
If the answer to (4) or (5) is yes, the company must provide a U.S. Federal Employer Identification #.
Part III
Certification
Under penalties of perjury, I certify that the information included on this form is true, correct
and complete.
Signature:
Date:
For IEEE Use only:
Mandatory: IEEE Staff Use Only
Supplier Number: ______________________________
Staff Name: ______________________________ Tel. Ext. _______
Site: ____________
Payment is for: Expense Reimbursement ___ Refund ___ Goods ___
Only IEEE Staff can submit this form directly
Services ___ Award ___ IEEE Foundation Supplier: Yes ___ No ___
to IEEE Strategic Sourcing
Reason for Add/Change: ________________________________________
General instructions for IEEE use only
IEEE Vendor Add Form and Substitute Form W-8 is required to be completed prior to making payment to a non U.S. person (individual, sole proprietor, or
partnership) or a non U.S. company. Part II of Form W-8 is not required to be completed for payments made for services performed outside of the United States
or for purchases of tangible property from a non-U.S. company. All W-8 forms completed by individuals must be signed. Digital and faxed signatures are
acceptable. Form W-8 is valid for three years from the date signed unless a change of circumstances makes the information on the form incorrect.
IEEE Substitute W-8 Form Revised April 2013

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