Foreign National Information Form
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1Foreign National Information Form
Foreign Nationals receiving payments through Accounts Payable, of non-employee compensation, including honorariums, must
complete the Foreign National Information Form.
Name _______________________________
Social Security Number or Taxpayer
Address _______________________________
Identification number, if any.
_______________________________
__________________
_______________________________
1. Visa Status ________________.
If immigration status is a J-1, what is the subtype? Please circle one.
01 Student 02 Short Term Scholar
05 Professor 12 Research Scholar
Other
If immigration status is a B-1/B-2 or Visa Waiver, how many institutions do you plan on performing services for
during the current tax year? ______
What country are you a citizen of? ____________.
What country are you a tax resident of, if different from above? _____________.
2. What is the actual date you entered the United States? _____/___/___.
Month Day Year
3
What date do you anticipate leaving the United States? _____/___/___
.
Month Day Year
4.
Were you present in the United States for any other days during the current or previous seven years?
4a. If yes, please list the date(s) and visa status.
Date of Entry
Date of Exit
Visa Status
_/__/___
_/__/___
_______
_
_
_/__/___
_/__/___
_______
_
_
_/__/___
_/__/___
_______
_
_
_/__/___
_/__/___
_______
_
_
5. What is the payment for? _____________________________________________
6. Are you eligible for and do you want to elect to claim treaty benefits? ______.
If yes, please complete Form 8233 Exemption From Withholding on Compensation for Independent (and Certain
Dependent) Personal Services of a Nonresident Alien Individual. Form 8233 must be submitted to the Controller’s
Office for review and for filing with the IRS.
7. If you answered yes to question 6 and you do not have a social security number or individual taxpayer identification
number, and you are ineligible for a social security number, you must complete Form W-7, Application for IRS
Individual Taxpayer Identification Number. Form W-7 must be either mailed or brought to an IRS Office with the
proper documentation. A copy must be provided to the Controller’s Office.
8. If you answered no to question 6, please complete Parts I & III of Form W-8BEN Certificate of Foreign Status of
Form W-8BEN must be submitted to the Controller’s Office.
Beneficial Owner for United States Tax Withholding
.
Form W-8BEN is not filed with the IRS. A 30% federal income tax will be withheld on your payment.
I hereby certify that all of the above information is true and correct. I understand that if my status changes from that which I have
indicated on this form, I must submit a new Foreign National Information Form to the Controller’s Office.
Signature_______________________________________________________________Date___________
This form must be submitted to the Controller’s Office with the appropriate forms attached prior to a disbursement being
made.
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