Form 8946 - Ptin Supplemental Application For Foreign Persons Without A Social Security Number

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8946
PTIN Supplemental Application For Foreign Persons
Form
Without a Social Security Number
OMB No. 1545-2189
(Rev. September 2012)
Department of the Treasury
Information about Form 8946 and its instructions is at
Internal Revenue Service
▶
Do not submit this form if you have, or are eligible to get, a U.S. Social Security Number (SSN).
Name
1 First name
Middle name
Last name
(see instructions)
Applicant's
2 Street address, apartment number, or rural route number. Do not use a P.O. box number.
Non-U.S.
Physical
Address
City or town, state or province, and country. Include postal code when appropriate.
(see instructions)
3 Date of birth (mm/dd/yyyy)
Birth
4
Country of birth
Male
Information
Female
Name at birth (if different from above)
First name
Middle name
Last name
Foreign Status
5 Foreign status and identification document(s) submitted (see instructions)
Passport
Foreign Driver's License
National ID Card
and
Identification
Foreign Voter's
Information
U.S. Military ID Card
U.S. Visa
Registration Card
Civil Birth Certificate
Foreign Military ID Card
Sign
Under penalties of perjury, I declare that I have examined this application, including accompanying
documentation and statements, and to the best of my knowledge and belief, it is true, correct, and
Here
complete.
Phone number
Signature of applicant
Date
For IRS Use Only
8946
For Paperwork Reduction Act Notice, see instructions.
Form
(Rev. 9-2012)
Cat. No. 37764H

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