Form 8802 - Application For United States Residency Certification Page 3
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Worksheet for U.S. Residency Certification Application
Form 8802 (Rev. 4-2012)
Page
Applicant Name
Applicant TIN
Appointee Name (If Applicable)
Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)
11
Enter the number of certifications needed in the column to the right of each country for which certification is requested.
Note. If you are requesting certifications for more than one calendar year per country, enter the total number of certifications for all years for
each country (see instructions).
Column A
Column B
Column C
Column D
Country
CC
#
Country
CC
#
Country
CC
#
Country
CC
#
Armenia
AM
Finland
FI
Latvia
LG
South Africa
SF
Australia
AS
France
FR
Lithuania
LH
Spain
SP
Austria
AU
Georgia
GG
Luxembourg
LU
Sri Lanka
CE
Azerbaijan
AJ
Germany
GM
Mexico
MX
Sweden
SW
Bangladesh
BG
Greece
GR
Moldova
MD
Switzerland
SZ
Barbados
BB
Hungary
HU
Morocco
MO
Tajikistan
TI
Belarus
BO
Iceland
IC
Netherlands
NL
Thailand
TH
Belgium
BE
India
IN
New Zealand
NZ
Trinidad and Tobago
TD
Bermuda
BD
Indonesia
ID
Norway
NO
Tunisia
TS
Bulgaria
BU
Ireland
EI
Pakistan
PK
Turkey
TU
Canada
CA
Israel
IS
Philippines
RP
Turkmenistan
TX
China
CH
Italy
IT
Poland
PL
Ukraine
UP
Cyprus
CY
Jamaica
JM
Portugal
PO
United Kingdom
UK
Czech Republic
EZ
Japan
JA
Romania
RO
Uzbekistan
UZ
Denmark
DA
Kazakhstan
KZ
Russia
RS
Venezuela
VE
Egypt
EG
Korea, South
KS
Slovak Republic
LO
Estonia
EN
Kyrgyzstan
KG
Slovenia
SI
Column A - Total
Column B - Total
Column C - Total
Column D - Total
12 Enter the total number of certifications requested (add columns A, B, C, and D of line 11) .
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8802
Form
(Rev. 4-2012)
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