3415 Fr.01 - International Information Form & Substitute Irs Form W-8 Ben - Yale University Page 2
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3International Information Form
3415 FR.01 -
& Substitute IRS Form W-8 BEN
SECTION 4: Complete if claiming tax treaty benefits
I certify that: (check all that apply)
q
A.
The beneficial owner is a resident of _______________________ within the meaning of the income tax treaty between the United States and that country.
q
B.
If required, the U.S. taxpayer identification number is stated on line 2 above.
q
C.
The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file form 8833 if the
amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000.
Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article ________ of the treaty identified on line A
above to claim a _______% rate of withholding on (specify type of income): __________________________________________________________________.
Explain the reasons the beneficial owner meets the terms of the treaty article: ___________________________________________________________________
__________________________________________________________________________________________________________________________________
SECTION 5
Please list any visa immigration activity for prior visits to the U.S.: ________________________ (attach additional sheets if needed)
Have You Taken Any Treaty
Date of Entry
Date of Exit
Visa Immigration Status
J-1 Subtype (if applicable)
Primary Activity
Benefits
q
q
___/___/___
___/___/___
_______________________ ____________________ ______________________
Yes
No
q
q
___/___/___
___/___/___
_______________________ ____________________ ______________________
Yes
No
q
q
___/___/___
___/___/___
_______________________ ____________________ ______________________
Yes
No
q
q
___/___/___
___/___/___
_______________________ ____________________ ______________________
Yes
No
SECTION 6
A. S
1: R
/
TEP
ESIDENT ALIEN
NONRESIDENT ALIEN DETERMINATION
q
I am a STUDENT on an F-1 or a J-1 visa AND I have been in the U.S. as a student for a total of five or fewer calendar years.
q
I am a PROFESSOR or RESEARCH SCHOLAR on a J-1 visa AND I have been in the U.S. as a Professor or Research Scholar for a total of two or fewer
of the past six calendar years.
If you marked either box, you are a NONRESIDENT ALIEN for tax purposes. Do not complete the Substantial Presence Test, but complete Part C.
If you did not mark either box above, complete Part B, the Substantial Presence Test, and then complete Part C.
3/2002
Questions? Contact jodie.stewart-moore@yale.edu
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