Form Uh Wh-1 - Wh-1 Statement Of Citizenship And Federal Tax Status - University Of Hawaii

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UH WH-1 Revised Jan 2011

UNIVERSITY OF HAWAII

Reset Form

WH-1 STATEMENT OF CITZENSHIP AND FEDERAL TAX STATUS

This form is for individuals. In order to comply with applicable tax provisions of the Internal Revenue

PURPOSE:

Service (IRS), the information requested on this form is required to determine the appropriate federal tax

withholding and is required for each calendar year. (Business entities should use IRS Form W-9.)

DIRECTIONS: UNITED STATES (US) CITIZENS:

1. Complete Sections A and E only.

PERMANENT RESIDENT ALIENS:

1. Complete Sections A and E only

2. Attach a photocopy (front and back) of your Alien Registration Card

ALL OTHERS:

1. Complete Sections A, B, C, and E

4. Submit IRS Form W-8BEN for foreign status

2. Complete Section D if applicable

5. For J-1 Visaholders, submit copy of DS-2019

3. Submit copy (front and back) of your I-94,

6. For B Visaholders, submit FMIS-45

Passport ID page, and Visa page

7. For F-1 Visaholders, submit copy of I-20

Section A. PERSONAL INFORMATION

1. General Information

Last Name

First

Middle

US Social Security Number or ITIN Number

Country of Citizenship

Country of Residence for Tax Purpose

E-Mail Address

If you did not provide a Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN), please answer the questions:

[

]

I elect not to provide this information to the University of Hawaii. I understand I may be subject to tax withholding on payments I’ll receive

from the University or if I’m from a foreign country, I will not qualify for tax treaty benefits.

[

]

I plan to request a SSN or ITIN and submit to the Disbursing Office at a later date.

Are you an employee? [

] YES [

] NO

If you answered “Yes”, please provide your employer’s information:

Employer’s Name

Number & Street

City

State

Postal Code

2. US Residence Address

Number & Street

City

State

Zip Code

3. Foreign Residence Address

Number & Street

City or Province

Country

Postal Code

Section B. US IMMIGRATION ACTIVITY

1. Current Visa Status

Date of US Entry

Expiration Date of Current Visa

Intended Length of Stay (Days)

Anticipated Departure Date

Current Visa Type (check appropriate box):

What is the primary purpose of the visit? (check appropriate box)

[

] F-1 Student

[

] Studying/Training/Research in a Degree Program

[

] J-1 Student

[

] Studying/Training/Research in a Non-Degree Program

[

] J-1 Visitor (Non-Student)

[

] Training/Research as a Post-Doctoral Fellow

[

] B-1/WB Visitor for Business

[

] Providing Service as an Independent Contractor (e.g.,

[

] B-2/WT Visitor for Pleasure (Tourist)

consulting, conducting a workshop, etc.

[

] Other INS Classification (list status):

[

] Other:

[

] YES [

] NO

2. Is this the first time you have entered the United States?

3. Past Visa History

Provide the requested information to detail the number of days you were physically present in the United States during the calendar years listed below.

Note: Calendar year refers to the period January 1 through December 31.

Enter Visa Type/INS

Enter period(s) when you were physically

Calendar

classification held while

present in the US during the listed

Number of days

Have you taken any

Year

present in the US during

calendar year. (list dates as mm/dd/yy,

present in the