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Enter the appropriate calendar year. This form needs to be completed each calendar year if you wish to claim an exemption.
1. Enter your name (last name first, exactly shown on your social security card).
2. Enter your U.S. social security number.
3. Enter your foreign tax identifying number, if any (optional). For example, i fyou are a resident of Canada, enter your Social Insurance Number.
4. Enter your permanent foreign address in your country of legal residence (street, apt. or suite no., or rural route). Do not use a P.O. Box.
4a. Enter city or town, province (state) and include postal code.
4b. Enter the name of country (do not abbreviate).
5.
5a.
Enter city or town, state and zip code.
6.
Enter your U.S. visa type (found on your Form I-94). For example, foreign
students are usually granted an "F-1" visa. Foreign professors, teachers,
or researchers are usually granted a "J-1" visa.
Note: Citizens of Canada or Mexico are not required to complete
lines 7a and 7b.
7a.
Enter the country that issued your passport.
7b.
Enter your passport number.
8.
Enter your date of original entry into the United States that pertains to
your current nonimmigrant status.
9a.
Enter your current nonimmigrant status. For example, enter student,
trainee, professor/teacher, or researcher.
9b.
Enter the date your current nonimmigrant status expires which is shown on
your current INS Form I-94.
10.
Check this box if you are a foreign student, trainee, professor/teacher,
or researcher.
11a.
Describe briefly the services for which you are being compensated.
11b.
Enter your anticipated compensation from the UW for the current calendar
year.
12a.
Enter the tax treaty and article number you are claiming.
12b.
Enter the amount of compensation that is exempt from tax under your tax
treaty article claimed. For example, the U.S./Korean tax treaty exempts
$2000 of wages of students, so $2000 would be entered on line 12b.
12c.
Enter your country or permanent residence.
13a.
Leave blank.
13b.
Leave blank.
13c.
Leave blank.
14.
Leave blank.
15.
Leave blank.
16.
Leave blank.
17.
Leave blank.
18.
Leave blank.
19.
Sign and date the form.
B.
Attach and complete the appropriate statement for the treaty
provision you are claiming.