Addendum to Form W-8BEN Certificate of Foreign Status of Beneficial

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Addendum to Form W-8BEN Certificate of Foreign Status of Beneficial Powered By Docstoc
					    Addendum to Form W-8BEN: Certificate of Foreign Status of Beneficial
                 Owner for United States Tax Withholding
          ALL INFORMATION IN THIS FORM IS REQUIRED
 Applicant’s Name: ________________________________ Applicant’s Employee Identification Number: _________________

 Applicant’s e-mail:_________________________________________________

 Payroll Coordinator’s Name: _________________________________________

 Unit Code: _________________________________________________________

 Payroll Coordinator’s Phone number: _________________________                Payroll Coordinator Box Number:_____________________


Part II: Claim of Tax Treaty Benefits Line 10: Explain the reasons the beneficial owner meets the terms of the treaty article:
 I was a resident of ______________________________ immediately before my visit to the U.S.A. I am presently in the U.S.A.
 for the primary purpose of studying or doing research at the University of Washington. Any research I perform will be undertaken
 in the public interest and not primarily for the private benefit of a specific person or persons.
 PART III: CITIZENSHIP AND VISA INFORMATION Circle Your Choice Where Applicable
 1.Country of Citizenship             2.Country of Residence (Foreign 3.Candidate for a U.W. Degree:
                                      Country)
                                                                          Yes                No

 4A.Current Visa Classification                        6. When does your permission to         7. Have you ever been in the United States
   Immigrant/Permanent Resident                        stay in the U. S. expire? Date          before?

    F-1 Student                                                                                      Yes           No

    J-1 Exchange Visitor (Student)
                                                                                               If yes, what VISA Type for each instance
    J-1 Exchange Visitor (Teacher/Researcher)                                                  AND when (date of first entry mm/dd/yy
                                                                                               and day of permanent exit mm/dd/yy):

    Other. Please specify.                                                                     Visa Type    Entry Date      Permanent
                                                                                                                            Exit Date

 _____________________________                                                                 ____________________________________

 4B.Date of your original entry to the United                                                  ___________________________________
 States under your current VISA:
                                                                                               ___________________________________




 COMMENTS:




 ___________________________________                                   ______________
  Signature of beneficial owner (or individual                         Date
  Authorized to sign for beneficial owner)