J1 Data Form by aus12721

VIEWS: 0 PAGES: 5

More Info
									              Foreign National Information System Data Gathering Form


Use this form to gather information for each foreign national employee, contractor, or vendor that must
be tracked in the Windstar Tax Navigator. The information gathered on this form will be used to enter
the data into the Foreign National Information System (FNIS) to be uploaded into Tax Navigator at a
later date.
              Foreign National Information System Data Gathering Form

Screen 1 Information
Title:
Last Name:
First Name:
Middle Name:
Post Title:
Student Type:
Trainee Type:
Your SSN / ITIN:
Applied for SSN / ITIN:
Institution-Assigned ID Number:                      Leave this field blank.
Department at Institution:
Occupation at Institution:          (enter GC for G reen C ard and Expiration Date in this field)

Foreign Taxpayer ID:

Screen 2 Information
Date of Birth:
Marital Status:
Spouse in USA?:
Spouse Working in USA?
Total Number of Dependents:
Number of Dependents Who Were
With Me in the U.S. at Some Time
in the Calendar Year:
Number of Dependents Who Are
U.S. Citizens or Residents:
Home Phone:
Day Phone:
Fax:
Email Address:
Date First in USA:

Screen 3 Information
U.S. Address Line 1:
U.S. Address Line 2:
U.S. Address Line 3:
City:
State:
Zip code:
Foreign Address Line 1:
Foreign Address Line 2:
Foreign Address Line 3:
Foreign City:
Province/Region:
Postal Code:
Country of Residence Address:




                                                                                    OSC-FN04 Revised: 2/22/2011
Screen 4 Information
Country of Passport/Citizenship:
Passport Number:
Passport Expiration Date:

U.S. Citizen?:
Country of Tax Residence Before
Entering US:
Office in USA?:
Days of Office Availability:
Recipient of Grant?:
Proven Closer Connection?:
Application for LPR?:
In Full-time Program?:
Wish to claim treaty benefits?:
                                       VISA / IMMIGRATION STATUS HISTORY
Screen 5 Information                               See TAB - Immigration Status Codes for HELP.
Visa Record # 1
Immigration Status (Visa Type):
J Subcategory (J1 & J2):
Primary Purpose of Visit:
Tax Residence:
Treaty benefit taken as:
Visa Number:
First day in USA:
Last Day in USA:

Visa Record # 2
Immigration Status (Visa Type):
J Subcategory (J1 & J2):
Primary Purpose of Visit:
Tax Residence:
Treaty benefit taken as:
Visa Number:
First day in USA:
Last Day in USA:

Visa Record # 3
Immigration Status (Visa Type):
J Subcategory (J1 & J2):
Primary Purpose of Visit:
Tax Residence:
Treaty benefit taken as:
Visa Number:
First day in USA:
Last Day in USA:
I hereby authorize North Carolina Office of the State Controller to release this information to Windstar Technologies, Inc., P.O.
Box 800; 1400 Providence Hwy.; Suite 3250; Norwood, MA 02062-0800 for the following purpose: technical software support for
the International Tax Navigator system.
I hereby certify under penalty of perjury that all of the following information is true, complete and correct. I understand that if my
status changes from that which I have indicated on this form I must submit a new form to the appropriate department.



Foreign National Signature                                                                                Date:


Agency Authorized Signature                                                                               Date:
                                                                                                             OSC-FN04 Revised: 2/22/2011
                                            Data Gathering Form
                                          Immigration Status Codes
                                            IMMIGRATION STATUS (VISA TYPES)




D:\Docstoc\Working\pdf\e3bfbc0c-cf57-4c09-a80d-2b0fde13e05f.xls
                                            Data Gathering Form
                                          Immigration Status Codes



J1 & J2 Sub Categories                                            PURPOSE OF VISIT




D:\Docstoc\Working\pdf\e3bfbc0c-cf57-4c09-a80d-2b0fde13e05f.xls

								
To top