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UH WH-1

(11/22/13)

UNIVERSITY OF HAWAII

STATEMENT OF CITIZENSHIP AND FEDERAL TAX STATUS

PURPOSE: This form is for individuals. To comply with applicable tax provisions of the Internal Revenue Service (IRS) regulations, 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	5.	For J-1 visaholders, submit copy of DS-2019
2.	Complete Section D if applicable	6.	For B visaholders, submit DISB-45
3.	Submit copy (front and back) of your I-94	7.	For F-1 visaholders, submit copy of I-20
	Passport ID Page and Visa page	8.	Submit IRS Form 8233 if performing services as
4.	Submit IRS Form W8-BEN for foreign status		independent contractor (Treaty only).

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

[FOR NON-UH PERSONNEL] Are you employed anywhere? [			] 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 and Street		City	State	Zip Code

3.	Foreign Residence Address.

Number and Street		City/Province	Country	Postal Code

Section B. US IMMIGRATION ACTIVITY

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., consulting, conducting a workshop, etc.)

[

]

B-2/WT Visitor for Pleasure (Tourist)

[

]

Other:

[

]

Other INS Classification (list status):

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

[

] YES

[ ] NO

Past Visa History

Provide the number of days you were physically present in the United States. Note: Calendar year refers to the period January 1 - 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

Are you leaving the

treaty benefits during

the listed calendar year

e.g., 01/01/12 – 12/31/12

United States?

US this year?

the listed year?

[ ] YES [ ] NO

[

] YES

[

] NO

[

] YES

[

] NO

[

] YES

[

] NO

[

] YES

[

] NO

[

] YES

[

] NO

[

] YES

[

] NO

[

] YES

[

] NO

Section C. Tax Status Determination

STEP 1: Complete the Substantial Presence Test (SPT) by completing the table below. For F, J, M or Q Visaholders, please note the following:

For F, J, or M Student Visaholders:

For J or Q Non-Student Visaholders:

Do NOT count any days during your first 5 years in the United States in which you held an F, J, or M student visa.

Do NOT count any days during your first 2 years in the previous 6 years in the United States in which you held a J or Q Non-Student visa.

		ENTER TOTAL NUMBER OF DAYS
	CALENDAR	PRESENT IN THE UNITED STATES		CALCULATE TOTAL NUMBER OF DAYS TO
	YEAR	FOR EACH YEAR	RATIO	COUNT FOR EACH YEAR
		(A)	(B)	(A X B)
			1

			1/3

			1/6

			TOTAL # OF DAYS
STEP 2: Please answer the following questions:
STEP 2: Please answer the following questions:
	A. Does the TOTAL NUMBER OF DAYS TO COUNT for the current calendar year equal to 31 days or more? [				] YES	[	] NO
	B. Does the TOTAL # OF DAYS for all three years equal to 183 days or more?			[	] YES	[	] NO

STEP 3: Determine your tax status:

If you marked “YES” to both questions A and B, then you passed the Substantial Presence Test and will be treated as a RESIDENT ALIEN (RA) FOR TAX PURPOSES for this calendar year. Go to and sign Section E below.

If you marked “No” to one or both questions, then you did not pass the Substantial Presence Test and will be treated as a NONRESIDENT ALIEN FOR TAX PURPOSES for this calendar year. Go to Section D below.

Section D. EXEMPTION FROM WITHHOLDING FOR THE NONRESIDENT ALIEN

1.All Payments made to Nonresident Aliens are subject to US federal tax withholding at a statutory rate of 30%.

However, you may claim an exemption from withholding or reduced rate via a US Tax Treaty if you meet the following requirements:

a. You must be a resident of a country that has a tax treaty with the US. (Consult IRS Publication 901, US Tax Treaties, at http://www.irs.gov/pub/irs-pdf/p901.pdf. The tax treaty must have a treaty article applicable to the type of payment you'll be receiving:

Scholarship or Fellowship Article for Scholarship, Fellowship, Traineeship, and Stipend Payments.

Independent Personal Services Article for Fee for Services, Honoraria, and Reportable Travel payments.

b.You must meet all requirements regarding residency, time, and dollar limitations described in the tax treaty.

c.You must have a Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) to claim a treaty exemption.

2.Do you want to claim a treaty exemption from US federal tax withholding? (Check one box only.)

[	] YES	I am a resident of a country that has a tax treaty with the US and has an applicable tax treaty article. Therefore, I claim
		exemption from US tax withholding via a US Tax Treaty with _________________________, my country of residence.
		I have attached one of the following IRS forms: (Consult IRS website for Forms and Instructions at
		http://www.irs.gov/formspubs/index.html)
		 IRS Form 8233 for Fee for Services, Honoraria, and Reportable Travel payments.
		OR
		 IRS Form W8-BEN for Scholarship, Fellowship, Traineeship, Stipend, and Royalty payments.
[	] NO	I choose not to claim a treaty exemption from US tax withholding, even though I am a resident of a country that has a tax
		treaty with the US and an applicable treaty article. I understand taxes will be withheld at 14% (Scholarships, Fellowship,
		Traineeship, or Stipend) or 30% (All other payments.).
[	] NO	I cannot claim a treaty exemption from US tax withholding because I do not meet the requirements stated in Part 1 above.
		I understand taxes will be withheld at 14% (Scholarships, Fellowship, Traineeship, or Stipend) or 30% (All other payments).

Section E. CERTIFICATION OF INFORMATION PROVIDED ON THIS FORM

Under penalties of perjury, I certify the information entered above is correct; and if a reduced rate of exemption from tax applies, I further certify that I have complied with all tax treaty requirements to qualify for the reduced rate. (For Resident Aliens, IRS has not notified me of backup withholding.)

Signature:Date:

Disbursing Office Use Only

Tax		[ ] US Citizen			[ ] Permanent Resident Alien
Status:		[ ] Resident Alien for Tax Purposes (SPT exp 12/____)			[ ] Nonresident Alien


Nonresident Withholding:				Expiration Date
[	] Statutory Rate of 30%		Form 8233	______________
[	] Reduced Rate of 14% or ___%		Form W8-BEN	______________
[	] Exempt		Form W-9	______________

Vendor Code

1099/1042 & WH Ind:

Initials	Date

Question	Answer
Form Name	Uh Wh 1 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	W8-BEN, SPT, visaholders, 2014

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