Wh 1 Form – Fill Out and Use This PDF

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)

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 a PostDoc?	[	] YES	[	] NO
Are you employed anywhere?	[	] YES	[	] NO If you answered "YES", please provide your employer's information:
Employer's Name				Number & Street		City / Province	State	Postal Code
2. US Mailing Address
Number and Street						City	State	Zip Code
3. Foreign Mailing Address
Number and Street						City/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., consulting, conducting a workshop, etc.)
[ ] B-2/WT Visitor for Pleasure (Tourist)			[	] Other:
[ ] Other INS Classification (liststatus):
2.	Is this the first time you have entered theUnited States?		[	] YES [ ] NO

3. Past Visa History

Provide the number of days you were or will be 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 or
Calendar	classification held while	will be physically present in the US	Number of days		Have you taken any
Year	present in the US during	during the listed calendar year.	present in the	Are you leaving the	treaty benefits during
	the listed calendaryear	(list dates as mm/dd/yy, 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
					[	] YES	[	] NO

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

		ENTER TOTAL NUMBER OF DAYS YOU
	CALENDAR	WERE OR WILL BE PRESENT IN THE		CALCULATE TOTAL NUMBER OF DAYS TO
	YEAR	UNITED STATES 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:
	A. Does the TOTAL NUMBER OF DAYS TO COUNT for the current calendar year equal to 31 daysor more? [				] YES	[	] NO
	B. Does the TOTAL # OF DAYS for all three years equal to 183 daysor 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 asa 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 asa 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 of30%.

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.

OR

•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 boxonly.)

[ ] 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 TaxTreaty 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 Royaltypayments.

[	] 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

Vendor Code

Status: [

] Resident Alien for Tax Purposes(SPT exp 12/

)

[

] Nonresident Alien

Nonresident Withholding:

Expiration Date

1099/1042 & WH Ind:

[

] Statutory Rate of 30%

Form

8233

[

] Reduced Rate of 14% or

%

Form

W8-BEN

[

] Exempt

Form W-9

Initials

Date

RESET FORM

UNIVERSITY OF HAWAII

UH Disbursing Office

1402 Lower Campus Rd, Bldg, Rm 34

Honolulu, Hawaii 96822Electronic Funds Transfer Authorization

Phone (808) 956-7126

Select one:

New Authorization

Change Bank Information

Cancel Direct Deposit

Business / Individual Name and Mailing Address (General)

Name

DBA

		(doing business as)
Address
City
State	Zip Code	Vendor Number
		(optional-11 digit number starting w/ V found on Univ of Hawaii check)

Contact Information

Contact Name

Title

EmailAddress

Phone

Ext.

FAX

Tax Identification Information (SSN for Individual's)

Federal ID Name

Federal ID Number

Financial Institution Information

Financial Institution Name

ABA Routing Number

(9 digit number, identifies bank's location, name, Federal Reserve district, and area; contact your bank to be sure)

Authorization to Make Electronic Fund Payments

I authorize the University of Hawaii to direct deposit payments, by electronic fund transfer, to my checking or savings and if necessary, debit entries and adjustmentsforanyamounts deposited electronicallyin error. The payments shall be deposited in thefinancial institutiondesignated above. I recognize that if I fail to provide complete and accurate information on this authorization form, the processing of the form may be delayed or my payments may be erroneously transferred electronically.

This Authorization will remain in effect until I submit written notification of its cancellation in such time and such manner, as to afford the University of Hawaii and my financial institution named above a reasonable opportunity to act on it.

I consent to and agree with the National Automated Clearing House Association (NACHA) Rules and Regulations about electronic transfers as they exist on the date of my signature on this form or as subsequently adopted, amended or repealed. ACH/EFT is not available to foreign companies due to

NACHA regulations for monetary transfer to foreign banking institutions.

Mail form to: UH Disbursing Office, 1402 Lower Campus Rd, Bldg H, Rm 34, Honolulu, HI 96822

(Rev 101920 ADA)

UNIVERSITY OF HAWAII

UH Disbursing Office

1402 Lower Campus Rd., Bldg H, Rm 34

Honolulu, HI 96822

Phone (808) 956-7126

International Electronic Funds Transfer Certification

Effective September 18, 2009, the National Automated Clearing House Association (NACHA) changed the requirements for receiving electronic payments. As of that date, all electronic payments to banks in another country have to be coded as an international payment.

Although the University of Hawaii only allows electronic payments to U.S. banks, a vendor could instruct their U.S. bank to forward their payment to a bank in another country. In this scenario, the vendor's electronic payment to their U.S. bank must be coded as an international payment. Please see below for a sample scenario:

Sample Scenario

Company XYZ has their payment for services direct deposited into their U.S. bank account and then 100% of those funds are moved by their U.S. bank to a bank in Mexico. Effective September 18, 2009, this transaction must be coded as an international payment.

In order to comply with this requirement, please indicate in the check boxes below of the final destination of your electronic payments.

The final destination of my electronic payment is a U.S. bank

Electronic payments to my U.S. bank will be forwarded to a bank in another country

Routing of funds outside the U.S. is considered high risk by Bank of Hawaii,

our financial institution, and are not currenly supported.

Business Name:

Authorized Signature:					Date:
Printed Name:			Title:

Mail form to: UH Disbursing Office, 1402 Lower Campus Rd, Bldg H, Rm 34, Honolulu, HI 96822

IEFTC (REV 101920 ADA)