Login

Fillable Printable Form 8802

Fillable Printable Form 8802

Form 8802

Form 8802

Form 8802
(Rev. April 2012)
Department of the Treasury
Internal Revenue Service
Application for United States
Residency Certification
See separate instructions.
OMB No. 1545-1817
Important. For applications filed after March 31, 2012, the user fee is $85 per application.
For IRS use only:
Additional request (see instructions)Foreign claim form attached
Pmt Amt $ .
Deposit Date: / /
Date Pmt Vrfd: / /
Electronic payment confirmation no.
Applicant’s nameApplicant’s U.S. taxpayer identification number
If a joint return was filed, spouse’s name (see instructions)
If a separate certification is needed for spouse, check here
If a joint return was filed, spouse’s U.S. taxpayer
identification number
1
Applicant’s name and taxpayer identification number as it should appear on the certification if different from above
2
Applicant’s address during the calendar year for which certification is requested, including country and ZIP or postal code. If a P.O.
box, see instructions.
3a
Mail Form 6166 to the following address:
b
Appointee Information (see instructions):
Appointee Name
CAF No.
Phone No.
( )
Fax No.
( )
4
Applicant is (check appropriate box(es)):
a
Individual. Check all applicable boxes.
U.S. citizenU.S. lawful permanent resident (green card holder)Sole proprietor
Other U.S. resident alien. Type of entry visa
Current nonimmigrant status
and date of change (see instructions)
Dual-status U.S. resident (see instructions). From
to
Partial-year Form 2555 filer (see instructions). U.S. resident from
to
b
Partnership. Check all applicable boxes.U.S.ForeignLLC
c
Trust. Check if:Grantor (U.S.)
SimpleRev. Rul. 81-100 Trust
IRA (for Individual)
Grantor (foreign)ComplexSection 584IRA (for Financial Institution)
d
Estate
e
Corporation. If incorporated in the United States only, go to line 5. Otherwise, continue.
Check if:Section 269BSection 943(e)(1)Section 953(d)Section 1504(d)
Country or countries of incorporation
If a dual-resident corporation, specify other country of residence
If included on a consolidated return, attach page 1 of Form 1120 and Form 851.
f
S corporation
g
Employee benefit plan/trust. Plan number, if applicable
Check if:Section 401(a)Section 403(b)
Section 457(b)
h
Exempt organization. If organized in the United States, check all applicable boxes.
Section 501(c)Section 501(c)(3)Governmental entity
Indian tribeOther (specify)
i
Disregarded entity. Check if:LLCLPLLPOther (specify)
j
Nominee applicant (must specify the type of entity/individual for whom the nominee is acting)
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10003D
Form 8802 (Rev. 4-2012)
Form 8802 (Rev. 4-2012)
Page 2
Applicant name:
5
Was the applicant required to file a U.S. tax form for the tax period(s) on which certification will be based?
Yes.Check the appropriate box for the form filed and go to line 7.
990990-T10401041106511201120S3520-A52275500
Other (specify)
No.Attach explanation (see instructions). Check applicable box and go to line 6.
Minor childQSubU.S. DREForeign DRESection 761(a) election
FASITForeign partnershipOther
6
Was the applicant’s parent, parent organization or owner required to file a U.S. tax form? (Complete this line only if you checked
“No” on line 5.)
Yes.Check the appropriate box for the form filed by the parent.
990990-T10401041106511201120S5500
Other (specify)
Parent’s/owner’s name and address
and U.S. taxpayer identification number
No.Attach explanation (see instructions).
7Calendar year(s) for which certification is requested.
Note. If certification is for the current calendar year or a year for which a tax return is not yet required to be filed, a penalties
of perjury statement from Table 2 of the instructions must be entered on line 10 or attached to Form 8802 (see instructions).
8
Tax period(s) on which certification will be based (see instructions).
9Purpose of certification. Must check applicable box (see instructions).
Income taxVAT (specify NAICS codes)
Other (must specify)
10
Enter penalties of perjury statements and any additional required information here (see instructions).
Sign
here
Under penalties of perjury, I declare that I have examined this application and accompanying attachments, and to the best of my knowledge and belief,
they are true, correct, and complete. If I have designated a third party to receive the residency certification(s), I declare that the certification(s) will be used
only for obtaining information or assistance from that person relating to matters designated on line 9.
Keep a
copy for
your
records.
Applicant’s signature (or individual authorized to sign for the applicant)
Signature
Date
Applicant’s daytime phone no.:
Name and title (print or type)
Spouse’s signature. If a joint application, both must sign.
Name (print or type)
Form 8802 (Rev. 4-2012)
Form 8802 (Rev. 4-2012)
Worksheet for U.S. Residency Certification Application
Page 3
Applicant NameApplicant TIN
Appointee Name (If Applicable)
Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)
11Enter the number of certifications needed in the column to the right of each country for which certification is requested.
Note. If you are requesting certifications for more than one calendar year per country, enter the total number of certifications for allyears for
each country (see instructions).
Column A
CountryCC#
ArmeniaAM
AustraliaAS
AustriaAU
AzerbaijanAJ
BangladeshBG
BarbadosBB
BelarusBO
BelgiumBE
BermudaBD
BulgariaBU
CanadaCA
ChinaCH
CyprusCY
Czech RepublicEZ
DenmarkDA
EgyptEG
EstoniaEN
Column A - Total
Column B
CountryCC#
FinlandFI
FranceFR
GeorgiaGG
GermanyGM
GreeceGR
HungaryHU
IcelandIC
IndiaIN
IndonesiaID
IrelandEI
IsraelIS
ItalyIT
JamaicaJM
JapanJA
KazakhstanKZ
Korea, SouthKS
KyrgyzstanKG
Column B - Total
Column C
CountryCC#
LatviaLG
LithuaniaLH
LuxembourgLU
MexicoMX
MoldovaMD
MoroccoMO
NetherlandsNL
New ZealandNZ
NorwayNO
PakistanPK
PhilippinesRP
PolandPL
PortugalPO
RomaniaRO
RussiaRS
Slovak RepublicLO
SloveniaSI
Column C - Total
Column D
CountryCC#
South AfricaSF
SpainSP
Sri LankaCE
SwedenSW
SwitzerlandSZ
TajikistanTI
ThailandTH
Trinidad and TobagoTD
TunisiaTS
TurkeyTU
TurkmenistanTX
UkraineUP
United KingdomUK
UzbekistanUZ
VenezuelaVE
Column D - Total
12Enter the total number of certifications requested (add columns A, B, C, and D of line 11) ..........
Form 8802 (Rev. 4-2012)
Login to HandyPDF
Tips: Editig or filling the file you need via PC is much more easier!
By logging in, you indicate that you have read and agree our Terms and Privacy Policy.