Form 8802, Application for U.S. Residency Certification Instructions

Check this box when the applicant submitting the residency certification application is an estate.

Check this box when the applicant is an organization that is exempt from U.S. federal income tax and is applying for a U.S. residency certification.

Check this box when the applicant is a trust that is treated as a grantor trust with the grantor being a U.S. person.

Check this box if the applicant is a trust and meets the requirements to be treated as a simple trust under IRS rules.

Check this box if the applicant is a trust classified under IRS Revenue Ruling 81-100.

Check this box when the applicant’s entity type is an individual retirement account maintained for a single individual applying for U.S. residency certification.

Check this box if the applicant is a U.S. exempt organization organized in the United States and recognized under Internal Revenue Code Section 501(c)(3).

Enter the specific exempt organization classification here if you checked the “Other” box in the Exempt organization section. Provide the full statutory designation or descriptive name exactly as recognized (for example, “Section 501(d) organization”). No additional formatting is required.

Enter the exact form number and title of the U.S. tax form you filed if it is not listed among the checkboxes under “Yes” on line 5. Complete this field only when you check “Other (specify).” For example, type “Form 2553 (Election by a Small Business Corporation).”

Enter the complete address where the IRS should mail Form 6166. In the “Mail Form 6166 to the following address” field, list on separate lines: street address, city, state or province, ZIP or postal code, and country. This field is required.

Enter the nine-digit U.S. taxpayer identification number (EIN or SSN) of the parent or owner. Complete this field only if you checked Yes on 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.). Use the format XX-XXXXXXX for an EIN or XXX-XX-XXXX for an SSN.

Enter the calendar year or years for which you are requesting U.S. residency certification. Use four-digit year format (YYYY). For multiple individual years, separate each with a comma (for example, 2020, 2021). To specify a continuous range, enter the first and last year separated by a hyphen (for example, 2018-2020).

Enter the calendar year(s) or tax period(s) on which the certification will be based. List multiple years or periods separated by commas (for example, 2019, 2020) or as a date range using a hyphen (for example, January 1, 2019–December 31, 2019). If the certification is for the current calendar year or for a year for which a tax return is not yet required, also complete the Enter penalties of perjury statements and any additional required information here (see instructions) field.

If you checked the “Dual-status U.S. resident (see instructions)” box in the Applicant is (Part 4a) section, enter the date your dual-status U.S. residency period began in MM/DD/YYYY format. Required only when claiming dual-status residency.

Enter the end date of your dual-status U.S. resident period in MM/DD/YYYY format. Required only if you have checked “Dual-status U.S. resident (see instructions).”

Enter the applicant’s full legal name exactly as shown on U.S. tax documents, including first name, middle initial (if any), last name, and any suffix (e.g., Jr., Sr.). This field is required.

Enter the ending date of your U.S. residency period for Partial-year Form 2555 filer in MM/DD/YYYY format. Only complete this field if you checked “Partial-year Form 2555 filer (see instructions)” and provided a start date in the “U.S. resident from ►” field.

Enter the end date of your U.S. residency period for the “Partial-year Form 2555 filer (see instructions)” option in section 4a. Provide the date in MM/DD/YYYY format. This field is required if you check the “Partial-year Form 2555 filer (see instructions)” box.

Enter the full legal name of the individual or entity applying for U.S. residency certification. For an individual, enter last name, first name, and middle initial exactly as shown on your U.S. tax return. For a partnership, trust, corporation, or other organization, enter the full legal business name. This field is required for every application.

Enter the applicant’s full legal name exactly as shown on your U.S. income tax return for the calendar year for which certification is requested. Include first name, middle initial (if any), and last name. This field is required.

Check this box if you were a U.S. resident for only part of the year and filed Form 2555, specifying the start and end dates of your residency.

Check this box when the applicant entity is a partnership seeking United States residency certification.

Check this box if the applicant is a partnership that is a U.S. (domestic) entity.

Check this box when the applicant is a partnership formed outside the United States.

Check this box if the applicant is organized as a limited liability company that is treated as a partnership for purposes of this residency certification application.

Check this box when the entity applying for U.S. residency certification is a trust.

Check this box if the applicant is a trust and its grantor is a foreign person.

Check this box if the applicant is a trust and the trust is organized as a complex trust.

Check this box when the applicant is a trust that qualifies as a Section 584 trust under the Internal Revenue Code.

Check this box if the applicant is a trust organized as an Individual Retirement Account (IRA) maintained by a financial institution when requesting U.S. residency certification.

Check this box when the applicant is an employee benefit plan or trust applying for United States residency certification.

Check this box if the applicant filed Form 1120 for the tax period(s) on which the residency certification will be based.

Check this box if the applicant filed U.S. Tax Form 1120S for the tax period(s) on which the residency certification is based.

Select this box if the applicant was required to file IRS Form 3520-A for the tax period(s) on which the residency certification will be based.

Check this box if the applicant was required to file IRS Form 5227 for the tax period(s) on which the residency certification will be based.

Check this box if the applicant filed Form 5500 for the tax period(s) on which the residency certification is based.

Check this box when the applicant was required to file a U.S. tax form for the tax period(s) on which certification is based but filed a form not listed among the standard options, and specify that form in the space provided.

Check this box if the applicant was not required to file a U.S. tax form for the certification period because it is classified as a financial asset securitization investment trust (FASIT).

Check this box if the applicant is a foreign partnership and thus was not required to file a U.S. tax form for the tax period on which the certification is based.

Check when the applicant was not required to file a U.S. tax form for the certification period and the reason for not filing does not fall under any of the specific exception categories.

Check this box when you are submitting an additional residency certification request beyond your primary request as outlined in the form instructions.

Check this box when you are including a foreign claim form along with your application for United States residency certification.

Check this box when you require a separate United States residency certification for your spouse distinct from your own.

Check this box if the applicant is an individual applying for United States residency certification.

Check this box if the applicant is an individual who is a U.S. citizen.

Check this box if the applicant is an individual who holds U.S. lawful permanent resident status (green card holder).

Check this box if the applicant is an individual who operates their trade or business as a sole proprietor.

Check this box if the applicant is a U.S. resident alien who is neither a citizen nor a lawful permanent resident, and then provide the type of entry visa.

Check this box when the applicant is an individual who held dual-status U.S. resident status for the year covered by this residency certification.

Check this box when the applicant’s parent, parent organization, or owner filed a U.S. tax form that is not listed among the standard options and you need to specify the form type.

Check this box when you are requesting the U.S. residency certification for income tax purposes.

Check this box when requesting U.S. residency certification for Value-Added Tax purposes and provide the applicable NAICS codes in the space provided.

Check this box when the certification purpose is neither income tax nor VAT and you must specify the alternative purpose on the provided line.

Enter the full legal name (first name, middle initial, last name) of the individual or entity you have designated under Appointee Information (see instructions). Only complete this field if you are appointing someone to receive your Form 6166 mailing; otherwise leave it blank.

Check this box if the applicant is a disregarded entity for U.S. tax purposes, meaning it is not treated as separate from its owner.

Check this box when the applicant entity is a corporation that has elected to be taxed under Subchapter S of the Internal Revenue Code.

Enter the penalties of perjury statement(s) exactly as provided in Table 2 of the Instructions for Form 8802 and include any additional required information. Complete this field only if you are requesting certification for the current calendar year or for a year for which a U.S. tax return is not yet required to be filed; otherwise leave it blank. Use plain text. If you need more space or wish to attach a separate sheet, enter “See attached” here and attach your statement immediately following page 2 of Form 8802.

Enter the date the applicant (or individual authorized to sign for the applicant) signed this form in MM/DD/YYYY format. This field is required.

Enter the full name and official title of the individual who signed in the “Signature” field. Print or type the information legibly. This field is required when signing the application.

Print or type the spouse’s full legal name, including first name, middle initial (if any), and last name. Only complete this field if submitting a joint application under Spouse’s signature. Do not include prefixes or titles.

Enter the sum of the amounts shown in “Column A - Total,” “Column B - Total,” “Column C - Total,” and “Column D - Total” on line 11. Provide a whole-number total in this field.

Enter the appointee’s three-digit telephone area code for the Phone No. field under Appointee Information. Required if providing an appointee phone number. Enter exactly three digits, digits only, with no parentheses or spaces.

For the first Country entry under Column D (South Africa), enter the total number of U.S. residency certifications you are requesting for South Africa. If you are requesting certifications for more than one calendar year for South Africa, enter the combined total. Use a whole number with no decimals. Required when certification for South Africa is requested.

Enter the total number of certifications you need for South Africa for the calendar year(s) indicated in Calendar year(s) for which certification is requested. Enter a whole number without commas. Only complete this field if you are requesting a U.S. residency certification for South Africa.

Enter the total number of U.S. residency certifications you are requesting for Sri Lanka. If you require certifications for more than one calendar year, enter the combined total for all years. Use a whole number only (no commas, decimals, or spaces). If you are not requesting any certifications for Sri Lanka, enter 0.

Enter the number of certifications needed for Sweden for the calendar year(s) entered in the Calendar year(s) for which certification is requested field. If you are requesting certifications for more than one calendar year for Sweden, enter the total number of certifications for all years. Enter a whole number without commas or decimal points. Leave blank if you are not requesting a certification for Sweden.

Enter the total number of U.S. residency certifications needed for Switzerland. Use a whole number (no decimals). If none are requested, enter 0.

Enter the total number of residency certifications you need for Tajikistan as a whole number (no commas or symbols). If you’re requesting certifications for more than one calendar year for Tajikistan, combine the total for all years. Leave blank if no certification is requested for Tajikistan.

In the seventh Number of Certifications field in Column D for Thailand, enter the total number of U.S. residency certifications needed for Thailand for the calendar year(s) indicated on "Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)". If you are requesting certifications for multiple calendar years for Thailand, enter the combined total. Enter a whole number. Leave this field blank if no certification is requested for Thailand.

Enter the total number of U.S. residency certifications needed for Trinidad and Tobago in the field labeled Column D #. If requesting certifications for more than one calendar year, enter the combined total across all years. Use whole numbers only (no decimals or symbols). Leave blank if you are not requesting any certifications for Trinidad and Tobago.

Enter the total number of U.S. residency certifications you are requesting for Tunisia. Provide a whole number (no decimals). Required only if you are requesting certification for Tunisia; otherwise, leave this field blank.

Enter, as a whole number, the total number of U.S. residency certifications you need for Turkmenistan for the calendar year(s) indicated on Calendar year(s) for which certification is requested. Leave this field blank if you are not requesting a certification for Turkmenistan.

Enter the total number of U.S. residency certifications needed for Finland. Provide a whole number (no decimals). Leave blank if you are not requesting certification for Finland.

Enter the total number of U.S. residency certification certificates you need for France for the calendar year(s) you entered on “Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)”. If you are not requesting any certifications for France, enter 0. Enter a whole-number value with no commas or decimals.

Enter the whole number of U.S. residency certifications requested for Georgia as the third entry under Column B “#.” If no certification is requested for Georgia, enter 0.

Enter the total number of certifications requested for Germany. If you are requesting certifications for more than one calendar year, enter the combined total for all years. Only enter a whole number without commas or decimals. Leave blank if you are not requesting certification for Germany.

Enter the number of U.S. residency certifications you are requesting for Greece for the calendar year(s) indicated on “Calendar year(s) for which certification is requested.” Use a whole number; if you are requesting certifications for more than one calendar year for Greece, enter the total number of certifications for all years.

Enter the total number of U.S. residency certifications needed for Hungary for the Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7). If requesting certifications for more than one calendar year for Hungary, enter the combined total. Enter a whole number (no decimals); leave blank if no certifications are requested.

Check this box when the applicant is an exempt organization organized in the United States that qualifies as a governmental entity.

Check this box if the applicant is an exempt organization organized in the United States that qualifies as an Indian tribe.

Check this box if the applicant is an exempt organization organized in the United States whose specific exemption type is not listed and you will specify that type.

If you checked “No” on line 5 and selected the “Other” box, enter a concise explanation of why the applicant was not required to file a U.S. tax form for the tax period.

Enter the total number of U.S. residency certifications you are requesting for Iceland. If you are requesting certifications for more than one calendar year for Iceland, enter the combined total for all years. Provide a whole number. Leave this field blank if you are not requesting a certification for Iceland.

Enter the total number of U.S. residency certifications you are requesting for India. Only complete this field if you are requesting certification for India. Enter a whole number without decimals. If requesting certifications for more than one calendar year for India, enter the combined total.

Enter the total number of U.S. residency certifications needed for Indonesia for the calendar year(s) indicated on "Calendar year(s) for which certification is requested" in Worksheet for U.S. Residency Certification Application. If you are requesting certifications for more than one calendar year for Indonesia, enter the combined total. Enter only whole numbers (no decimals).

Enter the total number of U.S. residency certifications you are requesting for Ireland in Column B “#”. If you do not need any, enter 0. Use a whole number with no decimals.

Enter the total number of U.S. residency certifications you are requesting for Ireland for the calendar year(s) indicated in “Calendar year(s) for which certification is requested.” If you are requesting certifications for more than one calendar year for Ireland, enter the combined total for all years. Use whole digits only (no commas or decimal points).

Enter the total number of U.S. residency certifications you are requesting for Italy for the calendar year(s) entered in “Calendar year(s) for which certification is requested.” If you are requesting certifications for more than one calendar year for Italy, enter the combined total. Enter a whole number (enter 0 if none).

Enter the number of U.S. residency certifications you are requesting for Jamaica. Provide a whole number with no decimals. If you are requesting certifications for more than one calendar year for Jamaica, enter the combined total. Leave blank if you do not need certification for Jamaica.

Enter the total number of U.S. residency certifications needed for Japan for all requested calendar year(s). Provide a whole number (no decimals, letters, or symbols). Leave blank or enter 0 if you are not requesting a certification for Japan.

Enter the total number of U.S. residency certifications requested for Kazakhstan. Complete this field if you are requesting a certification for Kazakhstan for the calendar year(s) indicated in the “Calendar year(s) for which certification is requested” field. If requesting certifications for multiple years for Kazakhstan, enter the combined total. Use a whole number (no decimals). Leave blank if no certification is needed for Kazakhstan.

Enter the total number of U.S. residency certifications needed for Korea, South. If requesting certifications for multiple calendar years, enter the combined total for all years for this country. Use only whole numeric digits; leave blank if no certifications are needed.

Check this box if the applicant’s parent, parent organization, or owner was required to file and did file IRS Form 990 for the tax period on which the residency certification is based.

Check this box if the applicant’s parent, parent organization, or owner was required to file IRS Form 990-T for the tax period on which the residency certification will be based.

Check this box if the applicant’s parent, parent organization, or owner was required to file U.S. Form 1040 for the period used to determine residency when the applicant did not file a U.S. tax return.

Check this box if the applicant’s parent, parent organization, or owner was required to file U.S. Form 1041 for the tax period on which the residency certification is based.

Check this box if the applicant’s parent, parent organization, or owner filed IRS Form 1065 for the tax period on which the residency certification is based.

Check this box if the applicant’s parent, parent organization, or owner was required to file U.S. Form 1120 for the tax period on which the residency certification is based, and only when the applicant itself did not have a U.S. tax-filing requirement.

Check this box when the applicant’s parent, parent organization, or owner filed Form 1120S for the tax period(s) on which the residency certification will be based, applicable only if the applicant itself did not file a U.S. tax form.

Check this box if the applicant’s parent, parent organization, or owner was required to file Form 5500 for the tax period on which the residency certification is based.

Enter the calendar year or years for which you are requesting U.S. residency certification, exactly as shown on Form 8802, line 7. Use the four-digit year format (YYYY). If you are requesting multiple years, separate each year with a comma (for example, 2021, 2022).

If you checked the “Other (must specify)” box under Purpose of certification, enter a brief description of the certification purpose not covered by ‘Income tax’ or ‘VAT (specify NAICS codes)’. Leave blank if you did not check ‘Other (must specify)’. Enter your description as plain text; no special formatting is required.

Enter the full penalties of perjury statement text as specified in Table 2 of the Form 8802 instructions, along with any additional information required for the calendar year(s) entered on line 7. Complete this field only if certification is requested for the current calendar year or for a year for which a tax return is not yet required to be filed; otherwise leave blank. Free-text entry; no special formatting required.

Enter the total number of U.S. residency certifications requested for Kyrgyzstan (Country Code KG). Leave blank or enter 0 if none. If you are requesting certifications for more than one calendar year, enter the combined total across all years as a whole number without commas or symbols.

Enter the sum of all certification counts you entered in Column B of line 11. If you did not request any certifications in Column B, enter 0. Provide a whole-number total (no decimals).

Check this box when the applicant is a disregarded entity organized as a single-member limited liability company.

Check this box if the applicant is a disregarded entity that is a limited partnership.

Check this box when the entity for which U.S. residency certification is requested is a disregarded entity organized as a limited liability partnership.

Check this box if the applicant is a disregarded entity that does not fall under the LLC, LP, or LLP categories and you need to specify its actual type.

Enter the applicant’s daytime telephone number, including the three-digit area code and seven-digit number. Use the format NNN-NNN-NNNN (for example, 555-123-4567).

Enter the total number of U.S. residency certifications requested for Norway (country code NO) in Column C of the Worksheet for U.S. Residency Certification Application. If you are requesting certification for Norway, enter the total number; otherwise, leave the field blank or enter 0. Use a whole number without decimals.

Enter the total number of U.S. residency certifications you are requesting for Pakistan in Column C. If you are requesting certifications for more than one calendar year, enter the combined total for all years. Use only whole digits with no commas or decimal points.

In the eleventh certifications requested field, enter a whole number representing the total number of certifications you are requesting for Philippines for the calendar year(s) for which certification is requested. If requesting certifications for more than one calendar year for Philippines, enter the combined total across all years. Leave blank or enter 0 if no certifications are requested for Philippines.

Enter the number of certifications needed for Poland as a whole number. If requesting certifications for more than one calendar year for Poland, enter the combined total for all years. Leave blank if no certifications are requested for Poland.

Enter the total number of U.S. residency certifications you are requesting for Portugal. Enter a whole number. Leave blank if you are not requesting certification for Portugal.

Enter the total number of U.S. residency certifications you are requesting for Romania. Provide a whole number (no decimals). If you are not requesting any certifications for Romania, leave this field blank.

Enter the total number of certifications requested for Russia in the # column (Column C). Complete this field only if you are requesting a certification for Russia. If you are requesting certifications for more than one calendar year for Russia, enter the combined total. Enter digits only (no commas or symbols); enter 0 if none.

In this sixteenth certification count field for Column C, enter the total number of U.S. residency certifications requested for the Slovak Republic. Provide a whole number without commas or decimals. If no certifications are requested for this country, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Slovenia. If requesting certifications for more than one calendar year, combine the totals here. Enter a whole number (no decimals). If you are not requesting any certification for Slovenia, enter 0. See line 11 of the Worksheet for U.S. Residency Certification Application.

Enter the total number of U.S. residency certifications you need for Denmark. If you are requesting certifications for more than one calendar year for Denmark, enter the combined total for all calendar year(s) you indicated in the “Calendar year(s) for which certification is requested” field. Use only whole numbers (no commas or decimal points). Leave this field blank if you are not requesting certification for Denmark.

Enter the total number of U.S. residency certifications you are requesting for Egypt. If requesting certifications for more than one calendar year, enter the combined total. Use whole numbers only (numeric digits); if none are needed, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Estonia for the calendar year(s) entered in the Calendar year(s) for which certification is requested field. Provide a whole number. Leave blank if no certification is requested for Estonia.

Enter the total number of certifications requested for all countries listed in Column A. Provide a whole-number sum of the values you entered in the “#” column for each country under Column A. Do not include commas or decimal points.

Enter the total number of U.S. residency certifications you need for Latvia for the calendar year(s) indicated in "Calendar year(s) for which certification is requested". If you are requesting certifications for more than one calendar year for Latvia, enter the combined total for all years. Provide a whole number (no commas).

Enter the total number of U.S. residency certifications you are requesting for Lithuania for the calendar year(s) indicated on “Calendar year(s) for which certification is requested.” If you are requesting certifications for more than one calendar year, enter the combined total for all years (see Note under line 11). Use a whole number without commas or decimals.

For the third entry in Column C (Country: Luxembourg), enter the total number of certifications needed for Luxembourg for the calendar year(s) indicated on Calendar year(s) for which certification is requested. Enter a whole number; if you are not requesting any certifications for Luxembourg, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Mexico. If you are requesting certifications for more than one calendar year for Mexico, enter the combined total for all years. Use a whole number without symbols. Leave blank if no certification is requested for Mexico.

Enter the total number of U.S. residency certifications you are requesting for Moldova. If you are requesting certifications for more than one calendar year for Moldova, enter the combined total. Use whole numbers only.

Enter the total number of U.S. residency certifications you are requesting for Morocco, using the same calendar year(s) as entered in Calendar year(s) for which certification is requested. If you are requesting certifications for more than one calendar year, enter the combined total here. Enter a whole number (no decimals). Leave blank if no certifications are needed for Morocco.

Enter the total number of U.S. residency certifications you are requesting for the Netherlands (Country Code NL) in Column C of the Worksheet for U.S. Residency Certification Application. Use a whole number (no decimals). Leave blank or enter 0 if you are not requesting certification for the Netherlands.

Enter the total number of residency certifications you are requesting for New Zealand for the calendar year(s) indicated in Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7). If you are requesting certifications for more than one calendar year for New Zealand, enter the cumulative total. Use a whole number; enter 0 if none.

Enter the full name of the country or countries in which the applicant corporation is legally incorporated. Complete this field only if you checked ‘Corporation’ in Section 4e and the corporation is not incorporated solely in the United States. For multiple countries, separate each country name with a comma.

Complete this field only if you selected the “e Corporation” box and your corporation is a dual-resident corporation. Enter the full name of the other country in which your corporation is treated as a resident (for example, Canada), using the country’s official name in English without abbreviations.

For the first country listed (Armenia), enter the total number of U.S. residency certifications you are requesting. Required only if you need certification for Armenia; enter a whole number with no commas.

Enter the total number of U.S. residency certifications you are requesting for Australia in Column A. If you are requesting certifications for more than one calendar year for Australia, combine all years’ certifications into a single whole-number total. Leave blank or enter 0 if you do not need any certifications for Australia.

Enter the total number of U.S. residency certifications you are requesting for Austria. Use a whole number (for example, 1, 2, 10). If you are requesting certifications for more than one calendar year for Austria, enter the combined total. If no certification is requested for Austria, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Azerbaijan. If you are requesting certifications for more than one calendar year for Azerbaijan, enter the combined total for all years. Provide a whole number without commas or decimals. Leave blank if no certifications are requested for Azerbaijan.

Enter the sum of all numbers entered in the “#” boxes for Column C on line 11. Format as a whole number without commas. If no certifications are requested for Column C, enter 0.

Check this box if the applicant is an employee benefit plan or trust that qualifies under Section 401(a) of the Internal Revenue Code.

Check this box if the applicant is an employee benefit plan or trust governed by Internal Revenue Code section 403(b).

Check this box if the applicant is an employee benefit plan or trust that qualifies under Internal Revenue Code Section 457(b).

Check this box if the applicant filed IRS Form 990 for the tax period(s) on which the residency certification will be based.

Check this box if the applicant was required to file Form 990-T for the tax period(s) on which the residency certification is based.

Check this box if the applicant was required to file IRS Form 1040 for the tax period(s) on which the residency certification will be based.

Select this box if the applicant filed Form 1041 for the tax period(s) on which the residency certification is based.

Check this box if the applicant filed U.S. Form 1065 for the tax period(s) on which the residency certification application is based.

Check this box when the applicant was not required to file a U.S. tax form for the relevant period because the applicant is a minor child.

Check this box when the applicant was not required to file a U.S. tax form for the certification period because it is a qualified Subchapter S subsidiary.

Check this box if the applicant did not have to file a U.S. tax form for the certification period because it is classified as a U.S. disregarded entity.

Check this box if the applicant was not required to file a U.S. tax form for the certification period because it is a foreign disregarded entity.

Check this box if the applicant was not required to file a U.S. tax form for the period(s) on which certification will be based because it made a Section 761(a) election.

Check this box when the applicant is a corporation incorporated in the United States.

Enter the specific type of entity or individual for whom the nominee is acting, such as “Individual,” “Partnership,” “Corporation,” or “LLC.” Required only if you checked the “Nominee applicant (must specify the type of entity/individual for whom the nominee is acting)” box on line j Nominee applicant. Otherwise leave this field blank.

Enter the full legal name of the parent organization or owner followed by its mailing street address, city, two-letter state abbreviation, and ZIP code, separated by commas (for example, "ABC Corp, 123 Main St, Springfield IL 62704"). Complete only if you checked "Yes" on line 6.

Enter the confirmation number shown on your electronic payment receipt if you paid the user fee electronically using EFTPS or another IRS payment system. If you did not pay electronically, leave this field blank. Include all characters (letters, numbers, hyphens) exactly as they appear on your confirmation notice.

If you filed a joint return, enter your spouse’s full name exactly as it appears on that joint return. Include first name, middle initial (if any), and last name. Leave this field blank if you did not file a joint return.

Enter the applicant’s legal name, then a single space, then the nine-digit U.S. taxpayer identification number (SSN or EIN) without dashes, exactly as you want them to appear on the residency certification. Only complete this field if the information differs from what you entered in “Applicant’s name” and “Applicant’s U.S. taxpayer identification number”; otherwise leave it blank.

Required: Enter the applicant’s full mailing address for the calendar year for which certification is requested. Include street address (or P.O. box if applicable), city, state or province, country, and ZIP or postal code.

Enter the appointee’s IRS-assigned Centralized Authorization File (CAF) number. Use only numeric digits without spaces or hyphens. Complete this field only if the appointee has a CAF number; otherwise, leave it blank.

Only complete this field if you checked the “Other U.S. resident alien” box in Section 4a. Enter the entry visa classification code exactly as it appears on your immigration documents (for example, H-1B, F-1, E-2). Use uppercase letters and include hyphens where applicable.

Enter your exact nonimmigrant classification (for example, F-1 Student, H-1B Specialty Occupation Worker, J-1 Exchange Visitor) as shown on your USCIS admission stamp or approval notice. Complete this field only if you checked “Other U.S. resident alien” under Applicant is in Section 4a. Use the official visa classification code (e.g., F-1, H-1B).

Enter the date on which your current nonimmigrant status changed, as indicated in "Current nonimmigrant status (see instructions)". Enter in MM/DD/YYYY format (month/day/four-digit year). Leave blank if you did not check "Current nonimmigrant status (see instructions)".

Check this box when the applicant is an organization organized in the United States that is exempt from federal tax under Internal Revenue Code Section 501(c).

Select this box when the applicant is a corporation that, although not incorporated in the United States, is treated as a U.S. resident corporation under Internal Revenue Code Section 269B.

Check this box when the applying corporation, though incorporated abroad, has elected to be treated as a domestic corporation for residency certification.

Check this box if the applicant is a corporation organized outside the United States that has elected to be treated as a domestic corporation for tax purposes under the relevant code provision.

Check this box if the applicant is a corporation that qualifies as a member of a consolidated group under Internal Revenue Code Section 1504(d).

Enter the full legal name and complete mailing address (street address, city, state or province, and ZIP or foreign postal code) of the parent, parent organization, or owner that was required to file a U.S. tax form. Complete this field only if you checked “Yes” on line 6, “Was the applicant’s parent, parent organization or owner required to file a U.S. tax form?”

Enter the full legal name of the individual you have authorized to act on your behalf—first name, middle initial (if any), and last name. This field is optional; leave blank if you have not designated an appointee.

Enter the spouse’s nine-digit U.S. taxpayer identification number (SSN, ITIN, or EIN) exactly as assigned by the IRS, including hyphens in the format XXX-XX-XXXX. Complete this field only if you filed a joint return.

Check this box if you are submitting the certification as a nominee on behalf of another entity or individual, and then specify the type of that entity or individual.

If you are acting as a nominee applicant, enter the type of entity or individual for whom you are acting (for example, “Corporation,” “Trust,” or “Individual”). Leave this field blank if you are not a nominee applicant.

Enter the total number of U.S. residency certifications you are requesting for Turkmenistan. If you are requesting certifications for more than one calendar year for Turkmenistan, enter the sum of all certifications for all years. If no certifications are needed, enter 0. Enter a whole number.

In Column D under “#,” enter the number of residency certifications requested for Ukraine as a whole number (no decimals). Only complete if requesting certification for Ukraine; otherwise, leave blank.

Enter the total number of certifications needed for United Kingdom as listed under Column D. Enter a whole number (for example, 1, 2, 3). If none are requested, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Uzbekistan (the fourteenth country listed) for the calendar year(s) indicated in “Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)”. If you need certifications for more than one calendar year for Uzbekistan, enter the combined total. Enter a whole number with no decimals. If you are not requesting any certifications for Uzbekistan, enter 0.

Enter the total number of U.S. residency certifications you are requesting for Venezuela for the calendar year(s) indicated on the form. Enter a whole number (no decimals). Leave this field blank if you are not requesting any certifications for Venezuela.

Enter the total number of certifications requested for all countries listed in Column D by adding the numbers entered in Column D of line 11. Enter the sum as a whole number.

If you checked “VAT (specify NAICS codes)” under the Purpose of certification section, enter the six-digit NAICS code(s) that correspond to your business activity for value added tax purposes. Enter each code as six digits; if you have multiple codes, separate them with commas (for example, 541110,311119).

Enter the total number of certifications needed for Bangladesh for the calendar year(s) indicated under "Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)". Use a whole number (no decimals). Complete this field only if you are requesting U.S. residency certification for Bangladesh; otherwise, leave it blank.

Enter the total number of U.S. residency certifications you are requesting for Barbados. Complete this field only if you need certification for Barbados. Enter a whole number (no decimal places).

Enter the total number of U.S. residency certifications you are requesting for Belarus. If you are requesting certifications for more than one calendar year for Belarus, enter the combined total number of certifications. Use a whole number (no decimals).

For the eighth entry (Belgium) in Column A on the Worksheet for U.S. Residency Certification Application, enter the total number of certifications needed. Provide a whole number; if no certifications are required, enter 0.

Enter the total number of residency certifications you are requesting for Bermuda. Provide a whole number (no decimals). If you are requesting certifications for multiple calendar years for Bermuda, enter the combined total for all years. Leave blank if you are not requesting a Bermuda certification.

Enter the number of U.S. residency certifications you need for Bulgaria. If you are requesting certifications for multiple calendar years for Bulgaria, enter the combined total for all years. Use digits only (no commas or decimals). Leave blank if no certifications are requested for Bulgaria.

Enter the total number of U.S. residency certifications you are requesting for Canada. Provide a whole integer (no decimals). If you are requesting certifications for more than one calendar year for Canada, enter the combined total. Enter 0 if no certifications are needed for Canada.

For the twelfth listed country, China, enter the total number of U.S. Residency Certifications you are requesting for the calendar year(s) indicated in Calendar year(s) for which certification is requested. Enter a whole number (no decimals). Leave blank if you are not requesting any certifications for China.

Enter the total number of residency certifications requested for Cyprus. If you are requesting certifications for more than one calendar year for Cyprus, enter the combined total. Provide a whole number (for example, 1, 2, 3). Leave blank if you are not requesting certification for Cyprus.

Enter the total number of U.S. residency certifications requested for the Czech Republic for the calendar year(s) shown on "Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7)". Use a whole number with no decimals. If you are not requesting any certifications for the Czech Republic, leave this field blank.

Required. Enter the nine-digit U.S. taxpayer identification number for the applicant named in “Applicant’s name.” For individuals, enter Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) in the format XXX-XX-XXXX (for example, 123-45-6789). For entities, enter Employer Identification Number (EIN) in the format XX-XXXXXXX (for example, 12-3456789).

Enter the full name and number of the U.S. tax form filed by the applicant’s parent, parent organization, or owner if it is not listed among the checkboxes. Complete this field only when you have checked “Other (specify)” in the Yes section of line 6. Format as “Form XXXX” (for example, “Form 8958”).

Enter the appointee’s U.S. telephone number, including a three-digit area code, in the format (###) ###-####. Complete this field when you provide Appointee Information (see Appointee Information).

Enter the appointee’s CAF No. assigned by the IRS. Complete this field only if you provided Appointee Name. Enter only numeric digits; omit hyphens or spaces; otherwise leave blank.

Enter the appointee’s fax number, including the area code in parentheses and the seven-digit number separated by a hyphen (for example, (202) 555-0123). Leave this field blank if the appointee does not have a fax number.

If you checked “Employee benefit plan/trust” in Section 4g, enter the IRS-assigned plan number for your plan or trust, exactly as issued. Use only the characters assigned (no spaces or dashes). Leave this field blank if you did not check “Employee benefit plan/trust.”

Enter the applicant’s nine-digit Taxpayer Identification Number issued by the IRS—Social Security Number (SSN) for individuals or Employer Identification Number (EIN) for entities. Enter digits only, without hyphens or spaces. This field is required.