Form 8802--Application for United States Residency Certification

Instructions for Form 8802

Department of the Treasury
Internal Revenue Service

(Rev. April 2012)

Application for United States Residency Certification
Section references are to the Internal
Revenue Code unless otherwise noted.

Contents
What’s New . . . . . . . . . . . . . . .
U.S. Residency Certification . . .
General Instructions . . . . . . .
Purpose of Form . . . . . . . . .
When To Apply . . . . . . . . . .
User Fee . . . . . . . . . . . . . . .
Where To Apply . . . . . . . . . .
Who Is Eligible for Form
6166 . . . . . . . . . . . . . . . . .
Who Is Not Eligible for Form
6166 . . . . . . . . . . . . . . . . .
Special Rules . . . . . . . . . . . . .
Form 8802 Filed Before
Return Posted by the IRS . .
Individuals With Residency
Outside the United States . .
Form 1116, Foreign Tax
Credit . . . . . . . . . . . . . . . .
United Kingdom . . . . . . . . . .
Specific Instructions . . . . . . .
Check Boxes at Top of
Page 1 . . . . . . . . . . . . . . .
Additional Requests . . . . . .
Foreign Claim Form . . . . . .
Applicant’s Name and U.S.
Taxpayer Identification
Number . . . . . . . . . . . . . . .
Line 2. Applicant’s Address
Line 3a. Mailing Address . . .
Line 3b. Third Party
Appointee’s Information . . .
Line 4a. Individual . . . . . . . .
Line 4b. Partnership . . . . . . .
Line 4c. Trust . . . . . . . . . . . .
Line 4d. Estate . . . . . . . . . . .
Line 4e. Corporation . . . . . . .
Line 4f. S Corporation . . . . .
Line 4g. Employee Benefit
Plan/Trust . . . . . . . . . . . . .
Line 4h. Exempt
Organization . . . . . . . . . . .
Line 4i. Disregarded Entity . .
Line 4j. Nominee Applicant . .
Line 5. Statement Required
If Applicant Did Not File a
U.S. Income Tax Return . . .
Table 1. . . . . . . . . . . . . . . .
Line 6. Parent, Parent
Organization, or Owner . . . .
Line 7. Calendar Year of
Request . . . . . . . . . . . . . . .
Line 8. Tax Period(s) . . . . . .
Line 9. Purpose of
Certification . . . . . . . . . . . .
Line 10. Penalties of Perjury
Statements and
Attachments . . . . . . . . . . . .
Mar 29, 2012

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Contents
Table 2. Current Year
Penalties of Perjury
Statements . . . . . . . . . . . .
Signature and Date . . . . . . .
Table 3. Who Has Authority
To Sign Form 8802 . . . . . .
Daytime Phone Number . . . .
Line 11. Number of
Certifications (Forms 6166)
Requested for Each
Country . . . . . . . . . . . . . . .
Line 12. Total Number of
Certifications (Forms 6166)
Requested . . . . . . . . . . . . .
When To Seek U.S.
Competent Authority
Assistance . . . . . . . . . . . . . .
Comments and Suggestions . .

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What’s New
User fee. For applications filed after
March 31, 2012, the user fee is $85 per
application. See User Fee on page 2.
Teaching or research activities. If
you receive payments for teaching or
research activities, see Individuals With
Residency Outside the United States
on page 3.
Future developments. The IRS has
created a page on IRS.gov for
information about Form 8802 and its
instructions at www.irs.gov/form8802.
Information about any future
developments affecting Form 8802
(such as legislation enacted after we
release it) will be posted on that page.

U.S. Residency
Certification
Income Tax Treaty
Many foreign countries withhold tax on
certain types of income paid from
sources within those countries to
residents of other countries. The rate of
withholding is set by that country’s
internal law. An income tax treaty
between the United States and a
foreign country often reduces the
withholding rates (sometimes to zero)
for certain types of income paid to
residents of the United States. This
reduced rate is referred to as the
treaty-reduced rate. For more
information on reduced rates, see Tax
Treaty Tables in Pub. 515, Withholding
of Tax on Nonresident Aliens and
Foreign Entities.
Cat. No. 10827V

Many U.S. treaty partners require
the IRS to certify that the person
claiming treaty benefits is a resident of
the United States for federal tax
purposes. The IRS provides this
residency certification on Form 6166, a
letter of U.S. residency certification.
Form 6166 is a computer-generated
letter printed on stationary bearing the
U.S. Department of Treasury
letterhead, and the facsimile signature
of the Field Director, Philadelphia
Accounts Management Center.
Form 6166 will only certify that, for
the certification year (the period for
which certification is requested), you
were a resident of the United States for
purposes of U.S. taxation, or in the
case of a fiscally transparent entity, that
the entity, when required, filed an
information return and its partners/
members/owners/beneficiaries filed
income tax returns as residents of the
United States.
Upon receiving Form 6166 from the
IRS, unless otherwise directed, you
should send Form 6166 to the foreign
withholding agent or other appropriate
person in the foreign country to claim
treaty benefits. Some foreign countries
will withhold at the treaty-reduced rate
at the time of payment, and other
foreign countries will initially withhold
tax at their statutory rate and will refund
the amount that is more than the
treaty-reduced rate on receiving proof
of U.S. residency.
Other conditions for claiming treaty
benefits. In order to claim a benefit
under a tax treaty, there are other
requirements in addition to residence.
These include the requirement that the
person claiming a treaty-reduced rate of
withholding be the beneficial owner of
the item of income and meet the
limitation on benefits article of the
treaty, if applicable.
The IRS cannot certify whether you
are the beneficial owner of an item of
income or that you meet the limitation
on benefits article, if any, in the treaty.
You may, however, be required by a
foreign withholding agent to establish
directly with the agent that these
requirements have been met.
You should examine the specific
TIP income tax treaty to determine if
any tax credit, tax exemption,
reduced rate of tax, or other treaty
benefit or safeguards apply.

Value Added Tax (VAT)
Form 6166 may also be used as proof
of U.S. tax residency status for
purposes of obtaining an exemption
from a VAT imposed by a foreign
country. In connection with a VAT
request, the United States can certify
only to certain matters in relation to
your U.S. federal income tax status,
and not that you meet any other
requirements for a VAT exemption in a
foreign country.

General Instructions
Purpose of Form

Form 8802 is used to request Form
6166, a letter of U.S. residency
certification for purposes of claiming
benefits under an income tax treaty or
VAT exemption. You cannot use Form
6166 to substantiate that U.S. taxes
were paid for purposes of claiming a
foreign tax credit.
You cannot claim a foreign tax credit
to reduce your U.S. tax liability with
respect to foreign taxes that have been
reduced or eliminated by reason of a
treaty. If you receive a refund of foreign
taxes paid with the benefit of Form
6166, you may need to file an amended
return with the IRS adjusting any
foreign tax credits previously claimed
for those taxes.

When To Apply

You should mail your application,
including full payment of the user fee,
at least 45 days before the date you
need Form 6166. We will contact you
after 30 days if there will be a delay in
processing your application. You can
call (267) 941-1000 (not a toll free
number) and select the U.S. residency
option if you have questions regarding
your application.
Early submission for a current year
certification. The IRS cannot accept
an early submission for a current year
Form 6166 that has a postmark date
before December 1. Requests received
with a postmark date earlier than
December 1 will be returned to the
sender. For example, a Form 6166
request for 2012:
• Received with a postmark date
before December 1, 2011, cannot be
processed.
• Received with a postmark date on or
after December 1, 2011, can be
processed with the appropriate
documentation.

User Fee

Form 8802 application(s) will not be
processed until the non-refundable user
fee is paid. The user fee is $85 for a
Form 8802 filed after March 31, 2012.
Additional request. Additional
requests for Form 6166 submitted on a
separate Form 8802, following the
procedures established on page 4, will
require the payment of an $85 user fee.
Applicants are advised to
request all Forms 6166 on a
CAUTION single Form 8802 to avoid
paying the $85 user fee charged for
processing a second Form 8802.

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Method of Payment
Payment of the user fee can be by
check, money order, or electronic
payment.

Check or Money Order
Form 8802 must be accompanied by a
check or money order in U.S. dollars,
payable to the United States Treasury,
in the appropriate amount. Do not send
cash.
Multiple Forms 8802. If you are
submitting multiple Forms 8802, you
may submit a single check or money
order payment to cover the aggregate
amount of the user fee for all Forms
8802. No more than 200 Forms 8802
can be associated with one check or
money order.
Note. If you pay by check, it will be
converted into an electronic funds
transfer (EFT). This means we will copy
your check and use the account
information on it to electronically debit
your account for the amount of the
check. The debit from your account will
usually occur within 24 hours, and will
be shown on your regular account
statement. You will not receive your
original check back. We will destroy
your original check, but we will keep a
copy of it. If the EFT cannot be
processed for technical reasons, you
authorize us to process the copy in
place of your original check.

Electronic Payment (e-payment)
Visit the IRS website at IRS.gov and
enter “e-pay” in the search box. Click
on the first search result, “e-pay.”
Choose “User Fees” at the bottom of
the Electronic Payments Options Home
Page and then click on U.S. Residency
User Fee. Complete the form and
submit online the information requested
on the website.

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Once your electronic payment has
been processed, you will receive an
electronic payment confirmation
number for the transaction. Enter the
electronic payment confirmation
number on page 1 of Form 8802 before
you submit the application. You can
use either the Agency Tracking ID or
the Pay.gov ID as the electronic
payment confirmation number. Either
one is acceptable. If you make an
electronic payment covering multiple
Forms 8802, the same electronic
payment confirmation number must be
written on each form. Form 8802 will
not be processed if the electronic
payment confirmation number has not
been entered on the application.
The user fee website requires the
entry of the following information.
• Applicant’s name.
• Applicant’s TIN or EIN.
• Submitter’s name (name of person or
entity submitting the payment).
• Contact email address.
• Number of Form(s) 6166 requested.
• Payment amount.
• Selection of Automatic Clearing
House (ACH) debit or credit card will
open a window for account information.

Supplemental User Fee
Payment
If you have been contacted by the U.S.
Residency Certification Unit to make a
supplemental payment, you can use the
e-payment system on IRS.gov by
checking the supplemental user fee
checkbox.

Where To Apply

The method by which you can submit
Form 8802 to the IRS depends upon
how you choose to pay the user fee.

Payment by Check or Money
Order
If you are paying the user fee by check
or money order, send the payment,
Form 8802, and all required
attachments to:
Internal Revenue Service
P.O. Box 71052
Philadelphia, PA 19176-6052
Or, by private delivery service to:
Citibank
Attn: IRS Lockbox Operations
500 White Clay Center Drive
Bldg. 500
Newark, DE 19711

Electronic Payment
After the electronic confirmation
number has been entered on page 1 of
Form 8802, you can submit Form 8802
and all required attachments to the
following address or by fax (see below
for limitations on the use of faxed
transmissions).
Mail or private delivery service.
Send Form 8802 and all required
attachments to this address only if you
paid the user fee by e-payment.
Department of the Treasury
Internal Revenue Service
Philadelphia, PA 19255-0625
Fax. You can fax up to 10 Forms 8802
(including all required attachments) for
a maximum of 50 pages to the fax
numbers below. A fax cover sheet
stating the number of pages included in
the transmission must be used.
The following fax numbers are not
toll-free:
• (267) 941-1035
• (267) 941-1366

Who Is Eligible for Form
6166

• You filed a return as a nonresident

(including Form 1040NR, U.S.
Nonresident Alien Income Tax Return;
Form 1040NR-EZ, U.S. Income Tax
Return for Certain Nonresident Aliens
With No Dependents; Form 1120-F,
U.S. Income Tax Return of a Foreign
Corporation; Form 1120-FSC, U.S.
Income Tax Return of a Foreign Sales
Corporation; or any of the U.S.
possession tax forms).
• You are a dual resident individual
who has made (or intends to make),
pursuant to the tie breaker provision
within an applicable treaty, a
determination that you are not a
resident of the United States and are a
resident of the other treaty country. For
more information and examples, see
Reg. section 301.7701(b)-7.
• You are a fiscally transparent entity
organized in the United States (that is,
a domestic partnership, domestic
grantor trust, or domestic LLC
disregarded as an entity separate from
its owner) and you do not have any
U.S. partners, beneficiaries, or owners.
• The entity requesting certification is
an exempt organization that is not
organized in the United States.

Special Rules

In general, under an income tax treaty,
an individual or entity is a resident of
the United States if the individual or
entity is subject to U.S. tax by reason of
residence, citizenship, place of
incorporation, or other similar criteria.
U.S. residents are subject to tax in the
United States on their worldwide
income. An entity may be considered
subject to tax on its worldwide income
even if it is statutorily exempt from tax,
such as a pension fund or charity.
Similarly, individuals are considered
subject to tax even if their income is
less than the amount that would require
that they file an income tax return.

Form 8802 Filed Before
Return Posted by the IRS

In general, Form 6166 is issued only
when the IRS can verify that for the
year for which certification is requested
one of the following applies:
• You filed an appropriate income tax
return (for example, Form 1120 for a
domestic corporation),
• In the case of a certification year for
which a return is not yet due, you filed a
return for the most recent year for
which a return was due, or
• You are not required to file an
income tax return for the tax period on
which certification will be based and
other documentation is provided.

If you are in any of the following
categories for the current or prior tax
year for which certification is requested,
you must submit a statement and
documentation, as described below,
with Form 8802.
1. You are a resident under the
internal law of both the United States
and the treaty country for which you are
requesting certification (you are a dual
resident).
2. You are a green card holder or
U.S. citizen who filed Form 2555,
Foreign Earned Income.
3. You are a bona fide resident of a
U.S. possession.

Who Is Not Eligible for
Form 6166

In general, you are not eligible for Form
6166 if, for the tax period for which your
Form 6166 is based, any of the
following applies:
• You did not file a required U.S.
return.

If your return has not been posted by
the IRS by the time you file Form 8802,
you will receive a request to provide a
signed copy of your most recent return.
If you recently filed your return, it may
take less time to process your
application if you include a copy of the
income tax return with your Form 8802.
Write “COPY — do not process” on the
tax return.

Individuals With Residency
Outside the United States

If you are a dual resident described
in category 1, above, your request may
be denied unless you submit evidence
to establish that you are a resident of
the United States under the tie breaker
provision in the residence article of the
treaty with the country for which you
are requesting certification.

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If you are described in category 2 or
3, attach a statement and
documentation to establish why you
believe you should be entitled to
certification as a resident of the U.S. for
purposes of the relevant treaty. Under
many U.S. treaties, U.S. citizens or
green card holders who do not have a
substantial presence, permanent home,
or habitual abode in the United States
during the tax year are not entitled to
treaty benefits. U.S. citizens or green
card holders who reside outside the
United States must examine the
specific treaty to determine if they are
eligible for treaty benefits and U.S.
residency certification. See Exceptions,
below.
If you are described in category 2
and are claiming treaty benefits under a
provision applicable to payments
received in consideration of teaching or
research activities, see Table 2 for the
penalties of perjury statement you must
either enter on line 10 of Form 8802 or
attach to the form.

Exceptions
You do not need to attach the
additional statement or documentation
requested if you:
• Are a U.S. citizen or green card
holder; and
• Are requesting certification only for
Bangladesh, Bulgaria, Cyprus,
Hungary, Iceland, India, Kazakhstan,
Malta, New Zealand, Russia, South
Africa, Sri Lanka, or Ukraine; and
• The country for which you are
requesting certification and your
country of residence are not the same.

Form 1116, Foreign Tax
Credit
If you have filed or intend to file a Form
1116, Foreign Tax Credit, claiming
either a foreign tax credit amount in
excess of $5,000 U.S. or a foreign tax
credit for any amount of foreign earned
income for the tax period for which
certification is requested, you must
submit evidence that you were (or will
be if the request relates to a current
year) a resident of the United States
and that the foreign taxes paid were not
imposed because you were a resident
of the foreign country.
In addition, individuals who have
already filed their federal income tax
return must submit a copy of it,
including any information return(s)
relating to income, such as Form W-2
or Form 1099, along with the Form
1116. Your request for U.S. residency
certification may be denied if you do not
submit the additional materials.

United Kingdom
If you are applying for relief at source
from United Kingdom (U.K.) income tax
or filing a claim for repayment of U.K.
income tax, you may need to complete
a U.K. certification form (US/Individual

2002 or US/Company 2002) in addition
to Form 8802. For copies of these
forms, contact HM Revenue and
Customs:
• On the Internet at
www.hmrc.gov.uk/cnr/usdownload.htm,
or
• Telephone at: 44-115-974-0897 if
calling from outside the U.K., or
0115-974-0897 if calling from the U.K.
Send the completed U.K. form to the
IRS with your completed Form 8802.

Specific Instructions
Check Boxes at Top of
Page 1
Additional Requests
Check this box if Form 8802 is being
submitted to request additional Form(s)
6166 for a tax period for which the IRS
has previously issued a Form 6166 to
you. Additional requests on a separate
Form 8802 will require a
non-refundable user fee of $85. See
User Fee on page 2.
An applicant can only use this
additional request procedure if there
are no changes to the applicant’s tax
information provided on the original
Form 8802. An applicant may use this
procedure to obtain a Form 6166 for
any country or countries, whether or not
the country was identified on a
previously filed Form 8802. An
additional request for Form 6166 using
this procedure must be made within 12
months of the most recently issued
Form 6166 relating to the same tax
period.
Additional documentation. If you are
requesting certification for a previously
identified country and if additional
documentation was necessary for the
original application, it does not need to
be resubmitted with the request for an
additional Form 6166. In the signature
line of the additional request form, write
“See attached copy of the original Form
8802.” Attach a copy of the original
Form 8802.
If you are requesting Form 6166 for
a country not identified on a previously
filed Form 8802 that requires
documentation not previously
submitted, you must include that
documentation with the additional
request. Sign and date the additional
request form. Attach a copy of the
original Form 8802.
Additional request made by third
party appointees. Third party
appointees cannot use this special
procedure to request additional Form(s)
6166 for countries that were not
originally authorized by the taxpayer in
their previously signed and dated Form
8802. If you anticipate using the
additional request procedure to

authorize a third party appointee to
request additional Forms 6166 for a
country not identified in your current
Form 8802, you must include in line 10,
a written statement authorizing the third
party appointee to request Form 6166
covering the same tax period for any
country.

name, contact customer service. For
businesses, the number is
1-800-829-4933. For individuals, the
number is 1-800-829-1040.

Foreign Claim Form

Do not enter a P.O. box number
or C/O address. Certification
CAUTION may be denied if the applicant
enters a P.O. box or C/O address.
Enter your address for the calendar
year for which you are requesting
certification. If you are an individual
who lived outside the United States
during the year for which certification is
requested, the special rules under
Individuals With Residency Outside the
United States, on page 3, may apply to
you.

Check the box if you have included with
Form 8802 a foreign claim form sent to
you by a foreign country. The
submission or omission of a foreign
claim form will not affect your residency
certification. If the IRS does not have
an agreement with the foreign country
to date stamp, or otherwise process the
form, we will not process it and such
foreign claim form will be mailed back
to you.
Note. For more information about
foreign countries with which the IRS
has an agreement to process a foreign
claim form, call the U.S. residency
certification unit at (267) 941-1000 (not
a toll-free number).

Applicant’s Name and
U.S. Taxpayer
Identification Number

As part of certifying U.S. residency, the
IRS must be able to match the name(s)
and taxpayer identification number(s)
(TIN(s)) on this application to those
previously verified on either the U.S.
return filed for the tax period for which
certification is to be based or on other
documentation you provide.
Enter the applicant’s name and TIN
exactly as they appear on the U.S.
return filed for the tax period(s) for
which certification will be based. If the
applicant was not required to file a U.S.
return, enter the applicant’s name and
TIN as they appear on documentation
previously provided to the IRS (for
example, Form 8832, Entity
Classification Election) or on
documentation provided by the IRS (for
example, a determination letter).
Joint return. If a joint income tax
return was filed for a tax period for
which certification will be based, enter
the spouse’s name and TIN exactly as
they appear on the return filed.
Change in taxpayer’s name. If the
taxpayer’s name has changed since the
most recent Form 8802 was filed with
the IRS, the Form 8802 and tax
disclosure authorization for each
individual or entity must be submitted
under the taxpayer’s new name. In
addition, documentation of the name
change must be submitted with Form
8802 (for example, trust agreement,
corporate charter).
Certification will not be issued if the
name change has not been updated in
the IRS database. For information on
how to update the IRS on your new

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Line 2. Applicant’s
Address

!

Line 3a. Mailing Address
Form 6166 and any related
correspondence may be mailed to you
or to a third party appointee. If you
provide an address on line 3a it will be
used for all mail correspondence
relating to your Form 6166 request. If
you do not indicate a mailing address
on line 3a, Form 6166 will be mailed to
the address on line 2.

Line 3b. Third Party
Appointee’s Information

If the mailing address entered on line
3a is for a third party appointee, you
must provide written authorization for
the IRS to release the certification to
the third party. By filling out the
appointee’s information in lines 3a and
3b (name and address), written
authorization will be deemed to have
been provided when you sign and date
the Form 8802. You are not required to
enter a phone number or a fax number
of your third party appointee. However,
by providing a phone number or fax
number, you are authorizing the IRS to
call or fax your third party appointee.
The Centralized Authorization File
(CAF) contains information on third
parties authorized to represent
taxpayers before the IRS and/or receive
and inspect confidential tax information.
If your appointee has a CAF number,
enter it on line 3b.
In general, you do not need to fill out
line 3b if you have attached Form 2848
or Form 8821. In line 3b, write “See
attached authorization.” Attach a Form
2848 or Form 8821 for each additional
third party that you wish to authorize to
receive your tax information.
Form 8821, Taxpayer Information
Authorization, and Form 2848, Power
of Attorney and Declaration of
Representative. Form 8821 is used to
authorize disclosure of tax information
to a third party designee of the
taxpayer. Form 8821 cannot be used to

authorize a third party to sign Form
8802 on your behalf, and it does not
authorize a third party to represent you
before the IRS. Pursuant to section
6103(c) and the regulations thereunder,
authorization on Form 8821 will not be
accepted if it covers matters other than
federal tax matters.
Form 2848 authorizes a third party to
represent you before the IRS. Only
individuals who are recognized to
practice before the IRS can be
authorized to represent you. The only
individuals who can be recognized
representatives are the following:
• Attorneys
• Certified Public Accountants
• Enrolled Agents
• Enrolled Actuaries (the authority to
practice before the IRS is limited)
• Registered Tax Return Preparer
under section 10.4 of Circular 230 (the
authority to practice before the IRS is
limited)
• Student attorney or CPA (must
receive permission to practice before
the IRS)
• Enrolled Retirement Plan Agents (the
authority to practice before the IRS is
limited)
• Certain individuals who have a
special relationship or status with the
taxpayer
For more information, see Pub. 947,
Practice Before the IRS and Power of
Attorney.

Line 4a. Individual
Green card holder. If you are a
resident alien with lawful permanent
resident status who recently arrived in
the United States and you have not yet
filed a U.S. income tax return, you
should provide a copy of your current
Form I-551, Alien Registration Receipt
Card (green card). Instead of a copy of
your green card, you can attach a
statement from U.S. Citizenship and
Immigration Services (USCIS) that
gives your alien registration number,
the date and port of entry, date of birth,
and classification. For more information
in determining your U.S. resident status
for tax purposes, see Nonresident Alien
or Resident Alien, in Pub. 519, U.S.
Tax Guide for Aliens.
Sole proprietor. Include on line 6 the
type of tax return, name, TIN, and any
other information that would be required
if certification were being requested for
the individual owner that filed the
Schedule C (Form 1040), Profit or Loss
From Business.
U.S. resident alien. An individual who
is not a lawful permanent resident of
the United States but who meets the
“substantial presence test” under
section 7701(b) is a resident alien for
purposes of U.S. taxation. If you are a
resident alien under the substantial
presence test and you have not yet
filed a U.S. income tax return for the

year for which certification is requested,
you must attach a copy of your current
Form I-94, Arrival-Departure Record.
Enter the date (YYYYMMDD) your
status changed on the line provided.
For information on determining your
period of residency, see Substantial
Presence Test in Pub. 519.
Students, teachers, and trainees.
If you filed Form 1040, U.S. Individual
Income Tax Return, and you are in the
United States under an “F1,” “J1,” “M1,”
or “Q1” visa, include the following with
Form 8802.
1. A statement explaining why Form
1040 was filed.
2. A statement and documentation
showing that you reported your
worldwide income.
First-year election. If you are an
individual who made or intends to make
the first-year election under section
7701(b)(4) applicable to the year for
which certification is requested, enter
the date (YYYYMMDD) your status as a
U.S. resident for tax purposes will
begin. For more information regarding
the first-year election and determining
your period of residency, see First-Year
Choice in Pub. 519.
• If you have made a first-year
residence election under section
7701(b)(4) applicable to the year for
which you are requesting certification,
attach to Form 8802 the election
statement you filed with your income
tax return for the taxable year of
election.
• If, for the calendar year for which
certification is requested, you have not
yet filed a first-year residence election
statement, attach to Form 8802 a
statement that you intend to file such
statement and that you are eligible to
make the election.
Dual-status alien. An individual is a
dual-status alien for U.S. tax purposes
if the individual is a part-year resident
alien and a part-year nonresident alien
during the calendar year(s) for which
certification is requested. Dual-status
generally occurs in the year an
individual acquires status as a U.S.
resident or terminates such status. For
example, you are a dual-status alien if
you are a U.S. citizen or green card
holder and you lost citizenship or green
card holder status during the same
calendar year. You may also be a
dual-status alien if you are a
non-resident alien but due to meeting
the substantial presence test become a
resident alien during the same calendar
year.
The dual-status alien classification
does not occur merely due to a
temporary absence from the United
States, nor will multiple periods of
temporary absence and re-entry into
the United States create multiple
periods of U.S. resident and
non-resident status. For information

-5-

and examples of a dual-status alien,
and to determine your period of
residency, see Pub. 519.
If you checked the dual-status box,
enter the dates (YYYYMMDD) that
correspond to the period that you were
a resident of the United States during
the year(s) for which certification is
requested.
Partial-year Form 2555 filer. Check
this box if you filed a Form 2555 that
covered only part of a year for which
certification is requested. For each year
that this applies, enter the eight-digit
dates (YYYYMMDD) that correspond to
the beginning and ending of the period
you were a resident of the United
States.

Line 4b. Partnership

Partnerships are not considered U.S.
residents within the meaning of the
residence article of U.S. income tax
treaties. Treaty benefits are only
available to a partner who is a U.S.
resident.
Note. The Form 6166 issued to
partnerships will include an attached list
of partners that are U.S. residents. The
IRS does not certify the percentage of
ownership interest of the listed
partners. It is the responsibility of the
partnership to provide such information
to the withholding agent.
Include the following with Form
8802:
1. The name and TIN of each
partner for which certification is
requested and any additional
information that would be required if
certification were being requested for
each of those partners.
2. Authorization (for example, Form
8821) from each partner, including all
partners listed within tiered
partnerships. Each authorization must
explicitly allow the third party requester
to receive the partner’s tax information
and must not address matters other
than federal tax matters.
3. Unless the requester is a partner
in the partnership during the tax year
for which certification is requested,
authorization from the partnership must
explicitly allow the third party requester
to receive the partnership’s tax
information. The authorization must not
address matters other than federal tax
matters.
An LLC that is classified as a
partnership follows the above
procedures. Members of the LLC are
treated as partners.
Nominee partnership. Do not check
the partnership box on line 4b. Instead,
check line 4j and attach the information
required by the instructions.

Line 4c. Trust

Domestic and foreign grantor trusts and
simple trusts can be certified for U.S.

residency, to the extent the owner of
the grantor trust or beneficiaries of
simple trusts are U.S. residents.
Domestic complex trusts may be
certified without regard to the residence
of the settler or beneficiaries.
A trust is domestic if a court within
the U.S. is able to exercise primary
supervision over the administration of
the trust and one or more U.S. persons
has authority to control all substantial
decisions of the trust.
Grantor trust. Include the following
with Form 8802:
1. The name and TIN of each owner
and any information that would be
required if certification were being
requested for each owner.
2. Authorization (for example, Form
8821) from each owner. Each
authorization must explicitly allow the
third party requester to receive the
owner’s tax information and must not
address matters other than federal tax
matters.
3. Unless the requester is a trustee
of the trust, authorization from the trust
must explicitly allow the third party
requester to receive the trust’s tax
information. The authorization must not
address matters other than federal tax
matters.
4. If the grantor trust is a foreign
trust, also include a copy of Form
3520-A, Annual Information Return of
Foreign Trust With a U.S. Owner,
including a copy of the foreign grantor
trust owner statement.
Domestic complex trust. Unless the
requester is a trustee of the trust during
the tax year for which certification is
requested, authorization from the trust
must explicitly allow the third party
requester to receive the trust’s tax
information. The authorization must not
address matters other than federal tax
matters.
Simple trust. Include the following
with Form 8802:
1. The name and TIN of each
beneficiary and any information that
would be required if certification were
being requested for each beneficiary.
2. Authorization (for example, Form
8821) from each beneficiary. Each
authorization must explicitly allow the
third party requester to receive the
beneficiary’s tax information and must
not address matters other than federal
tax matters.
3. Unless the requester is a trustee
of the trust, authorization from the trust
must explicitly allow the third party
requester to receive the trust’s tax
information. The authorization must not
address matters other than federal tax
matters.
Group trust arrangement, described
in Rev. Rul. 81-100. A group trust
arrangement that has received a
determination letter recognizing its

exempt status under section 501(a)
must attach a copy of that letter to
Form 8802.
A group trust arrangement that is
seeking benefits from Switzerland with
respect to dividends paid by a Swiss
corporation must also attach to Form
8802 the name of each participant and
a statement that each participant listed
is a trust forming part of a plan
described in section 401(a), 403(b), or
457(b).
IRA. Domestic individual retirement
arrangements (individual retirement
accounts within the meaning of section
408(a) and Roth IRAs within the
meaning of section 408A) (collectively
referred to as IRAs) may be certified as
residents (without regard to the
residence of the IRA holder). Either the
IRA holder or the trustee of the IRA
may request certification on behalf of
the IRA.
An IRA holder requesting
certification on behalf of an IRA must
provide the IRA account name (that is,
the IRA holder’s name) and number,
the IRA holder’s TIN, and a copy of
Form 8606, Nondeductible IRAs, or
Form 5498, IRA Contribution
Information. Complete the remainder of
Form 8802 as if certification were being
requested by the IRA.
A bank or financial institution acting
as the trustee for IRAs may request
certification for multiple IRAs grouped
by year and by country for which
certification is requested. The bank or
financial institution must include the
following with Form 8802:
1. A list of IRA account names and
account numbers for which certification
is requested.
2. A statement that each IRA
account name and number listed is an
IRA within the meaning of section
408(a) or 408A.
3. A statement that the bank or
financial institution is a trustee of the
IRA.
Common trust fund as defined in
section 584. Include the following with
Form 8802:
1. The name and TIN of each
participant and any information that
would be required if certification were
being requested for each participant.
2. Authorization (for example, Form
8821) from each participant. Each
authorization must explicitly allow the
third party requester to receive the
participant’s tax information and must
not address any matters other than
federal tax matters. If a pass-through
entity is a participant, you must list the
partners/shareholders/owners/
participants/members/beneficiaries in
the pass-through entity and obtain
authorization from each such
participant.

-6-

3. Unless the requester is a trustee
of the trust, authorization from the trust
must explicitly allow the third party
requester to receive the trust’s tax
information. The authorization must not
address matters other than federal tax
matters.
A common trust fund that is seeking
benefits from Switzerland with respect
to dividends paid by a Swiss
corporation must also attach to Form
8802 the name of each participant and
a statement that each participant listed
is a trust forming part of a plan that is
described in section 401(a), 403(b), or
457(b), or is a trust forming part of a
plan described in section 401(a),
403(b), or 457(b) that is within a group
trust arrangement described in Rev.
Rul. 81-100, 1981-13 I.R.B. 33, as
clarified and modified by Rev. Rul.
2004-67, 2004-28 I.R.B. 28 and
modified by Rev. Rul. 2011-1, 2011-2
I.R.B. 251. Also, see Notice 2012-6.

Line 4d. Estate

If you are filing a Form 8802 on behalf
of the estate of a decedent, you must
include proof that you are the executor
or administrator of the decedent’s
estate. Form 8802 can be submitted on
behalf of an estate for the year of the
taxpayer’s death or any prior year.
Proof can include a court certificate
naming you executor or administrator of
the estate. U.S. residency certification
will be based on the tax information and
residency of the decedent.

Line 4e. Corporation

Generally, a corporation that is not
incorporated in the United States is not
entitled to U.S. residency certification.
However, there are exceptions for
certain corporations that are treated as
U.S. corporations under sections 269B,
943(e)(1), 953(d), or 1504(d). Only
Canadian and Mexican corporations
are eligible to be treated as domestic
corporations under section 1504(d).
Corporations requesting U.S.
residency certification on behalf of their
subsidiaries must attach a list of the
subsidiaries and the Form 851,
Affiliations Schedule, filed with the
corporation’s consolidated return.
Dual-resident corporation. If you are
requesting certification for treaty
benefits in the other country of
residence named on line 4e,
certification depends on the terms of
the residence article of the relevant
treaty. If the treaty provides that
benefits are available only if the
competent authorities reach a mutual
agreement to that effect, request
competent authority assistance in
accordance with Rev. Proc. 2006-54,
2006-49 I.R.B. 1035, or its successor,
prior to seeking certification.

Effective January 1, 2005, the
special rules for financial asset
CAUTION securitization investment trusts
(FASITs) were repealed. However, the
special rules still apply to any FASIT in
existence on October 22, 2004, to the
extent that regular interests issued by
the FASIT before that date continue to
remain outstanding in accordance with
the original terms of issuance.

!

Line 4f. S Corporation

S corporations are not considered U.S.
residents within the meaning of the
residence article of U.S. income tax
treaties. Treaty benefits are only
available to a shareholder who is a U.S.
resident for purposes of the applicable
treaty.
Include the following with Form
8802:
1. The name and TIN of each
shareholder for which certification is
requested and any additional
information that would be required if
certification were being requested for
each of those shareholders.
2. Authorization (for example, Form
8821) from each shareholder. Each
authorization must explicitly allow the
third party requester to receive the
shareholder’s tax information and must
not address any matters other than
federal tax matters.
3. Unless the requester is a
shareholder in the S corporation during
the tax year for which certification is
requested, authorization from an officer
with legal authority to bind the
corporation must explicitly allow the
third party requester to receive the
corporation’s tax information. The
authorization must not address matters
other than federal tax matters.

Line 4g. Employee
Benefit Plan/Trust

Trusts that are part of an employee
benefit plan that is required to file Form
5500, Annual Return/Report of
Employee Benefit Plan, must include a
copy of the signed Form 5500 with
Form 8802.
An employee plan that is not subject
to the Employee Retirement Income
Security Act (ERISA) or is not otherwise
required to file Form 5500 must include

with Form 8802 a copy of the employee
benefit plan determination letter.
An employee plan that is not
required to file Form 5500 and does not
have a determination letter must
provide evidence that it is entitled to
certification. It must also provide a
statement under penalties of perjury
explaining why it is not required to file
Form 5500 and why it does not have a
determination letter.

Line 4h. Exempt
Organization

Generally, an organization that is
exempt from U.S. income tax must
attach to Form 8802 a copy of either
the organization’s determination letter
from the IRS or the determination letter
for the parent organization.
An exempt organization that is not
required to file a U.S. income tax return
and that has not received a
determination letter will not be issued a
Form 6166, unless such organization
has other means of proving U.S.
residency for tax treaty purposes. For
such an entity, include with Form 8802
the entity’s bylaws, corporate charter,
trust agreement, partnership
agreement, etc.
Governmental entity. Federal, state,
or local government agencies
requesting U.S. residency certification
that have not obtained a determination
letter, private letter ruling, revenue
ruling, etc., can submit in writing, on
official government letterhead, a letter
under penalties of perjury from a legally
authorized government official stating
that the organization is a government
agency.

Line 4i. Disregarded
Entity

Disregarded entities (DRE) are not
considered U.S. residents within the
meaning of the residence article of U.S.
income tax treaties. Treaty benefits will
only be available to a DRE owner who
is a U.S. resident. The DRE type must
be specified on line 4i.
Note. See line 5 for more information
regarding the DRE’s owner information
that may be required to be included
with your Form 8802.

-7-

Line 4j. Nominee
Applicant

If you act as a nominee for another
person or entity, you must provide all
certification information required for
each individual or entity for which you
are acting as a nominee. For example,
if you are acting as a nominee for a
resident alien, you must attach the
information required of applicants that
are resident aliens. Similarly, if one of
the entities for which you are acting as
a nominee is a partnership, then you
must submit the certification information
for each of the partners requesting
certification. In addition, you must
include the following with Form 8802.
1. Authorization (for example, Form
8821) from each individual or entity.
Each authorization must explicitly allow
the nominee applicant to receive the
individual’s or entity’s tax information
and must not address any matters
other than federal tax matters.
2. A statement under penalties of
perjury signed by an individual with
legal authority to bind the nominee
applicant, explicitly stating the nominee
applicant is acting as an agent on
behalf of the above-named individual(s)
or entity(ies) for whom the Form 6166 is
being requested.
Note. If you are a nominee
partnership, please do not provide
information concerning your partners.
The residence of your partners will not
be verified.

Line 5. Statement
Required If Applicant Did
Not File a U.S. Income
Tax Return
If the applicant was not required to file
a U.S. income tax return for the tax
period(s) for which certification will be
based, check the applicable box next to
“No.” If the applicant does not fit in any
of the categories listed, check “Other”
and on the dotted line that follows,
enter the code section that exempts the
applicant from the requirement to file a
U.S. income tax return. See Table 1 for
the statement required if the applicant
did not file a U.S. income tax return.

Table 1. Statement Required If Applicant Did Not File a U.S. Income Tax Return
IF the applicant was not
required to file a U.S. income
tax return and the applicant is... THEN ...
an individual

attach proof of income (for example, an income statement, Form W-2, Form 1099, etc.) and a written
statement that explains why the individual is not required to file an income tax return for the tax
period(s) for which certification is based. If the individual is a U.S. citizen, the written statement must
be made under penalties of perjury.

a child under age 19, or under age attach a signed copy of the Form 8814, Parents’ Election To Report Child’s Interest and Dividends.
24 if a full-time student, whose
parent(s) elected to report the
child’s income on their return
a qualified subchapter S
subsidiary (QSub) (include the
parent S corporation information
on line 6 of Form 8802)

attach proof of the election made on Form 8869, Qualified Subchapter S Subsidiary Election, and all
other requirements listed in the instructions for line 4f that apply to the parent S corporation.

a trust or estate

attach an explanation of why the trust or estate is not required to file Form 1041.

a common trust fund

attach a copy of the determination letter or proof that a participant is not required to file.

a group trust arrangement

attach a copy of the determination letter or private letter ruling.

a partnership described in section attach a copy of the section 761(a) election submitted with Form 1065, U.S. Return of Partnership
761(a)
Income, or a statement from a general partner that is signed and dated under penalties of perjury. See
Table 2, Current Year Penalties of Perjury Statements.
a financial asset securitization
investment trust (FASIT) (include
the parent C corporation
information on line 6 of Form
8802)1

attach a copy of the statement of election made by the parent C corporation requesting that the entity
be treated as a FASIT under section 860L(a)(3). See Table 2.

a government entity

submit in writing, on official government letterhead, an explanation of why the government entity is
exempt from a filing requirement. The letter must be signed and dated under penalty of perjury by a
government official with the authority to bind the organization or agency.

a foreign partnership

include all information indicated in the instructions for line 4b for each partner requesting certification.

a domestic disregarded entity
(domestic DRE)

include the entity’s single owner information on line 6 of Form 8802. Include with Form 8802: the
owner’s name and entity type (e.g., corporation, partnership), TIN, and all other certification
information required for the owner’s type of entity. If the DRE is either newly formed, was established
before 2001, or was established by default (no Form 8832 was filed), also include a statement from
the owner, signed under penalties of perjury (see Table 2).

a foreign disregarded entity
(foreign DRE)

For tax years beginning on or after January 1, 2004, if the disregarded entity is organized outside the
United States and the owner is a U.S. person, attach a copy of the Form 8858, Information Return of
U.S. Persons With Respect To Foreign Disregarded Entities, filed with the U.S. owner’s income tax
return for the calendar year(s) for which certification is requested. If the owner has not identified the
foreign DRE on the Form 8858, the foreign DRE cannot be certified. Include the foreign DRE’s owner
information on line 6. Include with Form 8802, the owner’s name and entity type, TIN, and all other
certification information required for the owner’s type of entity. If certification is being requested for tax
years prior to January 1, 2004, the U.S. owner is not required to attach a copy of the Form 8858, but
must attach proof that the foreign DRE is owned by a U.S. resident. For example, if the foreign DRE is
owned by a U.S. corporation, attach a copy of Schedule N (Form 1120), Foreign Operations of U.S.
Corporations, filed with the owner’s income tax return for the calendar year for which certification is
requested. If the owner has not identified the DRE on an attachment to its Schedule N, the foreign
DRE cannot be certified.

1 See Caution on page 7.

Line 6. Parent, Parent
Organization, or Owner

If you answered “Yes” to line 5, do not
complete line 6.
If you answered “No” to line 5, you
must complete line 6.
If you answered “Yes” to line 6,
check the appropriate box and enter
the parent’s, parent organization’s, or
owner’s information. If the applicant is a
minor child, enter the name, address,
and TIN of the parent who reported the
child’s income.

If you answered “No” to line 6, attach
proof of the parent’s, parent
organization’s, or owner’s income and
an explanation of why the parent is not
required to file a tax return for the tax
period(s) for which certification is
based.

Line 7. Calendar Year of
Request
The certification period is generally 1
year. You can request certification for
both the current year and any number
of prior years.

-8-

If you entered the most recent prior
year on this line, see Form 8802 Filed
Before Return Posted by the IRS on
page 3.
Enter the four-digit (YYYY) calendar
year(s) for which you are requesting
certification. However, see the
Exception below.
Exception. If you were a dual-status
alien during any year for which you are
requesting certification, enter instead
the eight-digit dates (YYYYMMDD) that
correspond to the beginning and ending
of the period you were a resident of the
United States. You must show the
specific period of residence for each

year for which you are requesting
certification. For information on
determining your period of residency,
see Pub. 519.
Current year certification. If
certification is requested for purposes
of claiming benefits under an income
tax treaty or VAT exemption for any
period during the current calendar year
or a year for which a tax return is not
yet required to be filed with the IRS,
penalties of perjury statement(s) will be
required from all applicants stating that
such applicant is a U.S. resident and
will continue to be so throughout the
current tax year. See Table 2 for the
current year penalties of perjury
statement you must enter on line 10 of
Form 8802 or attach to the form.
Note. For VAT certification, a
statement that the business activity has
not changed is also required. For more
information, see the instructions for line
10 below.

required to have been filed by an
individual requesting certification for
2012.
Example 2. On May 1, 2012, the
same Form 1040 filer would enter
201112 as the tax period for a
certification year of 2011 (the 2011
Form 1040 was required to have been
filed before May 1, 2012).
Example 3. On January 1, 2012, a
Form 1040 filer completing Form 8802
for a certification year of 2009 would
enter 200912.
If you were not required to file a U.S.
tax return for the tax period for which
certification is requested, enter the tax
period that would have been applicable,
if you were required to file a U.S. tax
return. After the tax period, add ‘‘(not
required to file).’’

Line 9. Purpose of
Certification

Line 8. Tax Period(s)

You must indicate the purpose of the
certification.

Example 1. A Form 1040 filer who
is completing Form 8802 for
certification year 2012 on January 1,
2012, would enter 201012 on line 8.
This is because on January 1, 2012,
the 2010 Form 1040 is the latest return

Your application will be returned
to you for completion if you do
CAUTION not include a purpose on the
application.
Income tax treaty. If you are
requesting certification to obtain
benefits under an income tax treaty but
you have requested certification for a
non-treaty country, your application will
be returned to you for correction.
VAT. The North American Industry
Classification System (NAICS) codes
can be found in the instructions for your
tax return (for example, Form 1120 or
Schedule C (Form 1040)). If you do not
provide a NAICS code on Form 8802

If you are requesting certification for a
tax period for which a tax return is not
yet due, enter the four-digit year and
two-digit month (YYYYMM) that
corresponds to the end of the most
recent tax period for which you filed a
tax return. For a prior year certification,
the four-digit year and two-digit month
should correspond to the end of the
prior year tax period for which
certification is requested.

!

and one was not provided on the return
you filed, one will not be entered
automatically. Form 6166 will only
certify that you filed a return with a
particular NAICS code if it matches the
NAICS code on your application. If you
provide a code that does not match,
Form 6166 will state that you represent
that your NAICS code is as stated on
Form 8802.

Line 10. Penalties of
Perjury Statements and
Attachments

Penalties of perjury statements from
Table 2 may be entered in the space
provided under line 10 or as an
attachment to Form 8802. Penalties of
perjury statements submitted
independently of Form 8802 must have
a valid signature and date. See Table
3.
VAT. For VAT certifications, the
penalties of perjury statement must also
include a statement that the business
activity (NAICS code) has not changed
since your last filed return.
Attachments. If any attachment is
submitted independently of Form 8802
and is prepared by someone other than
the person signing Form 8802, the
attachment must be signed and dated
under penalties of perjury by an
individual who has authority to sign
Form 8802. See Table 3.
Additional Information. If additional
information is required to be submitted
with Form 8802, use the space
provided under line 10 or attach the
information to the form.

Table 2. Current Year Penalties of Perjury Statements
THEN the Form
8802 penalties of
perjury statement
must include...

STATING: “This certification is given under penalties of perjury and to the best of
my knowledge and belief, the statements are true, correct, and complete.”

a statement from
the individual

[Insert name of individual and TIN] is a U.S. resident and will continue to be throughout
the current tax year.

an individual
a statement from
claiming treaty
the individual
benefits for
teaching or
research activities

Countries other than Japan: [Insert name of individual and TIN] was a U.S. resident
within the meaning of Article [#] of the U.S.-[country] treaty (including, in some cases,
physical presence in the United States) immediately before entering [country]. The
assignment began on [date] and ends on [date]. Article [#] of the U.S.-[country] treaty
provides a [2 or 3] year exemption from income tax.
Japan: [Insert name of individual and TIN] is (and will continue to be) a U.S. resident
within the meaning of Article 4(1) of the U.S.-Japan treaty. The assignment began on
[date] and ends on [date]. Article 20 of the U.S.-Japan treaty provides a 2 year
exemption from income tax.

IF the applicant
is...
an individual

a partnership

a statement from
each individual
partner for which
certification is
requested

[Insert name of partner and TIN] is a U.S. resident and will continue to be throughout the
current tax year, and

a statement from a
general partner

[Insert name of partnership and EIN] has filed its required return and the entity
classification has not changed since the return was filed.

-9-

IF the applicant
is...

THEN the Form
8802 penalties of
perjury statement
must include...

STATING: “This certification is given under penalties of perjury and to the best of
my knowledge and belief, the statements are true, correct, and complete.”

a statement from
[Insert name of shareholder and TIN] is a U.S. resident and will continue to be throughout
each individual
the current tax year, and
an S corporation shareholder for
which certification is
requested
a statement from an [Insert name of S corporation and EIN] has filed its required return and the entity
officer of the
classification has not changed since the return was filed.
corporation with the
authority to legally
bind the corporation
a statement from [Insert name and TIN] is a U.S. resident and will continue to be throughout the current tax
each individual
year, and
a common trust participant/
fund, grantor
beneficiary/
trust, or simple owner
trust
a statement from
the trustee with
authority to legally
bind the trust
a trust

[Insert name of trust and EIN] has filed its required return and the entity classification has
not changed since the return was filed.
Note: When the participant, beneficiary, or owner, is other than an individual, use the
statement that corresponds to the type of entity.

a statement from the [Insert name of trust and EIN] is a U.S. resident and will continue to be throughout the
trustee
w i t h current tax year.
authority to legally
bind the trust

a corporation

a statement from an [Insert name of corporation and EIN] is a U.S. resident and will continue to be throughout
officer of the
the current tax year.
corporation with the
authority to legally
bind the corporation

an exempt
organization

a statement from an [Insert name of organization and EIN] is a U.S. resident and will continue to be throughout
officer of the
the current tax year.
organization with
authority to legally
bind the
organization

an estate of a
decedent

a statement from
the personal
representative

[Insert name of estate and EIN] is a U.S. resident and will continue to be throughout the
current tax year.

a statement from an [Insert name of plan/trust and EIN] is a U.S. resident and will continue to be throughout
officer of the plan/ the current tax year.
an employee trust with authority
benefit plan/trust to legally bind the
plan/trust
a statement from
[Insert name of partner and TIN] is a U.S. resident and will continue to be throughout the
a partnership each partner for
current tax year, and
under IRC section which certification is
761(a) election requested
a statement from a
general partner

a foreign
an additional
partnership under statement from a
Regulations
general partner
section
1.6031(a)-1(b)

a. [Insert name of partnership and EIN] has made an election pursuant to IRC section
761(a). As a result, it is not required to file Form 1065 on an annual basis and all of its
partners report their respective shares of income, gain, loss, deductions, and credits on
their tax returns as required.
b. The [insert name of partnership] ’s entity classification has not changed since the filing
of the partners’ returns.
[Insert name of partnership and EIN] is not required to file Form 1065 under Regulations
section 1.6031(a)-1(b) and the entity classification has not changed since the filing of the
partners’ returns.

-10-

IF the applicant
is...

THEN the Form
8802 penalties of
perjury statement
must include...

STATING: “This certification is given under penalties of perjury and to the best of
my knowledge and belief, the statements are true, correct, and complete.”

a statement from an
officer of the
corporation with the
authority to legally
bind the corporation

a. [Insert name of corporation and EIN] is the corporate owner of [insert name of FASIT
and EIN] which is treated as a FASIT under IRC section 860H, and as such, [insert name
of corporation] reports all of [insert name of FASIT] ’s income, gain, loss, deductions, and
credits on [insert name of corporate owner] ’s Form 1120, U.S. Corporation Income Tax
Return.
b. The corporation is a U.S. resident and will continue to be throughout the current tax
year.

a statement from an
officer of the
a FASIT not
corporation with the
required to file a authority to legally
U.S. tax return1 bind the corporation

[Insert name of corporation and EIN] is the corporate owner of [insert name of FASIT and
EIN] which is treated as a FASIT under IRC section 860H, and as such, [insert corporate
owner] reports all of [insert name of FASIT] ’s income, gain, loss, deductions, and credits
on [insert name of corporate owner] ’s Form 1120, U.S. Corporation Income Tax Return.

a financial asset
securitization
investment trust
(FASIT) 1

a disregarded
entity (DRE)

a nominee

a statement from
the owner of the
DRE

This certifies that [insert name and TIN of the owner of the DRE corporation, partnership,
or individual] trading as [insert name of limited liability company] is a single-owner limited
liability company that is treated as a disregarded entity for U.S. income tax purposes, that
[insert name of corporation, partnership, or individual] is the single owner of [insert name
of limited liability company], and, as such, [insert name of corporation, partnership, or
individual] is required to take into account all the income, gain, loss, deductions, and
credits of [insert name of limited liability company] on its/his/her U.S. federal income tax or
information return.

a statement from
[Insert name and TIN of individual(s)/entity(ies) on whose behalf the nominee is acting] is
each individual or
a U.S. resident and will continue to be throughout the current year.
entity for whom the
nominee is acting

1 See Caution on page 7.

Signature and Date

Form 8802 will not be considered
complete and valid if the application is
not signed and dated by an individual
who has the authority to sign Form
8802. A third party representative with
authorization to sign Form 8802 must

attach documentation (for example,
Form 2848) of the authorization. See
Table 3 to determine who has authority
to sign Form 8802.
To avoid processing delays and
possible rejection of Form 8802, if Form
8802 is signed by an individual who is

not identified in the instructions, enter a
statement in line 10 and attach any
appropriate documentation to indicate
such individual’s authority to sign Form
8802. If you are granting authority to a
third party, you must sign and date the
documentation.

Table 3. Who Has Authority To Sign Form 8802
IF the applicant is...

THEN the individual with authority to sign Form 8802 is...

an individual

the individual.

a married couple

both the husband and the wife.

a minor child who cannot sign

either parent by signing the child’s name and adding “By (your signature), parent for minor child.”

a child under age 19, or under
age 24 if a full-time student,
whose parent(s) reported the
child’s income on Form 8814

the parent who filed Form 8814 with his/her income tax return.

a partnership

any partner or partners duly authorized to act for the partnership (general partner or tax matters
partner). Each partner must certify that he or she has such authority.

an S corporation

any corporate officer, for example, president, vice president, treasurer, chief accounting officer, etc.,
duly authorized by the corporation to bind the corporation in accordance with applicable state law.

a trust, common trust fund,
grantor trust or simple trust

the fiduciary (trustee, executor, administrator, receiver, or guardian).

an estate of a decedent

the personal representative (executor or administrator).

a corporation

any corporate officer, for example, president, vice president, treasurer, chief accounting officer, etc.,
duly authorized by the corporation to bind the corporation in accordance with applicable state law.

an employee benefit plan or trust any organization officer, for example, president, vice president, treasurer, chief accounting officer, etc.,
duly authorized by the plan or trust to bind the plan or trust in accordance with applicable state law.
an exempt organization

any organization officer, for example, president, vice president, treasurer, chief accounting officer, etc.,
duly authorized by the organization to bind the organization in accordance with applicable state law.

-11-

IF the applicant is...

THEN the individual with authority to sign Form 8802 is...

a partnership under an IRC
761(a) election

any partner or partners duly authorized to act for the partnership. Each partner must certify that he or
she has such authority.

a financial asset securitization
investment trust (FASIT)1

any corporate officer, for example, president, vice president, treasurer, chief accounting officer, etc.,
duly authorized by the owner corporation to bind the owner corporation in accordance with applicable
state law.

a governmental organization

an officer of the governmental organization with authority in the course of his or her official duties to bind
the organization.

1 See Caution on page 7.

Daytime Phone Number

Providing your daytime phone number
can help speed the processing of Form
8802. We may have questions about
items on your application, such as the
NAICS code, type of applicant, etc. By
answering our questions over the
phone, we may be able to continue
processing your Form 8802 without
mailing you a letter. If you are filing a
joint application, you can enter either
your or your spouse’s daytime phone
number.

Line 11. Number of
Certifications (Forms
6166) Requested for
Each Country

Enter the number of certifications
(Forms 6166) requested for each
country listed in columns A, B, C, and
D. For any country not listed, enter the
country in the blank spaces at the
bottom of Column D. If you are
requesting certifications for more than
one calendar year for a country, enter
the number of certifications requested
for all years to get the total number of
certifications requested for that country.
Example. You are requesting
certifications for Germany. You need 3
certifications for 2009, 2 certifications
for 2010, and 4 certifications for 2011.
Enter 9 as the total number of
certifications requested for Germany.

Line 12. Total Number of
Certifications (Forms
6166) Requested

Add the total number of certifications
requested in columns A, B, C, and D of
line 11, and enter the total on line 12.

When To Seek U.S.
Competent Authority
Assistance

If your request for Form 6166 is denied
and you believe you are entitled to
treaty benefits under a specific treaty
article, you can request assistance from
the U.S. competent authority following
the procedures established in Rev.
Proc. 2006-54, 2006-49 I.R.B. 1035, or
its successor. A request for U.S.

competent authority assistance
regarding a residency issue will be
accepted for consideration only if it is
established that the issue requires
consultation with the foreign competent
authority to ensure consistent treatment
by the United States and the applicable
treaty partner. The U.S. competent
authority does not make unilateral
determinations with respect to
residency. Residency determinations
are made by mutual agreement
between the two competent authorities.
The U.S. competent authority
cannot consider requests
CAUTION involving countries with which
the United States does not have an
income tax treaty.
Your request for U.S. competent
authority assistance should be mailed
to the address indicated in Rev. Proc.
2006-54, or its successor. Rev. Proc.
2006-54 is available at
www.irs.gov/irb/2006-49_IRB/ar13.html.

!

Comments and Suggestions
Do not send Form 8802 to this
address. This address is only for
comments or suggestions about Form
8802 and its separate instructions.
Internal Revenue Service
Office of Tax Treaty
SE:LB:IN:TAIT
1111 Constitution Avenue NW, MA
Washington, DC 20224
U.S.A.
Privacy Act and Paperwork
Reduction Act Notice. We ask for the
information on this form under sections
6103 and 6109 of the Internal Revenue
Code. You are required to provide the
information requested on this form only
if you wish to have your U.S. residency
for tax purposes certified in order to
claim VAT exemption or to claim certain
benefits under a tax treaty between the
United States and the foreign country
(countries) indicated on Form 8802. We
need this information to determine if the
applicant can be certified as a U.S.
resident for tax purposes for the period
specified. Failure to provide the
requested information may prevent
certification. Providing false or
fraudulent information may subject you
to penalties. If you designate an
appointee to receive Form 6166, but do

-12-

not provide all of the information
requested, we may be unable to honor
the designation.
Generally, tax returns and return
information are confidential, as required
by section 6103. However, section
6103 authorizes or requires us to
disclose this information in certain
circumstances. We may disclose the
information to the tax authorities of
other countries pursuant to a tax treaty.
We may disclose this information to the
Department of Justice for civil and
criminal litigation. We may also disclose
this information to cities, states, the
District of Columbia, and U.S.
commonwealths and possessions for
use in administering their tax laws, to
federal and state agencies to enforce
federal nontax criminal laws, or to
federal law enforcement and
intelligence agencies to combat
terrorism.
You are not required to provide the
information requested on a form that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB
control number. Books or records
relating to a form or its instructions
must be retained as long as their
contents may become material in the
administration of any Internal Revenue
law.
The time needed to complete and
file this form will vary depending on
individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . . .
Learning about the law
or the form . . . . . . . . . . .
Preparing the form . . . . .
Copying, assembling, and
sending the form
to the IRS . . . . . . . . . . . .

.

33 min.

.
.

1hr., 13 min.
1 hr., 3 min.

.

48 min.

If you have comments concerning
the accuracy of these time estimates or
suggestions for making this form
simpler, we would be happy to hear
from you. You can write to the Internal
Revenue Service, Tax Products
Coordinating Committee,
SE:W:CAR:MP:T:M:S, 1111
Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not send
the form to this address. Instead, see
Where To Apply on page 2.