Form 8802--Application for United States Residency Certification

Instructions for Form 8802

Department of the Treasury
Internal Revenue Service

(Rev. June 2014)

(Use with the April 2012 revision of Form 8802)
Application for United States Residency Certification
Section references are to the Internal Revenue
Code unless otherwise noted.

Contents

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 . . . . . . . . . .
Certification Under the
3-Year Procedure . .
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 . . .
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. Statement
Required If Applicant
Did Not File a U.S.
Income Tax Return .
Line 6. Parent, Parent
Organization, or Owner . .
Line 7. Calendar Year of
Request . . . . . . . . . . .
Line 8. Tax Period(s) . . . . .

Jun 17, 2014

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Contents

Page

Line 9. Purpose of
Certification . . . . . . . .
Line 10. Penalties of Perjury
Statements and
Attachments . . . . . . . .
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 . . . . . . . . .

. . . . 10
. . . . 10
. . . . 11
. . . . 13
. . . . 14
. . . . 14

. . . . 14
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Future Developments

For the latest information about
developments related to Form 8802 and
its instructions, such as legislation
enacted after they were published, go to
www.irs.gov/form8802.

What's New
3-year procedure. Estates, employee
benefit plans/trusts, and exempt
organizations can submit a Form 8802
that covers a 3-year period. See
Certification Under the 3-Year
Procedure, later.

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,
Cat. No. 10827V

Withholding of Tax on Nonresident
Aliens and Foreign Entities.
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 income tax treaty to
determine if any tax credit, tax
exemption, reduced rate of tax, or other
treaty benefit or safeguards apply.

TIP

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 of the prior year.
Requests received with a postmark date
earlier than December 1 will be returned
to the sender. For example, a Form
6166 request for 2015:

Received with a postmark date
before December 1, 2014, cannot be
processed.
Received with a postmark date on or
after December 1, 2014, can be
processed with the appropriate
documentation.

User Fee

Form 8802 application(s) will not be
processed until the $85 non-refundable
user fee is paid.
Additional request. Additional
requests for Form 6166 submitted on a
separate Form 8802, following the
procedures established under
Additional Requests, later, 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.

!

3-year procedure. You are required
to pay the $85 user fee for each Form
8802 application submitted under the
3-year procedure. See Certification
Under the 3-Year Procedure, later.

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
-2-

authorize us to process the copy of the
check.

Electronic Payment (e-payment)
Visit the IRS website at IRS.gov and
enter “e-pay” in the search box. Click on
the search result, Electronic Payment
Options Home Page. Choose “User
Fees” at the bottom of the page, and
then click on U.S. Residency User Fee.
Complete the form and submit online
the information requested on the
website.
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:
Internal Revenue Service
2970 Market Street
BLN# 3-G23.100
Philadelphia, PA 19104-5002

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 by mail, private
delivery service, or fax (see below for
limitations on the use of faxed
transmissions).
If you are paying the user fee by
e-payment, send Form 8802 and all
required attachments to:
Department of the Treasury
Internal Revenue Service
Philadelphia, PA 19255-0625
Or, by private delivery service to:
Internal Revenue Service
2970 Market Street
BLN# 3-G23.100
Philadelphia, PA 19104-5002

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

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.

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.

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.
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
Certification Under the 3-Year
Procedure

Estates, employee benefit plans/trusts,
and exempt organizations (lines 4d, 4g,
and 4h) can submit a Form 8802 that
covers up to a 3-year period (the current
year and the following two tax years). If
you request certification under this
procedure, you must submit a Form
-3-

8802 for each year, but in years 2 and 3
you only need to attach a copy of the
year 1 Form 8802 (including the
penalties of perjury statement), provided
there are no material changes to the
information entered on the Form 8802 in
year 1.
Note. If you choose to use the 3-year
procedure, write “Filed Under the 3-Year
Procedure” at the top of page 1 of the
Form(s) 8802 filed for each year.
You cannot use this procedure if
there is a material change of fact
(including name or permanent address)
with respect to the estate, employee
benefit plan/trust, or exempt
organization during the period for which
the certification is requested.
First year. In the first year for which a
certification is requested under this
procedure, you must submit a
completed Form 8802, signed and
dated by the applicant, with the current
year entered on line 7. Attach Form
2848 or Form 8821, as applicable, to
Form 8802. Form 2848 or Form 8821
must apply to all of the years for which
certification is requested. For the rules
relating to Forms 2848 and 8821, see
3-year procedure under Line 3b. Third
Party Appointee's Information, later.
In year 1, a penalty of perjury
statement is required stating that the
applicant is a U.S. resident and will
continue to be so through the current tax
year and the following two tax years.
See Table 2 for the penalty of perjury
statement for the 3-year procedure that
must be entered on line 10 of Form
8802 or attached to the form.
Second year. In the second year for
which certification is requested under
this procedure, you must submit a
completed Form 8802 requesting
certification for year 2 with a copy of the
year 1 Form 8802 (including the penalty
of perjury statement) and Form 2848 or
Form 8821 attached, as applicable.
Enter the current year on line 7. A
penalty of perjury statement and
signature are not required on the Form
8802 filed in year 2. However, you must
enter “See attached year 1 Form 8802
filed under the 3-year procedure” on
line 10.
Third year. In the third year for which
certification is requested under this
procedure, you must submit a
completed Form 8802 requesting
certification for year 3 and attach a copy
of the year 1 Form 8802 (including the
penalty of perjury statement) and Form

2848 or Form 8821 attached, as
applicable.
Enter the current year on line 7. A
penalty of perjury statement and
signature are not required on the Form
8802 filed in year 3. However, you must
enter “See attached year 1 Form 8802
filed under the 3-year procedure” on
line 10.

Form 8802 Filed Before Return
Posted by the IRS

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 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.
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.
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, 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, or
Telephone at: 44-115-974-0897 if
calling from outside the U.K., or
0115-974-0897 if calling from the U.K.
-4-

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, earlier.
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.

Foreign Claim Form

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

Line 2. Applicant's
Address
Do not enter a P.O. box
number or C/O address.
CAUTION
Certification 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, earlier, may apply to you.

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
-5-

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)
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.
3-year procedure. Under the 3-year
procedure, the third party appointee
completes a Form 8802 in the first year
that must be signed and dated by the
applicant. In the following two tax years
the third party appointee must complete
a new Form 8802 that is not required to
be signed and dated by the applicant.
Form 2848 or Form 8821 must be
attached to Form 8802 in year 1 and
must indicate all years in the 3-year
period for which certification is
requested.
For more information, see
Certification Under the 3-Year
Procedure, earlier.

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 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
-6-

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.
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
-7-

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.
3-year procedure. If you check
box 4d, you may be able to use the
3-year procedure. See Certification
Under the 3-Year Procedure, earlier.

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.
3-year procedure. If you check
box 4g, you may be able to use the
3-year procedure. See Certification
Under the 3-Year Procedure, earlier.

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.
3-year procedure. If you check
box 4h, you may be able to use the
3-year procedure. See Certification
Under the 3-Year Procedure, earlier.

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.

-8-

Note. See line 5 for more information
regarding the DRE's owner information
that may be required to be included with
your Form 8802.

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...
an individual

THEN ...
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
attach a signed copy of the Form 8814, Parents' Election To Report Child's Interest and
age 24 if a full-time student,
Dividends.
whose parent(s) elected to
report the child's income on their
return
a qualified subchapter S
attach proof of the election made on Form 8869, Qualified Subchapter S Subsidiary Election, and
subsidiary (QSub) (include the
all other requirements listed in the instructions for line 4f that apply to the parent S corporation.
parent S corporation information
on line 6 of Form 8802)
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 761(a)

attach a copy of the section 761(a) election submitted with Form 1065, U.S. Return of
Partnership 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
attach a copy of the statement of election made by the parent C corporation requesting that the
investment trust (FASIT)
entity be treated as a FASIT under section 860L(a)(3). See Table 2.
(include the parent C corporation
information on line 6 of Form
8802)1
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 under Line 4e. Corporation, earlier.

-9-

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.
If you entered the most recent prior
year on this line, see Form 8802 Filed
Before Return Posted by the IRS,
earlier.
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.
Fiscal year taxpayers. Fiscal year
filers also enter a four digit (YYYY)
calendar year on line 7. You must
request a separate calendar year
certification for any part of a fiscal tax
year that falls outside the calendar year.
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.
3-year procedure. If you are using the
3-year procedure (discussed earlier),
enter all years in the 3-year period, as
applicable, on the Form 8802 filed for
the first year. For years two and three,
enter only the current calendar year for
which you are requesting certification.

Line 8. Tax Period(s)

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 latest return required
to have been filed (including
extensions). If you are a fiscal year
taxpayer, enter the year and month that
corresponds to the end of that fiscal tax
year. 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.
Example 1. A Form 1040 filer who is
completing Form 8802 for certification
year 2014 on January 1, 2014, would
enter 201212 on line 8. This is because
on January 1, 2014, the 2012 Form
1040 is the latest return required to have
been filed by an individual requesting
certification for 2014.
Example 2. On May 1, 2014, the
same Form 1040 filer would enter
201312 on line 8 as the tax period for
certification year 2014 (the 2013 Form
1040 was required to have been filed
before May 1, 2014).
If the Form 1040 filer had filed an
extension for 2013, the filer would enter
201212 on line 8. This is because on
May 1, 2014, the 2012 Form 1040 is the
latest return required to be filed.
Example 3. On January 1, 2014, a
Form 1040 filer completing Form 8802
for certification year 2011 would enter
201112.
Example 4. A Form 1120 filer has a
fiscal year ending on September 30.
The Form 1120 filer completing Form
8802 for certification year 2014 on
January 15, 2014, would enter 201309
-10-

on line 8. This is because on January
15, 2014, the 2012 Form 1120 with
fiscal year ending September 30, 2013,
is the latest return required to have been
filed.
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

You must indicate the purpose of the
certification.
Your application will be
returned to you for completion if
CAUTION
you do 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
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.
3-year procedure. If you are using the
3-year procedure (discussed earlier),
you are required to enter a penalty of

perjury statement in the first year stating
that the applicant is a U.S. resident and
will continue to be so through the
current tax year and the following two
tax years. See Table 2 for the 3-year
procedure penalty of perjury statement
you must enter on line 10 of Form 8802
or attach to Form 8802.
Note. For a Form 8802 submitted after
the first year of the 3-year procedure,

enter “See attached year 1 Form 8802
filed under the 3-year procedure” in
place of the penalty of perjury statement
on line 10.
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
IF the applicant perjury statement STATING: “This certification is given under penalties of perjury and to the best of
is...
must include...
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
claiming treaty
benefits for
teaching or
research
activities

a statement from
the individual

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.

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.

an individual

a statement from
each individual
an S corporation shareholder for
which certification
is requested

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

a statement from
[Insert name of S corporation and EIN] has filed its required return and the entity
an officer of the
classification has not changed since the return was filed.
corporation with the
authority to legally
bind the corporation
a common trust
fund, grantor
trust, or simple
trust

a trust

a statement from
each individual
participant/
beneficiary/
owner

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

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

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THEN the Form
8802 penalties of
IF the applicant perjury statement STATING: “This certification is given under penalties of perjury and to the best of
is...
must include...
my knowledge and belief, the statements are true, correct, and complete.”
a corporation

an exempt
organization

an exempt
organization
submitting a
Form 8802 under
the 3-year
procedure (in
year 1)
an estate of a
decedent

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

an estate of a
a statement from
decedent
the personal
submitting a
representative
Form 8802 under
the 3-year
procedure (in
year 1)
a statement from
an employee
an officer of the
benefit plan/trust plan/trust with
authority to legally
bind the plan/trust

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

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

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

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

an employee
benefit plan/trust
submitting a
Form 8802 under
the 3-year
procedure (in
year 1)

a statement from
an officer of the
plan/trust with
authority to legally
bind the plan/trust

[Insert name of plan/trust and EIN] is a U.S. resident and will continue to be throughout
the current tax year and the following two tax years.

a partnership
under IRC
section 761(a)
election

a statement from
each 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

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.

-12-

THEN the Form
8802 penalties of
IF the applicant perjury statement STATING: “This certification is given under penalties of perjury and to the best of
is...
must include...
my knowledge and belief, the statements are true, correct, and complete.”
a foreign
partnership
under
Regulations
section
1.6031(a)-1(b)
a financial asset
securitization
investment trust
(FASIT) 1

an additional
statement from a
general partner

[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.

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
required to file a corporation with the
U.S. tax return1 authority to legally
bind the corporation
a disregarded
entity (DRE)

a nominee

[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 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
each individual or
entity for whom the
nominee is acting

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

1 See Caution under Line 4e. Corporation, earlier.

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

-13-

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.

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 under Line 4e. Corporation, earlier.

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 2011, 2 certifications
for 2012, and 4 certifications for 2013.
Enter 9 as the total number of
certifications requested for Germany.
Note. If you are requesting
certifications for multiple years, attach a
statement to Form 8802 identifying the
country, year, and number of
certifications per year. The total must
agree with the number entered to the
-14-

right of the related country code on
line 11.

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 U.S. competent
authority assistance following the
procedures established in Rev. Proc.

2006-54, 2006-49 I.R.B. 1035, or its
successor.
Note. See Notice 2013-78, which
provides proposed updates to the
procedures for requesting U.S.
competent authority assistance under
Rev. Proc. 2006-54.
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.
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
not provide all of the information
requested, we may be unable to honor
the designation.
Generally, tax returns and tax 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.

-15-

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 send us comments
from www.irs.gov/formspubs/. Click on
“More Information” and then on “Give us
feedback.” You can write to the Internal
Revenue Service, Tax Forms and
Publications Division, 1111 Constitution
Ave. NW IR-6526, Washington, DC
20024. Do not send the form to this
address. Instead, see Where To Apply,
earlier.