Exemption From Withholding on Compensation

for Independent (and Certain Dependent) Personal

Services of a Nonresident Alien Individual

Form 8233

(Rev. December 2001) OMB No. 1545-0795

Identification of Beneficial Owner (See instructions.)

Name of individual who is the beneficial owner

Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box.

City or town, state or province. Include postal code where appropriate.

Department of the Treasury

Internal Revenue Service

Part I

Caution: See the line 10 instructions for the required additional statement you must attach.

 See separate instructions.

This exemption is applicable for compensation for calendar year , or other tax year beginning

IF you are a nonresident alien individual who is

receiving . . .

Compensation for independent personal

services performed in the United States

THEN, if you are the beneficial owner of that

income, use this form to claim . . .

A tax treaty withholding exemption for part or

all of that compensation and/or to claim the

daily personal exemption amount.

A tax treaty withholding exemption for part or

all of that compensation.

Claiming only foreign status or treaty benefits

with respect to income that is not

compensation for personal services

IF you are a beneficial owner who is . . .

Form W-8BEN

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 62292K Form 8233 (Rev. 12-2001)

Compensation for dependent personal

services performed in the United States

INSTEAD, use . . .

1 23 U.S. taxpayer identifying number Foreign tax identifying number, if any (optional)

4

5 Address in the United States (street, apt. or suite no., or rural route). Do not use a P.O. box.

Country (do not abbreviate)

City or town, state, and ZIP code

7a Country issuing passport

8 Date of entry into the United States

6 U.S. visa type

Note: Citizens of Canada or Mexico are not required to complete lines 7a and 7b.

10 If you are a foreign student, trainee, professor/teacher, or researcher, check this box 

DO NOT Use

This Form. . .

Who Should

Use This Form?

and ending .

Date your current nonimmigrant status expires

7b Passport number

A tax treaty withholding exemption for part or

all of both types of income.

Noncompensatory scholarship or fellowship

income and personal services income from

the same withholding agent

Note: Do not use Form 8233 to claim the daily

personal exemption amount.

Receiving compensation for dependent

personal services performed in the United

States and you are not claiming a tax treaty

withholding exemption for that compensation

Receiving noncompensatory scholarship or

fellowship income and you are not receiving

any personal services income from the same

withholding agent

Form W-4

Form W-8BEN or, if elected by the

withholding agent, Form W-4 for the

noncompensatory scholarship or

fellowship income

Note: For

definitions of terms

used in this section

and detailed

instructions on

required

withholding forms

for each type of

income, see

Definitions on

pages 1 through 3

of the instructions.

9a 9b Current nonimmigrant status
Form 8233 (Rev. 12-2001) Page 2

How many days will you perform services in

the United States during this tax year? 

Number of personal exemptions 16

claimed 

Withholding Agent Acceptance and Certification

Name Employer identification number

Address (number and street) (Include apt. or suite no. or P.O. box, if applicable.)

City, state, and ZIP code Telephone number

Under penalties of perjury, I certify that I have examined this form and any accompanying statements, that I am satisfied that an exemption from withholding is warranted,

and that I do not know or have reason to know that the nonresident alien individual is not entitled to the exemption or that the nonresident alien’s eligibility for the

exemption cannot be readily determined.

Signature of withholding agent  Date 

Sufficient facts to justify the exemption from withholding claimed on line 12 and/or line 13 (see instructions)

15

Noncompensatory scholarship or fellowship income:

14

a Amount $

b Tax treaty and treaty article on which you are basing exemption from withholding

13

Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. 

I further certify under penalties of perjury that:

● I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates.

● The beneficial owner is not a U.S. person.

● The beneficial owner is a resident of the treaty country listed on line 12a and/or 13b above within the meaning of the income tax treaty between the United States

and that country.

● The beneficial owner is not a former citizen or long-term resident of the United States subject to section 877 (relating to certain acts of expatriation) or, if subject

to section 877, the beneficial owner is nevertheless entitled to treaty benefits with respect to the amounts received.

Sign Here  Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date

Certification

Part IV

Note: Lines 15 through 18 are to be completed only for certain independent personal services (see instructions).

Part III

17 Daily personal exemption amount claimed (see instructions) 

Note: Do not complete lines 13a through 13c unless you also received compensation for personal services from the same

withholding agent.

a Description of personal services you are providing

b Total compensation you expect to be paid for these services in this calendar or tax year $

12 If compensation is exempt from withholding based on a tax treaty benefit, provide:

a Tax treaty and treaty article on which you are basing exemption from withholding

b Total compensation listed on line 11b above that is exempt from tax under this treaty $

c

11 Compensation for independent (and certain dependent) personal services:

Country of permanent residence

Part II Claim for Tax Treaty Withholding Exemption and/or Personal Exemption Amount

Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or

any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.

18 Total personal exemption amount claimed. Multiply line 16 by line 17 

c Total income listed on line 13a above that is exempt from tax under this treaty $