ࡱ>  KbjbjWW >555I@@8`)4rj"}#1)3)3)3)3)3)3)$+P.xW)#"##W)@@9l)!'!'!'#R@81)!'#1)!'!'x!'[V O$&!'))0)!'.u&.!'!'.5'##!'#####W)W)!'###)####.######### :   TOC \o "1-3" \h \z \u HYPERLINK \l "_Toc264448167"Bangladesh - Article 21(2)  PAGEREF _Toc264448167 \h 2 HYPERLINK \l "_Toc264448168"Belgium - Article 19(1)(b)  PAGEREF _Toc264448168 \h 3 HYPERLINK \l "_Toc264448169"Bulgaria - Article 19(1)(b)  PAGEREF _Toc264448169 \h 4 HYPERLINK \l "_Toc264448170"China, Peoples Republic of Article 20(c)  PAGEREF _Toc264448170 \h 5 HYPERLINK \l "_Toc264448171"Cyprus Article 21(1)  PAGEREF _Toc264448171 \h 6 HYPERLINK \l "_Toc264448172"Czech Republic Article 21(1)  PAGEREF _Toc264448172 \h 7 HYPERLINK \l "_Toc264448173"Egypt Article 23(1)  PAGEREF _Toc264448173 \h 8 HYPERLINK \l "_Toc264448174"Estonia Article 20(1)  PAGEREF _Toc264448174 \h 9 HYPERLINK \l "_Toc264448175"France Article 21(1)  PAGEREF _Toc264448175 \h 10 HYPERLINK \l "_Toc264448176"Germany - Article 20(4)  PAGEREF _Toc264448176 \h 11 HYPERLINK \l "_Toc264448177"Iceland Article 19(1)  PAGEREF _Toc264448177 \h 12 HYPERLINK \l "_Toc264448178"Indonesia - Article 19(1)  PAGEREF _Toc264448178 \h 13 HYPERLINK \l "_Toc264448179"Israel Article 24(1)  PAGEREF _Toc264448179 \h 14 HYPERLINK \l "_Toc264448180"Korea, South Article 21(1)  PAGEREF _Toc264448180 \h 15 HYPERLINK \l "_Toc264448181"Latvia Article 20(1)  PAGEREF _Toc264448181 \h 16 HYPERLINK \l "_Toc264448182"Lithuania Article 20(1)  PAGEREF _Toc264448182 \h 17 HYPERLINK \l "_Toc264448183"Morocco Article 18  PAGEREF _Toc264448183 \h 18 HYPERLINK \l "_Toc264448184"Netherlands Article 22(1)  PAGEREF _Toc264448184 \h 19 HYPERLINK \l "_Toc264448185"Norway Article 16(1)  PAGEREF _Toc264448185 \h 20 HYPERLINK \l "_Toc264448186"Pakistan Article XIII(1)  PAGEREF _Toc264448186 \h 21 HYPERLINK \l "_Toc264448187"Philippines Article 22(1)  PAGEREF _Toc264448187 \h 22 HYPERLINK \l "_Toc264448188"Poland Article 18(1)  PAGEREF _Toc264448188 \h 23 HYPERLINK \l "_Toc264448189"Portugal Article 23(1)  PAGEREF _Toc264448189 \h 24 HYPERLINK \l "_Toc264448190"Romania Article 20(1)  PAGEREF _Toc264448190 \h 25 HYPERLINK \l "_Toc264448191"Slovak Republic Article 21(1)  PAGEREF _Toc264448191 \h 26 HYPERLINK \l "_Toc264448192"Slovenia Article 20(1)  PAGEREF _Toc264448192 \h 27 HYPERLINK \l "_Toc264448193"Spain - Article 22(1)  PAGEREF _Toc264448193 \h 28 HYPERLINK \l "_Toc264448194"Thailand Article 22(1)  PAGEREF _Toc264448194 \h 29 HYPERLINK \l "_Toc264448195"Trinidad and Tobago Article 19(1)  PAGEREF _Toc264448195 \h 30 HYPERLINK \l "_Toc264448196"Tunisia - Article 20  PAGEREF _Toc264448196 \h 31 HYPERLINK \l "_Toc264448197"Venezuela Article 21(1)  PAGEREF _Toc264448197 \h 32  Bangladesh - Article 21(2) 1. I was a resident of Bangladesh on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Bangladesh in an amount not in excess of $8,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. For business apprentices only: The treaty exemption is available only for compensation paid during a period of two taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________________________________________ Date ________________________________________ Belgium - Article 19(1)(b) 1. I was a resident of Belgium on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Belgium in an amount not in excess of $9,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________________________________________ Date ________________________________________ Bulgaria - Article 19(1)(b) 1. I was a resident of Bulgaria on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Bulgaria in an amount not in excess of $9,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________________________________________ Date ________________________________________ China, Peoples Republic of Article 20(c) 1. I was a resident of the Peoples Republic of China on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am present in the United States solely for the purpose of my education or training. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and the Peoples Republic of China in an amount not in excess of $5,000 for any taxable year. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. I am claiming this exemption only for such period of time as is reasonably necessary to complete the education or training. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Cyprus Article 21(1) 1. I was a resident of Cyprus on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Cyprus in an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a student before the date of my arrival in the United States. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date, and for such additional period of time as is necessary to complete, as a full-time student, educational requirements as a candidate for a postgraduate or professional degree from a recognized educational institution. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Czech Republic Article 21(1) 1. I was a resident of Czech Republic on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Czech Republic in an amount not in excess of $5,000.00 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Egypt Article 23(1) 1. I was a resident of Egypt on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Egypt in an amount not in excess of $3,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date, and for such period of time as is necessary to complete, as a full-time student, educational requirements as a candidate for a postgraduate or professional degree from a recognized educational institution. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Estonia Article 20(1) 1. I was a resident of Estonia on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Estonia in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five years taxable years. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ France Article 21(1) 1. I was a resident of France on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and France in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five years taxable years. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________________ Date ________________________________________ THE GERMAN TREATY BENEFIT IS NO LONGER OFFERED BY MN STATE COLLEGES & UNIVERSITIES 1/1/14 Germany - Article 20(4) 1. I was a resident of the Federal Republic of Germany on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States as a student or business apprentice for the purpose of full-time study or training at (enter the full name of the college or university at which the alien studies) _______________________________________________________ OR I am temporarily present in the United States as a recipient of a grant, allowance, or award from (enter the name of the nonprofit organization or government institution providing the grant, allowance, or award ______________________________________________-____________________________________________________________________. 3. I will receive compensation for dependent personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and the Federal Republic of Germany in an amount not in excess of $9,000 for any taxable year, provided that such services are performed for the purpose of supplementing funds otherwise available for my maintenance, education, or training. 4. I arrived in the United States I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of four taxable years beginning with the taxable year that includes my arrival date.* Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ * It is recommended that students who plan to be in the U.S. for more than 4 years not claim this tax treaty benefit because if the student is in the U.S. for more than 4 years all their U.S. earned compensation is retroactively taxable. Iceland Article 19(1) 1. I was a resident of Iceland on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Iceland an amount not in excess of $9,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________ Date ________________________________________ Indonesia - Article 19(1) 1. I was a resident of Indonesia on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States solely for the purpose of study (enter the full name of the college or university at which the alien studies) _______________________________________________________; OR, I am temporarily present in the United States as a recipient of a grant, allowance, or award (enter the name of the nonprofit organization or government institution providing the grant, allowance, or award _________________________________________________________________________________________ for the primary purpose of study, research, or training. 3. I will receive compensation for services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Indonesia in an amount not in excess of $2,000 for any taxable year, provided such services are performed in connection with my studies or are necessary for my maintenance. 4. I arrived in the United States I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Israel Article 24(1) 1. I was a resident of Israel on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Israel in an amount not in excess of $3,000.00 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Korea, South Article 21(1) 1. I was a resident of South Korea on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and South Korea an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________ Date ________________________________________ Latvia Article 20(1) 1. I was a resident of Latvia on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Latvia in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five years taxable years. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Lithuania Article 20(1) 1. I was a resident of Lithuania on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Lithuania in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five years taxable years. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Morocco Article 18 1. I was a resident of Morocco on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies) _______________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Morocco in an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a student before the date of my arrival in the United States. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years, beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Netherlands Article 22(1) 1. I was a resident of the Netherlands on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Netherlands in an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Norway Article 16(1) 1. I was a resident of Norway on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Norway an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________ Date ________________________________________ Pakistan Article XIII(1) 1. I am a resident of Pakistan. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States solely as a student at (enter the full name of the college or university at which the alien studies) _______________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Pakistan in an amount not in excess of $5,000 for any taxable year. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Philippines Article 22(1) 1. I was a resident of the Philippines on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies) _________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and the Philippines in an amount not in excess of $3,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Poland Article 18(1) 1. I was a resident of Poland on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Poland an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________ Date ________________________________________ Portugal Article 23(1) 1. I was a resident of Portugal on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Portugal in an amount not in excess of $5,000.00 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Romania Article 20(1) 1. I was a resident of Romania on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Romania an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual__________________________________________________ Date ________________________________________ Slovak Republic Article 21(1) 1. I was a resident of Slovak Republic on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Slovak Republic in an amount not in excess of $5,000.00 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Slovenia Article 20(1) 1. I was a resident of Slovenia on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Slovenia in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a student before the date of my arrival in the United States. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date, and for such additional period of time as is necessary to complete, as a full-time student, educational requirements as a candidate for a postgraduate or professional degree from a recognized educational institution. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Spain - Article 22(1) 1. I was a resident of Spain on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying or training at (enter the full name of the college or university at which the alien studies) _________________________________________________________________________; 3. I will receive compensation for services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Spain in an amount not in excess of $5,000* for any taxable year. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ *NOTE: $5,000 exemption includes any amount excluded or exempted from tax under U.S. tax law. This means that the actual benefit is $5,000 less the current years personal exemption amount. Thailand Article 22(1) 1. I was a resident of Thailand on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________ 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Thailand in an amount not in excess of $3,000.00 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Trinidad and Tobago Article 19(1) 1. I was a resident of Trinidad and Tobago on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and, Trinidad and Tobago in an amount not in excess of $2,000 for any taxable year. I have not previously claimed an income tax exemption under this treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States. 4. I will be present in the United States only for such period of time as may be reasonably or customarily required to effectuate the purpose of this visit. 5. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five years taxable years. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Tunisia - Article 20 1. I was a resident of Tunisia on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the purpose of full-time study, training, or research at (enter the full name of the college or university at which the alien studies) _________________________________________________________________________; 3. I will receive compensation for services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Tunisia in an amount not in excess of $4,000 for any taxable year. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college/university): _________________________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. Signature of nonresident alien individual___________________________________ Date ________________________________________ Venezuela Article 21(1) 1. I was a resident of Venezuela on the date of my arrival in the United States. I am not a United States citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant. 2. I am temporarily present in the United States for the primary purpose of studying at (enter the full name of the college or university at which the alien studies)__________________________________________________________________________________. 3. I will receive compensation for personal services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and Venezuela in an amount not in excess of $5,000 for any taxable year. I have not previously claimed an income tax exemption under that treaty for income received as a student before the date of my arrival in the United States. 4. I arrived in the United States on (enter date alien arrived in the United States to begin studying at your college or university):_______________________________________________________________. The treaty exemption is available only for compensation paid during a period of five taxable years beginning with the taxable year that includes my arrival date, and for such additional period of time as is necessary to complete, as a full-time student, educational requirements as a candidate for a postgraduate or professional degree from a recognized educational institution. Tax year treaty being claimed for_________________; Under penalties of perjury, I declare that I have prepared this form and to the best of my knowledge and belief, it is true, correct, and complete. 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