Appendix D-Federal Forms and Instructions Page 3 Worksheet for U.S. Residency Certification Application Form 8802 (Rev. 11-2018) Applicant Name Applicant TIN Appointee Name (If Applicable) Calendar year(s) for which certification is requested (must be the same year(s) indicated on line 7) 11 Enter the number of certifications needed in the column to the right of each country for which certification is requested. Note. If you are requesting certifications for more than one calendar year per country, enter the total number of certifications for all years for each country (see instructions). Column A Column B Column C Column D Country CC # Country CC # Country CC # Country CC Armenia AM Finland FI Latvia LG South Africa SF Australia AS France FR Lithuania LH Spain SP Austria AU Georgia GG Luxembourg LU Sri Lanka CE Azerbaijan AJ Germany GM Mexico MX Sweden SW Bangladesh BG Greece GR Moldova MD Switzerland SZ Barbados BB Hungary HU Morocco MO Tajikistan TI Belarus BO Iceland IC Netherlands NL Thailand TH Belgium BE India IN New Zealand NZ Trinidad and Tobago TD Bermuda BD Indonesia ID Norway NO Tunisia TS Bulgaria BU Ireland EI Pakistan PK Turkey TU Canada CA Israel IS Philippines RP Turkmenistan TX China CH Italy IT Poland PL Ukraine UP Cyprus CY Jamaica JM Portugal PO United Kingdom UK Czech Republic EZ Japan JA Romania RO Uzbekistan UZ Denmark DA Kazakhstan KZ Russia RS Venezuela VE Egypt EG Korea, South KS Slovak Republic LO Estonia EN Kyrgyzstan KG Slovenia SI Column A - Total Column B - Total Column C - Total 12 Enter the total number of certifications requested (add columns A, B, C, and D of line 11) . # Column D - Total . . . . . . . . . ▶ Form 8802 (Rev. 11-2018) D-175