Guide to Global Payroll Management - 2020 - D-187

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Appendix D--Federal Forms and Instructions

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 penalties of perjury
statement on line 10.

Attachments. If someone other than
the person signing Form 8802 prepares
an attachment that is submitted
independently of Form 8802, an
individual who has authority to sign
Form 8802 must sign and date the
attachment under penalties of perjury.
See Table 3.

Additional information. If you must
submit additional information 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
must include...
my knowledge and belief, the statements are true, correct, and complete."
is...
an individual
an individual
claiming treaty
benefits for
teaching or
research
activities

a partnership

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.

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
the individual

a statement from a
general partner

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

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.

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

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

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

a common trust
fund, grantor
trust, or simple
trust

any trust other
than a common
trust fund,
grantor trust, or
simple trust

a statement from
each individual
participant/owner/
beneficiary for
which certification
is requested
a statement from
the trustee with
authority to legally
bind the trust

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

[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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Instructions for Form 8802 (Rev. 11-2018)

D-187
Guide to Global Payroll Management - 2020

Table of Contents for the Digital Edition of Guide to Global Payroll Management - 2020
