Ieee Vendor Add Form And Substitute Form W-8 Certificate Of Non-U.s. Status

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IEEE Operations Center

IEEE Vendor Add Form and

445 Hoes Lane

Piscataway, NJ 08854-4141

Substitute Form W-8

CERTIFICATE OF NON-U.S. STATUS

Part I – General Information

Individual

Company

Services are only provided outside of the U.S. Complete Part I only.

Name

U.S. Taxpayer Identification Number

(if any)

Permanent address (include apt. or suite no.)

City and province or state

Postal code and country

Current mailing address (if different from permanent address)

City and province or state

Postal code and country

Part II – Information and questions regarding your residence status:

Country of Citizenship:

Individuals complete (1), (2), and (3) below:

Questions to determine if you are a U.S. resident under U.S. tax rules:

(1) - Were you a lawful permanent resident of the U.S. at any time during the calendar year, that is;

held an immigrant visa (a green card)?

Yes

(2) - Were you physically present in the U.S. at least 31 days during the current calendar year?

Yes

If “yes,” How many days:

___________

(3) - If you answered “yes” to Question (2), do the total days you were present in the U.S. during the

current year (shown above), plus one-third of the days you were present in the prior year, plus one-

sixth of the days you were present in the second prior year equal or exceed 183 days?

Yes

If you answered yes to either Question #(1) or #(3) above, the individual must provide a U.S.

Taxpayer Identification Number or U.S. Federal Employer Identification Number.

Companies complete (4) and (5) below.

(4) - Are you a company based or located in the United States?

Yes

(5) - If you answered no to (4), are the payments you receive from us for services performed within

the United States? Yes

If the answer to (4) or (5) is yes, the company must provide a U.S. Federal Employer Identification #.

Part III

Certification

Under penalties of perjury, I certify that the information included on this form is true, correct

and complete.

Signature:

Date:

For IEEE Use only:

Mandatory: IEEE Staff Use Only

Supplier Number: ______________________________

Staff Name: ______________________________ Tel. Ext. _______

Site: ____________

Payment is for: Expense Reimbursement ___ Refund ___ Goods ___

Only IEEE Staff can submit this form directly

Services ___ Award ___ IEEE Foundation Supplier: Yes ___ No ___

to the IEEE Procurement Department

Reason for Add/Change: ________________________________________

General instructions for IEEE use only

IEEE Vendor Add Form and Substitute Form W-8 is required to be completed prior to making payment to a non U.S. person (individual, sole proprietor, or

partnership) or a non U.S. company. Part II of Form W-8 is not required to be completed for payments made for services performed outside of the United States

or for purchases of tangible property from a non-U.S. company. All W-8 forms completed by individuals must be signed. Digital and faxed signatures are

acceptable. Form W-8 is valid for three years from the date signed unless a change of circumstances makes the information on the form incorrect.

Substitute W-8 Form Revised May 2008