W-7 Form

Form W-7 — Application for Individual Taxpayer Identification Number

1. Applicant Identification

Family name (Last):    Given name (First):

Middle name:    Name at birth (if different):

2. Mailing Address in the United States

3. Foreign Address (If different from mailing address)

4. Birth Information and Citizenship

Date of birth:    City of birth:    Country of birth:

Country(ies) of citizenship:

5. Additional Identification and Entry Information

Type of U.S. entry document (if applicable):    Entry date to U.S.:

6. Reason for Applying (check one box only)

a. Nonresident alien required to obtain an ITIN to claim treaty benefits or to file a U.S. tax return

b. Spouse or dependent of a U.S. citizen/resident filing a U.S. tax return

c. Nonresident student, professor, or researcher claiming treaty benefits or required to file

d. Other — explain below and state specific reason:

7. Supporting Documentation

Provide the documents that establish identity and foreign status. Check the documents included with this application:

Passport (standalone document establishing identity and foreign status)

National identification card (must show photo, name, current address, date of birth, and expiration)

Birth certificate

U.S. visa (if applicable)

8. Tax Return Information (if filing)

Are you submitting a U.S. tax return with this application?   Yes    No

9. Certification

Under penalties of perjury, I declare that I have examined the information on this application and to the best of my knowledge and belief it is true, correct, and complete. I further certify that I am not eligible to obtain a Social Security Number and that the documents submitted with this application support the identity and foreign status claimed.

Applicant daytime telephone number:    Applicant email address:

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