University of Pittsburgh
Payment Processing
Foreign National Information Form
for Non-Payroll Related Payments
Foreign National Tax Processing Unit
Payroll Department
University of Pittsburgh
207P Craig Hall
200 South Craig Street
Pittsburgh, PA 15260
Fax: 412-624-8072
Have we received a Foreign National information Form from you
already
The purpose of this form is to obtain additional information from foreign national payees so that the
University of Pittsburgh, as withholding agent, can determine if claims of tax treaty benefits by payees are
reasonable. If tax treaty benefits are available to the payee, information from the Foreign national
Information Form (F.N.I.F.) will be used by the University to prepare IRS forms 8233 or W8-BEN on behalf
of the payee. The payee will then review and certify the information on either form 8233 or W8-BEN, and
present to the University of Pittsburgh prior to payment.
PAYMENT ELIGIBILITY (Completed by Department and Accompanied by Form I-94)
I-94 Number of
International Visitor:
I-94 Expiration Date:
(Ex. 01-JAN-07)
Name of Department
Contact:
School or
Department:
Phone:
Fax: E-mail Address:
1.
Is this individual currently in the U.S.?
2. If you answered Yes to Question #1, does this
individual possess a Valid (unexpired) Form I-94
Arrival/Departure Record marked B-1, B-2, WB
or WT?
3.
Will this individual perform a "usual academic
activity or activities" that are for the benefit of the
University?
4.
Will this/these "usual academic activity or
activities" last longer than nine days?
5.
Has this individual accepted such payment or
expensesfrom more than five institutions or
organizations in the previous six-month period?
If you answered No to this question, please contact the Offiice of International
Services to discuss the individual's options before he/she enters the U.S. A
letter of invitation will be required and must include specific information.
If you answered Yes to this question and the individual is in B-2 or WT status,
and the event for which he/she is being offered the honorarium was arranged
before the individual traveled to the U.S., he/she is NOT eligible for this payment.
Please contact the Office of International Services immediately.
If you answered No this question, this individual may NOT receive any payment
from the University of Pittsburgh.
If you answeredYes to this question, this individual may NOT receive any
payment from the University of Pittsburgh.
If you answered Yes to this question, this individual may NOT receive any
payment from the University of Pittsburgh.
TREATY ELIGIBILITY (Completed by Payee)
Basic Information
Social Security Number or Individual
Taxypayer Identification Number:
If you do not have an SSN/ITIN
have you applied for one?
Department at Institution:
Home Phone in U.S.:
Day Phone in U.S.:
Date First Ever Entered U.S.:
(Example: 01-JAN-06)
E-mail Address:
If you answered Yes, you may simply
attach a copy of the ForeignNational
Information
Form from your prior visit.
If you answered No, please continue to
Personal Information
Date of Birth:
(Example: 01-JAN-02)
Spouse here in U.S.?:
Marital Status:
Spouse working in U.S.?:
(Disclosure of this information is mandatory, as required by IRS regulations, and will be used for tax reporting purposes only.)
Last Name:
First Name:
Middle Initial:
Yes
No
Yes No
Single
Married
Yes No
Yes No
Yes No
Yes
No
Yes No
Yes No
Yes
No
The purpose of this form is to obtain additional information from foreign national payees so that Liberty
University, as withholding agent, can determine if claims of tax treaty benefits by payees are reasonable.
If tax treaty benefits are available to the payee, information from the Foreign national Information Form
(F.N.I.F.) will be used by the University to prepare IRS forms 8233 or W8-BEN on behalf of the payee.
The payee will then review and certify the information on either form 8233 or W8-BEN, and present to
Liberty University prior to payment.
Liberty University
Purchasing Department
1971 University Blvd.
Lynchburg, VA 24502
Fax: 434-522-0424
If you answered No to this question, please contact the International
Specialist in HR to discuss the individual's options before he/she enters the
U.S. A letter of invitation will be required and must include specific
information.
If you answered Yes to this question and the individual is in B-2 or WT status,and
the event for which he/she is being offered the honorarium was arranged before the
individual traveled to the U.S., he/she is NOT eligible for this payment. Please
contact the International Specialist in HR.
If you answered No to this question, the individual mat NOT receive any payment
from the Liberty University.
If you answered Yes to this question, the individual mat NOT receive any
payment from the Liberty University.
If you answered Yes to this question, the individual mat NOT receive any
payment from the Liberty University.
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If you do not have any
dependents (not including
spouse) or if you are not
from any of the countries
listed here, skip to U.S.
Address below.
Number of dependents (not including spouse): [If none, write "0"]
Number
If you are a national of American Samoa, the Northern Mariana Islands, or the U.S. Virgin Islands,
or you are a tax resident of Canada or Mexico, enter your total number of dependents:
If you are a tax resident of Japan or the Republic of Korea (South), enter your total number of
dependents who were with you in the U.S. at some time in the calendar year:
If you are a resident of India who entered the U.S. for the primary purpose of studying, enter your
dependents who are U.S. citizens or residents:
U.S. Address:
Foreign Address:
Country Information:
Passport Expiration Date:
(Example: 01-JAN-07)
Visa Details:
Please list your current visa status in the first row. In the following rows, list all immigration activity in the
last three calendar years or any F, J, M, or Q visa immigration activity since 01-JAN-1985.
Visa Type/
Immigration
Status
Primary Purpose of
Visit
J-1 Subcategory
Country of Tax
Residence
Treaty Benefit
Taken As
Visa Number
First Day in
U.S.
Last Day in
U.S.
Other Information:
(Year Income)
Do you have an office regularly available to you in the U.S.?
Is this payment a Royalty?
If yes, how many days in this calendar year is the office
available to you?
Have you proven to the I.R.S. that you have a closer
connection to a foreign country than to the U.S.A.
Are you the recipient of a grant? (i.e. a non-service scholarship or
fellowship)
Have you submitted an application to become a U.S. lawful
permanent resident?
Is this payment an Award or Prize?
Are you engaged in a full-time program?
I hereby authorize the University of Pittsburgh to release information contained in this document
to Windstar Technologies, Inc., P.O. Box 800; 1504 Providence Hwy.;Suite 13; Norwood, MA
02062-0800 for the following purpose: technical support for the International Tax Navigator system.
I hereby certify that all of the above information is true, complete and correct. I
understand that if my status changes from that which I have indicated on this form
I must submit a new Foreign National Information Form to the Payroll Department.
Signature:
Today's Date:
Use U.S. Address for 1042S Mailer Slip?
Address Line 1:
Address Line 2:
Address Line 3:
Zip Code:City: State:
Use Foreign Address for 1042S Mailer Slip?
Address Line 1:
Address Line 2:
Address Line 3:
City:
Regional Postal Code:
Province/Region:
Country:
Country of Passport/Citizenship:
Passport Number:
Yes
No
Yes No
Yes No
Yes No
Yes No
Yes
No
Yes
No
If you are a tax resident of the Republic of Korea (South), enter your total number of dependents
who were with you in the U.S. at some time in the calendar year:
I hereby authorize Liberty University to release information contained in this document to Windstar
Technologies, Inc., P.O. Box 800; 1504 Providence Hwy.;Suite 13; Norwood, MA 02062-0800 for
the following purpose: technical support for the International Tax Navigator system.
I hereby certify that all of the above information is true, complete and correct. I understand
that if my status changes from that which I have indicated on this form I must submit a new
Foreign National Information Form to the Accounts Payable Department.
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