(Rev. November 2018)
Department of the Treasury
Internal Revenue Service
Application for United States
See separate instructions.
OMB No. 1545-1817
Important. For applicable user fee information, see the Instructions for Form 8802.
For IRS use only:
Additional request (see instructions) Foreign claim form attached
Pmt Amt $ .
Deposit Date: / /
Date Pmt Vrfd: / /
Electronic payment confirmation no.
Applicant’s name Applicant’s U.S. taxpayer identification number
If a joint return was filed, spouse’s name (see instructions)
If a separate certification is needed for spouse, check here
If a joint return was filed, spouse’s U.S. taxpayer
Applicant’s name and taxpayer identification number as it should appear on the certification if different from above
Applicant’s address during the calendar year for which certification is requested, including country and ZIP or postal code. If a P.O.
box, see instructions.
Mail Form 6166 to the following address:
Appointee Information (see instructions):
Applicant is (check appropriate box(es)):
Individual. Check all applicable boxes.
U.S. citizen U.S. lawful permanent resident (green card holder) Sole proprietor
Other U.S. resident alien. Type of entry visa
Current nonimmigrant status
and date of change (see instructions)
Dual-status U.S. resident (see instructions). From
Partial-year Form 2555 filer (see instructions). U.S. resident from
Partnership. Check all applicable boxes. U.S. Foreign LLC
Trust. Check if: Grantor (U.S.)
Simple Rev. Rul. 81-100 Trust
IRA (for Individual)
Grantor (foreign) Complex Section 584 IRA (for Financial Institution)
Corporation. If incorporated in the United States only, go to line 5. Otherwise, continue.
Check if: Section 269B Section 943(e)(1) Section 953(d) Section 1504(d)
Country or countries of incorporation
If a dual-resident corporation, specify other country of residence
If included on a consolidated return, attach page 1 of Form 1120 and Form 851.
Employee benefit plan/trust. Plan number, if applicable
Check if: Section 401(a) Section 403(b)
Exempt organization. If organized in the United States, check all applicable boxes.
Section 501(c) Section 501(c)(3) Governmental entity
Indian tribe Other (specify)
Disregarded entity. Check if: LLC LP LLP Other (specify)
Nominee applicant (must specify the type of entity/individual for whom the nominee is acting)
For Privacy Act and Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10003D
Form 8802 (Rev. 11-2018)