Form 8833 (Rev. 9-2017)
Page 4
or with respect to an interest in a
partnership or a simple or grantor trust,
and if the amounts do not total more
than $500,000 for the tax year.
Reporting specifically required by
Form 8833 instructions. The following
are amounts for which a treaty-based
return disclosure on Form 8833 is
specifically required under these
instructions.
• Amounts described in paragraph a or
c, above, that are received by a
corporation that is a resident under the
domestic law of both the United States
and a foreign treaty jurisdiction (a dual-
resident corporation).
• Amounts described in paragraph a or
c, above, that are received by a
corporation that is a resident of both the
jurisdiction whose treaty is invoked and
another foreign jurisdiction that has an
income tax treaty with that treaty
jurisdiction. See Revenue Ruling
2004-76, 2004-31 I.R.B. 111, available at
www.irs.gov/pub/irs-irbs/irb04-31.pdf.
• Amounts described in paragraph a or
c, above, that are received by a foreign
collective investment vehicle that is a
contractual arrangement and not a
person under foreign law. See Example 7
of Regulations section 1.894-1(d)(5).
• Amounts described in paragraph a or
c, above, that are received by a foreign
“interest holder” in a “domestic reverse
hybrid entity,” as those terms are used in
Regulations section 1.894-1(d)(2).
If you are an individual who is a
dual-resident taxpayer and you choose
to claim treaty benefits as a resident of
the foreign country, you are treated as a
nonresident alien in figuring your U.S.
income tax liability for the part of the tax
year you are considered a dual-resident
taxpayer. If you are eligible to be treated
as a resident of the foreign country
pursuant to the applicable income tax
treaty and you choose to claim benefits
as a resident of such foreign country,
attach Form 8833 to Form 1040NR, U.S.
Dual-resident taxpayer. An alien
individual is a dual-resident taxpayer if
that individual is considered to be a
resident of both the United States and
another country under each country’s
tax laws. If the income tax treaty
between the United States and the other
country contains a provision for
resolution of conflicting claims of
residence by the United States and its
treaty partner, and the individual
determines that under those provisions
he or she is a resident of the foreign
country for treaty purposes, the
individual may claim treaty benefits as a
resident of that foreign country, provided
that he or she complies with the
instructions below.
Nonresident Alien Income Tax Return, or
Form 1040NR-EZ, U.S. Income Tax
Return for Certain Nonresident Aliens
With No Dependents. In order to be
treated as a resident of the foreign
country, you must timely file (including
extensions) Form 1040NR or Form
1040NR-EZ with the Form 8833
attached. If you choose to be treated as
a resident of a foreign country under an
income tax treaty, you are still treated as
a U.S. resident for purposes other than
figuring your U.S. income tax liability
(see Regulations section
301.7701(b)-7(a)(3)).
When and Where To File
Attach Form 8833 to your tax return
(Form 1040NR, Form 1040NR-EZ, Form
1120-F, etc.). If you would not otherwise
be required to file a tax return, you must
file one at the IRS Service Center where
you would normally file a return to make
the treaty-based return position
disclosure under section 6114 (see
Regulations section 301.6114-1(a)(1)(ii))
or under Regulations section
301.7701(b)-7.
Specific Instructions
U.S. Taxpayer Identifying Number
The identifying number of an individual is
his or her social security number or
individual taxpayer identification number.
The identifying number of all others is
their employer identification number.
For more information about identifying
numbers, see the instructions for the tax
return with which this form is filed.
Reference ID Number
If the taxpayer is a foreign corporation,
enter any reference ID number assigned
to the foreign corporation by a U.S.
person with respect to which information
reporting is required (for example, on
Form 5471 or Form 5472).
Address in Country of Residence
Enter the information in the following
order: city, province or state, and
country. Follow the country’s practice for
entering the postal code. Please do not
abbreviate the country name.
Termination of U.S. Residency
If you are a dual-resident taxpayer and a
long-term resident (LTR) and you are
filing this form to be treated as a resident
of a foreign country for purposes of
claiming benefits under an applicable
U.S. income tax treaty, you will be
deemed to have terminated your U.S.
residency status for federal income tax
purposes. Because you are terminating
your U.S. residency status, you may be
subject to tax under section 877A and
you must file Form 8854, Initial and
Annual Expatriation Statement. You are
an LTR if you were a lawful permanent
resident of the United States in at least
8 of the last 15 tax years ending with the
year your status as an LTR ends. For
additional information, see the
Instructions for Form 8854, Initial and
Annual Expatriation Statement, and
Pub. 519, U.S. Tax Guide for Aliens.
Line 3
Income that is fixed or determinable
annual or periodical includes interest
(other than original issue discount),
dividends, rents, premiums, annuities,
salaries, wages, and other
compensation. For more information
(including other items of income that are
fix or determinable annual or periodical),
nonresident aliens and dual-resident
taxpayers filing as nonresident aliens
should see section 871(a) and
Regulations section 1.871-7(b) and (c).
Foreign corporations should see section
881(a) and Regulations section
1.881-2(b) and (c).
Line 4
Name the specific test in the Limitations
on Benefits (LOB) article that is met. See
Table 4, Limitation on Benefits, at
IRS.gov/Individuals/International-
Taxpayers/Tax-Treaty-Tables, for a
summary of the various tests contained
in the LOB article of each treaty. If you
have made a request with the U.S.
competent authority for a discretionary
determination and that request is still
pending, you may not claim benefits,
unless the treaty or technical explanation
specifically provides otherwise.
Line 5
If the taxpayer answers “Yes” to the
question on line 5, the taxpayer must
enter the subsection of Regulations
section 301.6114-1(b) with respect to
which the taxpayer is disclosing a treaty-
based return position. The taxpayer must
also provide the information requested
on line 6.
Line 6
All taxpayers taking a treaty-based return
position must provide the requested
information on line 6, regardless of
whether reporting is explicitly required
under Regulations section 301.6114-1(b),
unless it is waived under Regulations
section 301.6114-1(c). If applicable, the
taxpayer must explain why it meets the
Limitation on Benefits test identified on
line 4, the basis for the taxpayer meeting
any special requirements for claiming
benefits, such as those required to be
included on line 15 of Form W-8BEN-E,
and the amount (or a reasonable estimate
thereof) of the income affected by the
treaty claim. See Regulations section
301.6114-1(d)(3) regarding rules for
reporting estimates of certain types of
income, such as sales or services income.
