Screen 8802-2 - Application for United States Residency Certification, Page 2 (1040)

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Tax period(s) of certification
Use this field or statement to enter the 4-digit year and 2-digit month (YYYYMM) that correspond to the end of the prior year tax period for which certification is requested. If the applicant is not required to file a U.S. tax return or is requesting certification for a tax period for which a tax return is not yet due, use the Form 8802 instructions for more information.
Purpose of certification
Use this field or statement to indicate the purpose of the certification.
note
  • Income tax: Enter
    X
    if the application is for income tax
  • NAICS code: If the application is for VAT, Enter the principal business or professional activity code in the field provided, use the NAICS code search lookup, or use the dropdown to make your selection. VAT certification requires a penalties of perjury statement.
  • Other purpose: Use this statement to explain the purpose of the certification.
Penalties of perjury statements and additional information
Use this statement to enter penalties of perjury statements, see the instruction for Line 10.

Form 8802 - Worksheet for U.S. Residency Certification

Use this section to enter the number of certifications (Forms 6166) requested for each country listed in columns A, B, C, and D.
Number of certifications and country
Use this statement to select the country and the number of certifications. For any country not listed, use the
Other countries not listed
field to enter the country code, country name, and the number of certifications.

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