Research Corporation of the University of Hawaiʻi

Research Corporation
of the University of Hawai‘i
Human Resources Department
TAX TREATY STATEMENT FOR TEACHERS AND RESEARCHES Luxembourg
1. I am a resident of Luxembourg. I am not a U.S. citizen. I have not been lawfully accorded the privilege of residing permanently in the United States as an immigrant.
2. I have accepted an invitation by _____________________ [insert the name of the educational institution at which you teach or perform research], which is a recognized educational institution, to come to the United States for the purpose of teaching or engaging in research at that institution. I will receive compensation for my teaching or research activities.
3. The teaching or research compensation received during the entire tax year (or during the period from __________ to _________) qualifies for exemption from withholding of federal tax under the tax treaty between the United States and Luxembourg. I have not previously claimed an income tax exemption under that treaty for income received as a teacher, researcher, or student before the date of my arrival in the United States.
4. Any research I perform will not be carried on for the benefit of any person using or disseminating the results for purposes of profit.
5. IarrivedintheUnitedStateson____________[insertthedateofyourlastarrivalintothe United States before beginning the teaching services for which exemption is claimed]. The treaty exemption is available only for compensation received during a period of two years beginning on that date.
______________________________________ _____________________ Name (please print) Date
__________________________________________ Signature