Research Corporation of the University of Hawaiʻi

Research Corporation
of the University of Hawai‘i
Human Resources Department
TAX TREATY STATEMENT FOR STUDENTS Czech Republic, Estonia, Latvia, Lithuania, and Slovak Republic
1. I was a resident of the ____________ [insert the name of the country under whose treaty you claim exemption] on the date of my arrival in the United States. 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 am temporarily present in the United states for the primary purpose of studying or training at ________________________________ [insert the name of the university or other recognized educational institution at which you study]; or, I am temporarily present in the United States as a recipient of a grant, allowance, or award from ______________________________[insert the name of the nonprofit organization or government institution providing the grant, allowance, or award].
3. I will receive compensation for services performed in the United States. This compensation qualifies for exemption from withholding of federal income tax under the tax treaty between the United States and _____________________________[insert the name of the country] in the amount not in excess of $5,000 ($10,000 if you are a participant in a government sponsored program of study not exceeding one year) for any tax year.
4. I arrived in the United States on _________________[insert the date of your last arrival in the United States before beginning study at the U.S. educational institution]. The $5,000 treaty exemption is available only for compensation paid during a period of five tax years beginning with the tax year that includes my arrival date.
______________________________________ _____________________ Name (please print) Date
____________________________________________ Signature