Information and Documentation Requirements Sample Clauses

Information and Documentation Requirements. IDENTIFICATION DOCUMENTATION REQUIRED: W-8BEN and copies of Passport and I-94 Departure Record. ………………………………………………………………………………………………………………………………………………………….. Tax Residency Status WHAT COUNTRY DID YOU LIVE IN PRIOR TO THIS U.S. VISIT? DID YOU PAY TAXES AS A RESIDENT OF THAT COUNTRY? YES NO DID YOUR TAX RESIDENCY IN THAT COUNTRY END PRIOR TO THIS VISIT TO THE U.S.? YES NO IF YES, DATE THAT TAX RESIDENCY ENDED …………………………………………………………………………………………………. Immigration Status VISA type: Issue Date: Expiration Date: Have you ever had another immigration status in the U.S.? YES NO Have you ever been present in the U.S. prior to this visit? YES NO This agreement is made by and between the Trustees of the University of Pennsylvania, a Pennsylvania tax-exempt educational corporation (“University”), and (“Individual”), and is effective as of this day of . The parties agree as follows:

Information and Documentation Requirements. IDENTIFICATION DOCUMENTATION REQUIRED: W-8BEN and copies of Visa (if applicable*), Passport Biographical Page, and U.S. Entry Stamp in Passport. ………………………………………………………………………………………………………………………………………………………….. Tax Residency Status WHAT COUNTRY DID YOU LIVE IN PRIOR TO THIS U.S. VISIT? DID YOU PAY TAXES AS A RESIDENT OF THAT COUNTRY? YES NO DID YOUR TAX RESIDENCY IN THAT COUNTRY END PRIOR TO THIS VISIT TO THE U.S.? YES NO IF YES, DATE THAT TAX RESIDENCY ENDED …………………………………………………………………………………………………. Immigration Status Visa Information for current visit to U.S.: Visa Issue Date Visa Expiration Date Have You Ever Had Another Immigration Status in the U.S.? Yes No Have you ever been present in the U.S. prior to this visit? Yes No If Yes, please complete the substantial presence test below ………………………………………………………………………………………………………………………………………………………….. Substantial Presence Test – determines the days you were present in the U.S. to verify tax residency. Additional information may be requested. ………………………………………………………………………………………………………………………………………………………….. Date you first entered the United Sates Please provide the days of presence in the US for the last 3 calendar years and all F, J, M, Q, and H visa periods. Date of U.S. Entry Month/Day/Year Date of U.S. Exit Month/Day/ Year Visa Month/Day/Year Classification Month/Day/Year Primary Activity Have you taken any tax treaty benefits? Y N Y N Y N Y N Y N Continued on next page ► 2016-11-11 Limited Engagement Agreement Nonresident Aliens Page 2of 2 ………………………………………………………………………………………………………………………………………………………. This agreement is made by and between the Trustees of the University of Pennsylvania, a Pennsylvania tax exempt educational corporation (“University”), and _(“Individual”), and is effective as of this day of , . The parties agree as follows:

Information and Documentation Requirements. IDENTIFICATION DOCUMENTATION REQUIRED: W-9 (for U.S. persons), W-8BEN, and Certificate of Foreign Source Income (non- U . S . persons only). ……………………………………………………………………………………………………………………………… This agreement is made by and between the Trustees of the University of Pennsylvania, a Pennsylvania tax exempt educational corporation (“University”), and (“Individual”), and is effective as of this day of . The parties agree as follows: