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Form W-7

( Rev. January 2012)
Department of the Treasury Internal Revenue Service
Application for IRS Individual Taxpayer Identification Number
▶ For use by individuals who are not U. S. citizens or permanent residents.
▶ See instructions.
OMB No. 1545-0074
An IRS individual taxpayer identification number( ITIN) is for federal tax purposes only.
FOR IRS USE ONLY
Before you begin:
• Do not submit this form if you have, or are eligible to get, a U. S. social security number( SSN).
• Getting an ITIN does not change your immigration status or your right to work in the United States
and does not make you eligible for the earned income credit.
Reason you are submitting Form W-7. Read the instructions for the box you check. Caution: If you check box b, c, d,
e, f, or g, you must file a tax return with Form W-7 unless you meet one of the exceptions( see instructions).
a
Nonresident alien required to get ITIN to claim tax treaty benefit
b
Nonresident alien filing a U. S. tax return
c d e
U. S. resident alien( based on days present in the United States) filing a U. S. tax return
Dependent of U. S. citizen / resident alien
Enter name and SSN / ITIN of U. S. citizen / resident alien( see instructions)

} ▶

Spouse of U. S. citizen / resident alien
f
Nonresident alien student, professor, or researcher filing a U. S. tax return or claiming an exception
g
Dependent / spouse of a nonresident alien holding a U. S. visa
h
Other( see instructions) ▶
Additional information for a and f: Enter treaty country ▶
and treaty article number ▶
Name
1a First name
Middle name
Last name
( see instructions)
Name at birth if
1b First name
Middle name
Last name
different.
.
▶
2
Street address, apartment number, or rural route number. If you have a P. O. box, see separate instructions.
Applicant’ s
mailing address
City or town, state or province, and country. Include ZIP code or postal code where appropriate.
Foreign( non- U. S.) address( if different from above)( see instructions)
Birth information
Other information
Sign Here
3 Street address, apartment number, or rural route number. Do not use a P. O. box number.
City or town, state or province, and country. Include ZIP code or postal code where appropriate.
4
Date of birth( month / day / year)
Country of birth
City and state or province( optional)
5
Male Female
6a Country( ies) of citizenship
6b Foreign tax I. D. number( if any)
6c Type of U. S. visa( if any), number, and expiration date
6d Identification document( s) submitted( see instructions) Passport Driver’ s license / State I. D. USCIS documentation Other
Date of entry into the United States
Issued by: No.: Exp. date: / /( MM / DD / YYYY) / /
6e Have you previously received a U. S. temporary taxpayer identification number( TIN) or employer identification number( EIN)? No / Do not know. Skip line 6f. Yes. Complete line 6f. If more than one, list on a sheet and attach to this form( see instructions).
6f Enter: TIN or EIN ▶ and Name under which it was issued ▶
6g Name of college / university or company( see instructions) City and state
Length of stay
Under penalties of perjury, I( applicant / delegate / acceptance agent) declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I authorize the IRS to disclose to my acceptance agent returns or return information necessary to resolve matters regarding the assignment of my IRS individual taxpayer identification number( ITIN), including any previously assigned taxpayer identifying number.
Signature of applicant( if delegate, see instructions) Date( month / day / year) Phone number
▲
/
/
Keep a copy for your records.
Name of delegate, if applicable( type or print)
Delegate’ s relationship to applicant
Parent
Court-appointed guardian
Power of Attorney
Acceptance
Agent’ s
Use ONLY
Signature
Name and title( type or print)
Date( month / day / year)
/
/
Name of company
Phone
Fax
EIN
Office Code
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 10229L
Form W-7( Rev. 1-2012)
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