Prize/Award Packet for
Non-Residents Please follow the flow chart below to determine if this is the correct
packet for processing your payment
Are services required for you to
receive this prize or award?
Are you a current Northwestern
University employee or have you
been employed by Northwestern in
the past 12 months?
Is this prize or award REQUIRED to
be used for studying or training?
Are you a non-resident alien for tax
purposes? *if unsure contact Payroll
NO
Use Contracted Services Packet, Addi-
tional/ Special Pay Request Form, as
applicable.
NO
NO
YES
YES
YES
YES
NO
Use Additional /Special Pay Request
Form
Money that MUST be used for
studying or training is classified as
scholarship/fellowship income and paid
on an Appointment/Position Form
Prize payments for U.S. citizens,
permanent residents, and U.S. tax
residents should be processed through
Accounts Payable (unless currently
employed or in past 12 months, see
above)
Proceed with this payment packet for
Prizes & Awards
Northwestern University Payment Packet for Non-Resident Prizes and Awards Revised 06/18
The following forms and documents need to be submitted to Northwestern University for payment. Please make sure all of the forms are completely filled out.
Passport/I-94/Visa/Immigration Document – Please attach a copy of your foreign passport and I-94 arrival/departure record. Also attach a copy of your visa and immigration document, if you have one (for example I-20 for F-1 student, DS-2019 for J-1 student or researcher, etc.).. As long as no services are required for your receipt of the prize or award, any type of immigration status is eligible for payment.
W-8BEN Form - Certificate of Foreign Status - Please see instructions and treatycodes in the packet. You can only claim the tax treaty if you have a valid taxpayeridentification number.
Alien Tax Status Form- Tax residency form and substantial presence test information
Prize/Award Form for Non Residents – Fill out the top section down to the signature. The department official will complete the rest.
Please return the completed packet to the department/ person paying the prize. The department must add information to the packet and the payment cannot be processed without it.
If you have questions about….. Contact
Payment, when you will receive a check how to fill in paperwork, missing paperwork, or taxation
Diana MalishkevichNonresident Tax AnalystHR/Payroll Division720 University Place Evanston, IL 60208-1143 [emailprotected]
FORM W-8BEN
Certificate of Foreign Status
Enclosed is a copy of Form W-8BEN, Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding. All nonresident alien prize or award recipients must provide the University with a Social Security or Individual Taxpayer Identification number and certify foreign status by submitting a Form W-8BEN to the withholding agent. This form is also used to claim tax treaty benefits for Prize and Award payments, if applicable.
Listed below are the step by step instructions on how to complete the W-8BEN Form.
Please make sure to provide complete information to the fields listed below.
If you require complete instructions, please visit the IRS website http://www.irs.gov/pub/irs-pdf/iw8ben.pdf
1- Name: Enter the name of the individual receiving the royalty payment.2- Country of Incorporation or Organization: Country you are a tax resident of.3- Type of Beneficial Owner: Check off Individual.4- Permanent Address: Enter the permanent foreign address.5- Current Mailing Address: Enter a U.S. or current mailing address (if same as foreign address put same).6- U.S. Taxpayer Identification Number: Enter the Social Security or Individual Taxpayer Identification Number.9- a Check box A and enter country of tax residency.10- Put the treaty article number from the chart below. Enter Other Income under “specific type of income.”
Signature and Date: The nonresident alien must sign and date the form.
Prizes/Awards Tax Treaty Chart Residents of the following countries are eligible for exemption from United States and Illinois income taxes if they are receiving Prize or Award payments from Northwestern University. Tax treaties can only be applied after an individual has their U.S. taxpayer identification number (SSN or ITIN).
Treaty Articles are listed next to each country for inclusion on Form W8-BEN.
Austria- 21 Belgium- 20 Bulgaria - 20 Czech Republic- 22 Denmark - 21
Finland – 21 France – 21 Germany – 21 Hungary - 19 Iceland – 20
Ireland – 22 Italy – 22 Japan - 21 Latvia - 21 Lithuania - 21
Luxembourg – 21 Netherlands – 23 Russia – 19 Slovak Republic – 22 Slovenia – 21
So Africa – 21 Spain – 23 Sweden - 22 Switzerland – 21 Tunisia - 21
Turkey – 21 Ukraine – 21 United Kingdom - 22
Do NOT use this form if: Instead, use Form: • You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E
• You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9
• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S.(other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
• You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4
• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.
Part I Identification of Beneficial Owner (see instructions)
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
4 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)
Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of within the meaning of the income tax
treaty between the United States and that country. 10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income): .
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself for chapter 4 purposes,
• The person named on line 1 of this form is not a U.S. person,
• The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States,
(b) effectively connected but is not subject to tax under an applicable income tax treaty, or
(c) the partner’s share of a partnership's effectively connected income,
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty betweenthe United States and that country, and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner orany withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 daysif any certification made on this form becomes incorrect.
Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
Print name of signer Capacity in which acting (if form is not signed by beneficial owner)
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 1-2017)
1 Name of individual who is the beneficial owner 2 Country of citizenship
Form W-8BEN(Rev. January 2017)
Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)
▶ For use by individuals. Entities must use Form W-8BEN-E.▶ Information about Form W-8BEN and its separate instructions is at www.irs.gov/formw8ben.
▶ Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Department of the Treasury Internal Revenue Service
City or town, state or province. Include postal code where appropriate. Country
▲
NORTHWESTERN UNIVERSITY ALIEN TAX STATUS FOR PRIZES & AWARDS
Part A
Name: U.S. SSN or ITIN:
Country of Citizenship: Country of Tax Residence:
Part B (Residency Status)
PLEASE LIST ANY VISA/IMMIGRATION ACTIVITY IN THE LAST 3 CALENDAR YEARS
AND ALL F, M, J, OR Q VISITS SINCE 1985. Use an additional sheet of paper if necessary.
Date or Entry Date of Exit
Visa/Immigration
Status
J-1 subtype
(if applicable)
Primary Activity Have you taken
treaty benefits on
this status?
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
Part C - Type of Services
Part D- Treaty Benefits
To claim a tax treaty exemption, please answer the following questions:
Yes No
1- If your prize/award is covered by a treaty agreement between the United States and your home country, do you wish to claim exemption from United States and Illinois tax based on the treaty agreement? (Please complete Form W8-BEN)
I hereby certify under the penalties of perjury that all of the above information is true and correct. I understand that I must submit a new Alien Tax Status form if my status changes from that indicated on this form.
Signature of Alien
Date
IMPORTANT: If you wish to claim exemption from U.S. income taxes because your country of permanent residence has a tax treaty with the United States, please complete the attached IRS Form W8-BEN (Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding.
Please make sure to fill in this section completely (even if you think you are a non-resident alien). Incomplete information in this section will result in a delay in payment. This information will be used to verify tax residency.
Current Immigration status (i.e. F-1, J-1, H-1B, work permit):
Date you entered the U.S. in that status:
I am receiving a Prize or Award from Northwestern University
Prize/Award Form for Non-Residents Requestor Information Department: HRIS Department ID (6 digits): Check Address Code: Requestor: Phone: Email: @northwestern.edu
This form must be completed for each request for a prize or award. All checks will be delivered to the check address above
unless otherwise indicated. Prize/Award recipient information
Name: Amount of Prize or Award:
U.S. address or use hotel or lodging information
No & Street:
Apartment:
City, State Zip:
Description of Prize or Award:
Acknowledgement I understand that this payment is for a prize or award from Northwestern University. No services were completed in exchange for this money.
Signature:_____________________________________________ Date: __________________
University Payment Request
Expense Item Fund Dept Project Act Program Acct Amount
Prize/Award 75011
Addl. Chart String 75011
Total Payment
University Approvals I approve the payment for the prize or award noted above. The cost was incurred in conformance with the current policies and procedures of Northwestern University. If charged to a Sponsored Project account, it is understood and agreed that these expenditures are subject to review and audit and if found to be unallowable, they will be transferred to a non-sponsored departmental account. The payment requested includes only the payment associated with this prize or award and is not in payment for services, and is not in avoidance of immigration restrictions, Affirmative Action requirements, payment of fringe benefits, statutory taxes, fees, insurance premiums or any other applicable statutory employment regulation.
Approver Name (print) Signature Date
Principal Investigator or Hiring Representative
School or Center
OSR or Controller
OTHER PERTINENT INFORMATION FILING OF TAX RETURNS If you are a resident alien and earn taxable income, you must file Form 1040, a Form 1040EZ, or a Form 1040A with the Internal Revenue Service. These forms must be filed for each calendar year in which you have taxable earnings. If you are a nonresident alien and earn taxable income, you must file either a Form 1040NR or a 1040NR-EZ and form 8843 with the Internal Revenue Service. Northwestern University will issue you a 1042-A by March 15th of the following year to assist in preparing your tax return. The deadline for filing tax return Forms 1040, 1040EZ, 1040NR, 1040NR-EZ, and 1040A is April 15 for the previous calendar year ending on December 31. If all of your income was exempt under a tax treaty, you have until June 15th. You may obtain tax forms on-line at the IRS website. www.irs.gov If you need help in filing your federal income tax return, you may go to an office of the Internal Revenue Service for free assistance or you may hire a tax accountant. Generally, the newspapers contain advertisem*nts of several tax accountants at tax filing time. It is best to obtain a referral from a friend or associate. Be certain that you use someone who is familiar with the tax laws that apply to foreign citizens. Consult a telephone directory for the address of the Internal Revenue Service or Illinois Department of Revenue office nearest to you. Internal Revenue Service Publication 519, U.S. Tax guide for Aliens, may help you understand the U.S. tax law. You may obtain these publications by calling the Internal Revenue Service at 1-800-829-1040 or by visiting the IRS website.
