RCUH Policies and Procedures
TAX TREATY STATEMENTS FOR TEACHERS AND RESEARCHERS Belgium
1. I am a resident of Belgium. 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 visiting the United States for the purpose of teaching or engaging in research at _____________________________________ [insert the name of the educational or research institution at which you teach or perform research], for a period not exceeding two years. 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 __________) for these activities qualifies for exemption from withholding of federal tax under the tax treaty between the United States and Belgium.
4. Any research I perform will be undertaken in the public interest and not primarily for the private benefit of a specific person or persons.
5. I arrived in the United States on ________________ [insert the date of your last arrival in the United States before beginning the teaching or research 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