RCUH Policies and Procedures
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