Form Form-8946 PTIN Supplemental Application for Foreign Persons Withou

Form 8946
(Sept 2010)

PTIN Supplemental Application For Foreign Persons
Without A Social Security Number

OMB Number
1545-xxxx

Do not submit this form if you have, or are eligible to get, a U.S. Social Security Number (SSN)
Name
1 First name
Middle Name
Last Name
(see instructions)
Applicant’s
2 Street address, Apt. number, or rural route number. If you have a P.O. box, see instructions.
Complete
Mailing
_____________________________________________________________________________
Address
City or town, state or province, and country. Include ZIP code or postal code where appropriate
_________________________________________________________________________________________
Applicant’s
3 Street address, apartment number, or rural route number. Do not use a P.O. box number
Complete
Permanent
Non-U.S.
________________________________________________________________________________
Address
City or town, state or province, and country. Include postal code when appropriate
(see instructions)
__________________________________________________________________________________
Birth
4 Date of birth (mm/dd/yyyy)l Country of birth
l 5 □ Male
Information
l
l
□ Female
Name at birth (if different from above)
First name
Middle name
Last name

Foreign Status
And Identification
Information
Sign
Here

6 Foreign status and identification document(s) submitted (see instructions) □ Passport
□ Foreign Driver’s License □ National ID Card
□ Foreign Voter’s Registration Card
□ U.S. Military ID Card □ Foreign Military ID Card □ Civil Birth Certificate □ U.S. Visa

Under penalty of perjury, I 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.
Signature of applicant
Date
Phone number
►__________________________________________________________________________________

For IRS Use Only