University of California Certificate of Foreign Status for Federal Tax Withholding (UC W-8BEN) ‘rs vores ete in cance wth rons of he nal Reva Cas apa ef mea Tr ray wl ‘rae oe steep Fax! wy oa ry aye you tec You aco hs frm eso eg ‘yet en te Uae soa, ttre #9 ngs ya emg ave yu Mo conpse ar ar. Tern ean Dn EEcaAi Dar end orp eset you ceteris Pee wee nto tele careng nen TUFTED kam ataucetne aban erry: Sa yuma tah ssap ote spa nce fom sprees ‘e-solcompi hs fom ou am a US CITZEN oe LAWFUL PERMANENT RESIDENT of be Unted Stata. you wean employes, our RESP REARS mantinacte ty wet Us eto or unl pemanon icon ‘SECTION A IDENTIFICATION OF PAYEE (se nsctons) hoes Fs a Tiree hie] — aS a Dube, Nikhil 19024693 (38-11-8154 Toma Tralee . Material Science and Engineering, UC Berkeley _| _ndube@mall.com Tmeny Sue Geshe Tsay Sars sheet eapoe Sa FeooD Reet Sonar Connder A Wonngeumse me US ou a ox cart Sen Aad Posed Sen 2533 Hilegass Avene, Apt #206 No 479, IT Campus Gy Sa Oe iy Fn Ca, Pease Berkeley, Ca, 94704 [GA Kanpur, tia. {SECTION 8. HEALTH INSURANCE INFORMATION Ra TUS Fea ssw Cr ow reco) Canes sea ac SHI ee Teorey aierama "aaa | Saas E omenciocsmneeremenctr| 97 a9:m07 06-18-2012 Spateamn neers “The tart esere a! eed orn waar ar eae ae be Gaudet x papas be 8 AG aon A HEE ‘Rex Tort bao sao ctor fasta neeey ste ‘S067 [a |witbem eS tae tant geen pe nm clr yox br wich ato bang Geimined, Yous a area Ccpectne | ric pupeste. Dorotconpel Spl poeedibsecinnG Bree | elena STUDENT onanFt 311401 nrg cancer niche om bag rope, ent toy hve buon yay pees ear sto er gan at rte or toca ean ‘ein te fur sar year yal procance the U Sim uc ne ee fr ry at cara ser ea 1 cot yoo pea alos Bere ur ber ya he at Meee ot toca nto a a ee Yea ent iy net ase enon, you geet san ox prune fr clr yn wih fm is compli. Do ‘aad sae ect | GEES [aan TEAGIER RESEARCHER or TRANEE on bo Ov, and wh pet candy med er Boscate | lenecamnarysrin nan tirlam ang pepocs | war plenty pen mie US. aan, el Oa yer Sop (ect aes es tse © vse tr lene nn eo gh yar Pe pean ha US eh ‘U3 lar any steno clean Joan rt, Me rt wn blue ahora sade ase researches, oF 08 tye ma hae condone yu srt alan rae prea ced year wh hsm seamed. Do Gens at © pos wantin Sesmienet apie. Pose Sip 27a rae ee Te Ee TE SRT Se ee eee recess Sr — per mar eu WeRE RONG — RESONANT REIT ETE Et wae a | Saae 2010 O1/01/10-12/31/10_ 365 xis 365 = 01/01/09-12/31/09 365 x = 122 aaa 06-0708, 62308-12108 er 4 son, “1 ‘SESTION E. SUMMARY OF FOREIGN STATUS FOR FEDERAL TAX WITHHOLDING 2 oskgees ra nt vst oye You mee nt Fed pups ea 2 cea yet syn et gene ES. You eek en Foot pie ermecaet ‘SECTION F_ CLOSER CONNECTION TEST nn ugh uml war pemce nt wrt re opr vet len Fecal i pzpein, ou mayb gene ‘Snrcocadion acagtan Pesse oul he eswsurs or arma rear dose connects expo {2 Yen guy fone ow coro xan nah tase nS Slants, rset Sesion (2 Wide tule coer cemwcin xcepn. Pees S00 ‘SECTION 6. CLAIM OF TAXTREATY BENEFIT Conpse fala, ahrsa pio osaaan) Pease nom ar ay | Bis coats i atone Peso eT a “he pyres tat you ete fan Unwaty y be g anexempnan Fesral x wong nr a ey btoen Uigemariy ty mete ye cg oman swan repay boy end we ge sn tx ampeen Peace oo oman bw County cenecn India Weeyhdde youre an eros an provi ssh ar wey eampn ta year RW oe Re Bey eer. ee ‘Sout x er nerson at ay aston poeg maureen ‘SECTION H. WORKING OUTSIDE THE US. (se isrcors) ‘am ot, on or paranere ec he US. ae at my sacs fr tm Urey Ca re permed Niateriat Seience esate BC Berle ‘SECTION, CERTIFICATION "cant ates on fom 6 ea coy rence get i, cra a cola unesd Pa fy iran | Saat ree = le om 12082008 SPREE Sa (Sse |S = Fam Ue WEN 10.03