3 - U.S. 1040NR (Non- Resident Alien) Supplemental Checklist - Schedule B
Do Not Complete if you were a US Green Card Holder, US Resident or US Citizen throughout the year
Name
*
Mr.
Mrs.
Ms.
Dr.
Prefix
First Name
Middle Name
Last Name
Suffix
Tax Year of return and/or forms we need to complete for you
*
2023
2022
2021
2020
2019
Other
Days Spent in the USA
*
Tax Year
# of Days in US
Tax Year checked above
Prior Tax Year
Second Prior Tax Year
Were you previously a US Green Card Holder, Long Term US Resident or US Citizen?
*
NO
US Citizen
Green Card Holder
Long Term US Resident
Other
Date US Citizenship Lost, Green Card Surrendered or US Long-Term Residency Ceased
-
Month
-
Day
Year
Date
Indicate last US Visa type you possessed or unexpired Visa type on the last day of the year
*
NONE
Other
Expiry Date of Visa held at the end of the year or last expired Visa (If any)
-
Month
-
Day
Year
Date
# of Days you expect to be Physically present in the U.S. during the current year
*
Purpose of your Presence in the U.S.
*
No US Presence Days
Pleasure
Study
Business - Self Employed (No Company)
Employment - Canadian Employer (including your own Company)
Employment - US Employer (including your own Company)
Investment (including purchasing or selling rental or personal use Real Estate)
Other
What is the type of US Tax Return or Form you last filed (If any)
*
NONE
Form 1040
Form 1040NR
Form 8840 Closer Connection
Other
Do you Require a US Tax ID (ITIN)?
*
NO, I have a US Social Security Number or Unexpired ITIN
YES - Complete & Submit Form 3.1Information for ITIN Application
Did you have any of the following in the U.S. during the year - Provide details in space following :
Home
Immediate Family
Passenger Vehicle
Driver's License
Personal Belongings/ Furniture
Bank Accounts
Other Financial Accounts
Other
Types of US Source Income
Wages - W-2
Royalties - 1099/1042-S
Interest - 1099/1042-S
Social Security 1099-SSA
Pensions - 1099/1042-S
Scholarships - 1099/1042-S
Dividends - 1099/1042-S
Winnings - 1099/1042-S
Rental Real Estate - Complete Schedule E:
Business - Complete Schedule F:
Other
Type any other information that you think we should know in the box below:
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*
By drawing my signature in the box, I certify that the information provided is true, accurate & complete. I understand that if I submit the information by clicking the Green Submit Button that the information will be emailed to Bazar McBean and to me as a PDF. I understand that I may alternatively choose to print the information and submit it in an alternative manner.
*
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