ÐÏࡱá>þÿ 13þÿÿÿ0ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥ÁÀ ð¿Êbjbj]W]W 4?=?=ºÿÿÿÿÿÿ·**„„„„„ÿÿÿÿ˜˜˜8Ð$ô˜‚2DDD$´²f²'„DDDDD'„„4<   DF„„ D  m•ÿÿÿÿ59’QÓÿÿÿÿŠŽ…íR0‚�Ö•„•XDD DDDDD''îDDD‚DDDDÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿDDDDDDDDD* J: SOCIAL SECURITY & MEDICARE TAX WITHHOLDING QUESTIONNAIRE FOR FOREIGN NATIONALS Holders of F-1, J-1, M-1 or Q-1 student visas can be temporarily exempted from withholding taxes from their salaries for U.S. Social Security and Medicare benefits if defined conditions are met. This questionnaire will help us determine if you are eligible for this exemption, or whether you must pay these withholding taxes. 1. When did you first enter the U.S. this time in F-1, J-1, Q-1 or M-1 status? __________________ Month, Year 2. Please list all high schools, colleges or universities which you have attended in F-1, J-1, Q-1 or M-1 student status, and your dates of attendance. Did you work and list the job? _____________________________________________ ________________________ Institution Name From (M/Y) To (M/Y) ___________________________________________________________________ ____________________________________ Institution Name From (M/Y) To (M/Y) ___________________________________________________________________ ____________________________________ Institution Name From (M/Y) To (M/Y) ___________________________________________________________________ ____________________________________ Institution Name From (M/Y) To (M/Y) I certify that the information given above is correct and complete to the best of my knowledge and information. If the information I have given is incorrect, I may be subject to immediate retroactive assessment of withholding taxes. I will immediately notify my HR Manager of any changes or errors in this information. I will file Form 8843 with my federal income taxes for each year an exemption is claimed. _________________________ ___________________________ ___________________ Name - printed Signature Date For HR/Payroll Use Only: FICA/Medicare withholding begins (circle one and fill in date if future): Immediately __________________ OR Future: January 1, 20___     >ENO]_bowÄÈêó” • – » Å Ë Í Ð Ý ä å ø ÿ ðãðÓÆº­£­™£­£Œ‚Œxg\Q\IQI\I\gh›`)CJaJhž•hž•CJaJhž•h81øCJaJ hÞ¨h81øCJOJQJ^JaJh81ø@ˆCJaJhž•@ˆCJaJhÞ¨h81ø@ˆCJaJh›`)@ˆCJaJhž•@ˆCJaJhÞ¨h81ø@ˆCJaJhÄYÖh81ø5�@ˆ\�háyÇ5�@ˆCJ\�aJhž•hž•5�@ˆCJ\�aJhž•h81ø@ˆCJaJhž•h81ø5�@ˆCJ\�aJ+O• – ø v Ê Ë  ? @ A « × Ø Ù C o p q õõæáØáµµµµµµµµµµµµµµ Ƙþ„˜þ^„˜þgdž•$ ÆÐ!„�„˜þ¤D¤D]„�`„˜þgd¦„˜þ^„˜þgdž•gd81ø„˜þ„˜þ¤h]„˜þ^„˜þgdž• $¤$a$gd81øÿ     g i l u w { ƒ ‰ ‹ © É Ê å ç ð ò   ( ) / 8 9 @ òäÓÉÁ¹®¦®Á¹Á˜Š®w®sosososg_gWgWh MCJaJhÉjNCJaJhÞ¨CJaJhÉjNh Mh¦CJaJh¦6�>*CJaJhÉjNh¦6�>*CJaJhÉjNh M6�>*CJaJháh>CJaJhÞ¨h MCJaJh›`)CJaJhž•CJaJhž•@ˆCJaJ hÄYÖh81øCJOJQJ^JaJh›`)CJOJQJ^JaJhž•CJOJQJ^JaJ@ A k m � ƒ … † ž § © ª « Â Ã È Ð Ñ Ø Ù       8 B C Z [ ` h i p q t ¡ £ µ ¶ Ï Ù Û ò ó ø  y ô õ ü +IJ¥¦ÀÕÜñÿ øðèðèðèðèðèðàèàðàðøðèðèðèðèðàèàðàðøØðèðèðèðàèàðàðÍÅÍÅÍÅͽµÅµ­µÅµÅµÅhÒECJaJhÞ¨CJaJhÐ(ÖCJaJhž•CJaJhÞ¨hÞ¨CJaJhì}CJaJhÞ¨CJaJhÉjNCJaJh MCJaJh�7CJaJCq Û   ¦§ñ/0z{º¼½¿ÀÂÃÅÆÇÈòòòòòòòòÝòòòòòÛÛÛÛÛÛÛÛÒÛ„àþ^„àþgd›`) Ƙþ„˜þ&d PÆÿ ^„˜þgdž• Ƙþ„˜þ^„˜þgdž•./0?PQz{–šœµ·º»½¾ÀÁÃÄÆÇÈÉÊóçÜÔɾ²§É¾Ÿ—¾É�‹�‹�‹�‹€|‹Éh|·hJm®h|·CJaJhß46jhß46Uh‰5<CJaJhž•CJaJhž•h�7CJaJhž•hÄYÖ6�CJaJhž•hÒECJaJhž•hÄYÖCJaJhì}CJaJhž•hS2ŽCJaJhž•hÞ¨5�CJaJhž•hÄYÖ5�CJaJÈÉÊýð Æ˜þ„˜þ^„˜þgdž•21�h:p›`)°Ð/ °à=!°"°#�ì$�ì%°°Ð°° �Ð^ 02ÀÐàð 0@P`p€�ÀÐàð2(Øè 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�ÀÐàð 0@P`p€�8XøV~_HmH nH sH tH J`ñÿJ 81øNormal 1$7$8$CJ_HaJmH sH tH DA òÿ¡D Default Paragraph FontRióÿ³R  Table Normalö4Ö l4Öaö (k ôÿÁ(No List 4ò4 Jm®Header  ÆàÀ!4 @4 Jm®0Footer  ÆàÀ!6þoòÿ6 áh>0 Footer CharCJaJPK!éÞ¿ÿ[Content_Types].xml¬‘ËNÃ0E÷Hüƒå-Jœ²@%é‚ÇŽÇ¢|ÀÈ™$ÉØ²§Uû÷LÒTB¨ l,Ù3÷ž;ãr½µÃ˜œ§J¯òB+$ëG]¥ß7OÙ­V‰�$ùãûÿ©«×îÇ !)OÚ^ýrÍC$ñy@“°íÝö/­yH*œ˜ñ„´½)‘Þµ�÷ß»Š×UDb‚`}"×qÛ‹”J×—–¤ÃX^æ)I`nÌEŒ¼Šp)øèÆli¹V[]Š1M<”àÈÞ�©OÐP“ô6râ=¯‰’zÀgb Ig…Áu��SÙebÖö€OÀ�†ä¾òÃRÁDÛ«™Ÿ·´qu ¯g‹˜Z°¶´®o~ÙºlAp°lxŠpT0­÷­+[}`j×ëõº½zAϰV–2ÍF­ÞÉi–@öqžv·Ö¬5\|‰þʜ̭N§Óle²X¢dsøµÚjcsÙÁ�Å7çð�Îf·»êà ÈâWçðý+­Õ†‹7 ˆÑä`­ÚïgÔ È˜³íJøÀ×j|†‚h(¢K³óD-еß㢠dXÑ©iJÆØ‡(îâx$(Ö ð:Á¥;ä˹!Í I_ÐTµ½S 1£÷êù÷¯ž?EÇž?øéøáÃã?ZBΪmœ„åU/¿ýìÏÇ£?ž~óòÑÕxYÆÿúÃ'¿üüy5Òg&΋/ŸüöìÉ‹¯>ýý»GðM�Geø�ÆD¢›äíó3Vq%'#q¾ÃÓòŠÍ$”8ÁšKýžŠôÍ)f™w9:ĵàå£ x}rÏx‰‰¢œw¢ØîrÎ:\TZaGó*™y8IÂjæbRÆíc|XÅ»‹Ç¿½I u3KGñnD1÷NIBÒsü€� íîRêØu—ú‚K>Vè.EL+M2¤#'šf‹¶i ~™Vé þvl³{u8«Òz‹ºHÈ Ì*„æ˜ñ:ž(W‘☕ ~«¨JÈÁTøe\O*ðtHG½€HYµæ–}KNßÁP±*ݾ˦±‹ŠTѼ�9/#·øA7ÂqZ…Ð$*c?�¢íqUßån†èwðNºû%Ž»O¯·ièˆ4 =3¾¼N¸¿ƒ)cbJ u§VÇ4ù»ÂÍ(TnËáâ 7”Ê_?®�ûm-Ù›°{UåÌö‰B½w²ÒzÏû¨nœ”ÇÊœ"Z úàxŠÕJÜZšìp;‹“Êì ØåÞ{/å<óP;™Ž,)''KÐQÛk5—›òqÚöÆpN†Ç8¯KÝGbÂe“¯„ ûS“ÙdùÌ›­\17 êpõaí>§°SR!Õ–‘ 3•…K4'+ÿrÌzQ TT£³I±²Áð¯Ivt]KÆc⫲³K#Úvö5+¥|¢ˆDÁ±‰ØÇà~ª O@%\w˜Š _ànN[ÛL¹Å9Kºò�˜ÁÙqÌÒgåV§hžÉn R!ƒy+‰ºUÊn”;¿*&å/H•rÿÏTÑû Ü>¬Ú>\ Œt¦´=.TÄ¡ ¥õûS; Zà~¦!¨à‚ÚüäPÿ·9gi˜´†C¤Ú§!ö# Bö ,™è;…X=Û»,I–2UW¦Vì9$l¨kàªÞÛ=A¨›j’•ƒ;î{–A£P79å|s*Y±÷Úø§;›Ì ”[‡MC“Û¿±hf»ª]o–ç{oY=1k³yV³ÒVÐÊÒþ5E8çVk+ÖœÆËÍ\8ðâ¼Æ0X4D)Ü!!ýö?*|f¿vè uÈ÷¡¶"øx¡‰AØ@T_²�ÒÒŽ q²ƒ6˜4)kÚ¬uÒVË7ë ît ¾'Œ­%;‹¿Ïiì¢9sÙ9¹x‘ÆÎ,ìØÚŽ-45xödŠÂÐ8?ÈǘÏdå/Y|t½ß &LILð�J`è¡& ù-G³tã/ÿÿPK! 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