At the far-right of the top of the page are the words Page 5.Below this is a bolded line.Below this is the text: Additional information for (d) and (e): Name and SSN/ITIN of U.S. citizen/resident alien. Below this text is a line for the applicant to enter information.(f) Nonresident alien student, professor, or researcher filing a U.S. federal tax return or claiming an exception.(g) Dependent/Spouse of a nonresident alien holding a U.S. visa.(h) Other. To the right is a line for the applicant to enter information.Below this is the text: Additional information for (a) and (f): a line is to the right for the applicant to enter information.Below this is a box titled Treaty Country for the applicant to enter the information.To the right is a box titled Treaty Article number (SC13) for the applicant to enter the information.Below this is the text: You didn't provide your country of birth on Form W-7, line 4. Please provide your country of birth. A check box is to the right. Below this is a field titled: Country of birth (SC07) with space for the information to be entered.Below this is the text: You didn't provide country of citizenship on Form W-7, line 6a. Please provide your country of citizenship. A check box is to the right.Below this is a field titled: Country of citizenship (SC09) with space for the information to be entered.Below this is the text: You didn't provide your date of entry into the United States on Form W-7, line 6d. Please provide your date of entry into the United States. A check box is to the right.Below this is a field titled: Date of entry (MM/DD/YYYY) (SC19) with space for the information to be entered. Below this is the text: You didn't provide your foreign address on Form W-7, line 3. Please provide your foreign address. (You must use a street address; do not use a post office box or an In care of address). If you have permanently or temporarily given up your foreign residence to come to the United States, just enter the name of the country where you resided. A check box is to the right.Below this is a field titled: Address (number and street) with space to enter the information.To the right of this is a field titled: Apartment (if applicable). to the right of this is a field titled: Rural route numberBelow this is a field titled: City/State with space to enter the information.To the right of this is a field titled: Country with space to enter the information.To the right of this is a field titled: Zip code (SC04/05) with space to enter the informationBelow this the text: You didn't provide your date of birth on Form W-7, line 6c. Please provide your date of birth. A check box is to the right.Below this is a field titled: Date of birth (MM/DD/YYYY) (SC06) with space to enter the information.Below this is the text: You didn't provide information about your visa on Form W-7, line 6c. Please provide the following information about your visa. A check box is to the right. Below this is a field titled: Visa classification/type (SC12) with space to enter the information.To the right is a field titled: Number with space to enter the information.To the right is a field titled: Expiration date with space to enter the information.Below this the text: You didn't provide your U.S. mailing address. Please provide your U. S. mailing address. A check box is to the right.Below this is a field titled: Address (number and street) with space to enter the information.To the right is a field titled: Apartment (if applicable) with space to enter the information.To the right is a field titled: Rural Route number (if applicable) with space to enter the information.Below this is a field titled: City with space to enter the information.To the right is a field titled: State/Province with space to enter the information.To the right is a field titled: ZIP code (SC23) with space to enter the information. Below this is the text: You didn't indicate your country of citizenship (Form W-7, line 6a), and the country of birth (Form W-7, line 4). The U.S. Department of State must recognize the country of birth and citizenship. For a list of recognized countries, visit www.irs.gov and search for keyword Independent States in the World or Dependencies and Areas of Special Sovereignty. A check box is to the right.Below this is a field titled: Country of Citizenship (SC17/18) with space to enter the information.To the right is a field titled: Country of birth with space to enter the information.Below this is the text: You didn't provide the following information about the document you sent (Form W-7, line 6d). Please provide this information. A check box is to the right.Below this is a field titled: Type of document (SC11) with space to enter the information. To the right is a field titled: Country/State that issued document with space to enter the information. A check box is to the right. Below this is the text: You didn’t provide your ITIN and name under which it was issued (Form W-7, line 6f). Please provide the information in the spaces below. A check box is to the right. Below this is a field titled: ITIN with space to enter the information.To the right is a field titled: First name with space to enter the information.To the right is a field titled: Middle name with space to enter the information.To the right is a field titled: Last name with space to enter the information.Below this is a bolded line.Below this at the bottom of the form is the text Catalog Number 59848U, www.irs.gov., Form 14415 (Rev. 10-2016)