2019
1042-S
Foreign Person’s U.S. Source Income Subject to Withholding
OMB No. 1545-0096
Form
Copy A
Go to www.irs.gov/Form1042S for instructions and the latest information.
for
Department of the Treasury
Internal Revenue Service
Internal Revenue Service
UNIQUE FORM IDENTIFIER
AMENDED
AMENDMENT NO.
1 Income
2 Gross income 3 Chapter indicator. Enter “3” or “4”
13e Recipient's U.S. TIN, if any
13f Ch. 3 status code
code
13g Ch. 4 status code
3a Exemption code
4a Exemption code
13h Recipient's GIIN
13i Recipient's foreign tax identification
13j LOB code
3b Tax rate
.
4b Tax rate
.
number, if any
5 Withholding allowance
6 Net income
13k Recipient's account number
7a Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) .
.
.
.
.
.
13l Recipient's date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a
partnership interest .
.
.
.
.
.
.
.
.
.
.
.
.
.
14a Primary Withholding Agent's Name (if applicable)
8 Tax withheld by other agents
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
14b Primary Withholding Agent's EIN
(
)
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
15a Intermediary or flow-through entity's EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code
11 Tax paid by withholding agent (amounts not withheld) (see instructions)
15d Intermediary or flow-through entity's name
12a Withholding agent's EIN
12b Ch. 3 status code 12c Ch. 4 status code
15e Intermediary or flow-through entity's GIIN
15f Country code
15g Foreign tax identification number, if any
12d Withholding agent's name
12e Withholding agent's Global Intermediary Identification Number (GIIN)
15h Address (number and street)
12f Country code
12g Foreign tax identification number, if any
15i City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street)
16a Payer's name
16b Payer's TIN
12i City or town, state or province, country, ZIP or foreign postal code
16c Payer's GIIN
16d Ch. 3 status code 16e Ch. 4 status code
13a Recipient's name
13b Recipient's country code
17a State income tax withheld
17b Payer's state tax no. 17c Name of state
13c Address (number and street)
13d City or town, state or province, country, ZIP or foreign postal code
1042-S
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(2019)
Cat. No. 11386R
2019
1042-S
Foreign Person’s U.S. Source Income Subject to Withholding
OMB No. 1545-0096
Form
Copy A
Go to www.irs.gov/Form1042S for instructions and the latest information.
for
Department of the Treasury
Internal Revenue Service
Internal Revenue Service
UNIQUE FORM IDENTIFIER
AMENDED
AMENDMENT NO.
1 Income
2 Gross income 3 Chapter indicator. Enter “3” or “4”
13e Recipient's U.S. TIN, if any
13f Ch. 3 status code
code
13g Ch. 4 status code
3a Exemption code
4a Exemption code
13h Recipient's GIIN
13i Recipient's foreign tax identification
13j LOB code
3b Tax rate
.
4b Tax rate
.
number, if any
5 Withholding allowance
6 Net income
13k Recipient's account number
7a Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) .
.
.
.
.
.
13l Recipient's date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a
partnership interest .
.
.
.
.
.
.
.
.
.
.
.
.
.
14a Primary Withholding Agent's Name (if applicable)
8 Tax withheld by other agents
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
14b Primary Withholding Agent's EIN
(
)
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
15a Intermediary or flow-through entity's EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code
11 Tax paid by withholding agent (amounts not withheld) (see instructions)
15d Intermediary or flow-through entity's name
12a Withholding agent's EIN
12b Ch. 3 status code 12c Ch. 4 status code
15e Intermediary or flow-through entity's GIIN
15f Country code
15g Foreign tax identification number, if any
12d Withholding agent's name
12e Withholding agent's Global Intermediary Identification Number (GIIN)
15h Address (number and street)
12f Country code
12g Foreign tax identification number, if any
15i City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street)
16a Payer's name
16b Payer's TIN
12i City or town, state or province, country, ZIP or foreign postal code
16c Payer's GIIN
16d Ch. 3 status code 16e Ch. 4 status code
13a Recipient's name
13b Recipient's country code
17a State income tax withheld
17b Payer's state tax no. 17c Name of state
13c Address (number and street)
13d City or town, state or province, country, ZIP or foreign postal code
1042-S
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form
(2019)
Cat. No. 11386R
2019
1042-S
Foreign Person’s U.S. Source Income Subject to Withholding
OMB No. 1545-0096
Form
Copy B
Go to www.irs.gov/Form1042S for instructions and the latest information.
Department of the Treasury
for Recipient
Internal Revenue Service
UNIQUE FORM IDENTIFIER
AMENDED
AMENDMENT NO.
1 Income
2 Gross income 3 Chapter indicator. Enter “3” or “4”
13e Recipient's U.S. TIN, if any
13f Ch. 3 status code
code
13g Ch. 4 status code
3a Exemption code
4a Exemption code
13h Recipient's GIIN
13i Recipient's foreign tax identification
13j LOB code
3b Tax rate
.
4b Tax rate
.
number, if any
5 Withholding allowance
6 Net income
13k Recipient's account number
7a Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) .
.
.
.
.
.
13l Recipient's date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a
partnership interest .
.
.
.
.
.
.
.
.
.
.
.
.
.
14a Primary Withholding Agent's Name (if applicable)
8 Tax withheld by other agents
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
14b Primary Withholding Agent's EIN
(
)
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
15a Intermediary or flow-through entity's EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code
11 Tax paid by withholding agent (amounts not withheld) (see instructions)
15d Intermediary or flow-through entity's name
12a Withholding agent's EIN
12b Ch. 3 status code 12c Ch. 4 status code
15e Intermediary or flow-through entity's GIIN
15f Country code
15g Foreign tax identification number, if any
12d Withholding agent's name
12e Withholding agent's Global Intermediary Identification Number (GIIN)
15h Address (number and street)
12f Country code
12g Foreign tax identification number, if any
15i City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street)
16a Payer's name
16b Payer's TIN
12i City or town, state or province, country, ZIP or foreign postal code
16c Payer's GIIN
16d Ch. 3 status code 16e Ch. 4 status code
13a Recipient's name
13b Recipient's country code
17a State income tax withheld
17b Payer's state tax no. 17c Name of state
13c Address (number and street)
13d City or town, state or province, country, ZIP or foreign postal code
1042-S
(keep for your records)
Form
(2019)
U.S. Income Tax Filing Requirements
Por regla general, todo extranjero no residente, todo organismo
fideicomisario extranjero no residente y toda sociedad anónima
Generally, every nonresident alien individual, nonresident alien
extranjera que reciba ingresos en los Estados Unidos, incluyendo
fiduciary, and foreign corporation with U.S. income, including income
ingresos relacionados con la conducción de un negocio o comercio
that is effectively connected with the conduct of a trade or business in
dentro de los Estados Unidos, deberá presentar una declaración
the United States, must file a U.S. income tax return. However, no
estadounidense de impuestos sobre el ingreso. Sin embargo, no se
return is required to be filed by a nonresident alien individual,
requiere declaración alguna a un individuo extranjero, una sociedad
nonresident alien fiduciary, or foreign corporation if such person was
anónima extranjera u organismo fideicomisario extranjero no
not engaged in a trade or business in the United States at any time
residente, si tal persona no ha efectuado comercio o negocio en los
during the tax year and if the tax liability of such person was fully
Estados Unidos durante el año fiscal y si la responsabilidad con los
satisfied by the withholding of U.S. tax at the source. Corporations file
impuestos de tal persona ha sido satisfecha plenamente mediante
Form 1120-F; all others file Form 1040NR. You may get the return
retención del impuesto de los Estados Unidos en la fuente. Las
forms and instructions at IRS.gov, at any U.S. Embassy or consulate,
sociedades anónimas envían el Formulario 1120-F; todos los demás
or by writing to: Internal Revenue Service, 1201 N. Mitsubishi
contribuyentes envían el Formulario 1040NR. Se podrá obtener
Motorway, Bloomington, IL 61705-6613.
formularios e instrucciones en IRS.gov y en cualquier Embajada o
En règle générale, tout étranger non-résident, tout organisme
Consulado de los Estados Unidos o escribiendo directamente a:
fidéicommissaire étranger non-résident et toute société étrangère
Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington,
percevant un revenu aux Etats-Unis, y compris tout revenu dérivé, en
IL 61705-6613.
fait, du fonctionnement d’un commerce ou d’une affaire aux Etats-
Im allgemeinen muss jede ausländische Einzelperson, jeder
Unis, doit produire une déclaration d’impôt sur le revenu auprès des
ausländische Bevollmächtigte und jede ausländische Gesellschaft mit
services fiscaux des Etats-Unis. Cependant aucune déclaration
Einkommen in den Vereinigten Staaten, einschliesslich des
d’impôt sur le revenu n’est exigée d’un étranger non-résident, d’un
Einkommens, welches direkt mit der Ausübung von Handel oder
organisme fidéicommissaire étranger non-résident, ou d’une société
Gewerbe innerhalb der Staaten verbunden ist, eine
étrangère s’ils n’ont pris part à aucun commerce ou affaire aux Etats-
Einkommensteuererklärung der Vereinigten Staaten abgeben. Eine
Unis à aucun moment pendant l’année fiscale et si les impôts dont ils
Erklärung, muss jedoch nicht von Ausländern, ausländischen
sont redevables, ont été entièrement acquittés par une retenue à la
Bevollmächtigten oder ausländischen Gesellschaften in den
source sur leur salaire. Les sociétés doivent faire leur déclaration
Vereinigten Staaten eingereicht werden, falls eine solche Person
d’impôt en remplissant le formulaire 1120-F; tous les autres
während des Steuerjahres kein Gewerbe oder Handel in den
redevables doivent remplir le formulaire 1040NR. On peut se procurer
Vereinigten Staaten ausgeübt hat und die Steuerschuld durch
les formulaires de déclarations d’impôts et les instructions y afférentes
Einbehaltung der Steuern der Vereinigten Staaten durch die
à IRS.gov et dans toutes les ambassades et tous les consulats des
Einkommensquelle abgegolten ist. Gesellschaften reichen den
Etats-Unis. L’on peut également s’adresser pour tout renseignement
Vordruck 1120-F ein; alle anderen reichen das Formblatt 1040NR ein.
à: Internal Revenue Service, 1201 N. Mitsubishi Motorway,
Einkommensteuererklärungen und Instruktionen können unter IRS.gov
Bloomington, IL 61705-6613.
und bei den Botschaften und Konsulaten der Vereinigten Staaten
eingeholt werden. Um weitere Informationen wende man sich bitte an:
Internal Revenue Service, 1201 N. Mitsubishi Motorway,
Bloomington, IL 61705-6613.
Explanation of Codes
34
Substitute payment—dividends
Box 1. Income Code.
40
Other dividend equivalents under IRC section 871(m)
Code
Types of Income
(formerly 871(l))
Interest paid by U.S. obligors—general
01
52
Dividends paid on certain actively traded or publicly offered
securities
1
Interest paid on real property mortgages
02
Interest paid to controlling foreign corporations
03
53
Substitute payments-dividends from certain actively traded or
publicly offered securities
1
Interest paid by foreign corporations
04
Interest on tax-free covenant bonds
05
09
Capital gains
10
22
Interest paid on deposit with a foreign branch of a domestic
Industrial royalties
corporation or partnership
11
Motion picture or television copyright royalties
Deposit Interest
29
12
Other royalties (for example, copyright, software,
broadcasting, endorsement payments)
Original issue discount (OID)
30
Short-term OID
31
13
Royalties paid on certain publicly offered securities
1
Substitute payment—interest
33
14
Real property income and natural resources royalties
51
15
Pensions, annuities, alimony, and/or insurance premiums
Interest paid on certain actively traded or publicly offered
securities
1
16
Scholarship or fellowship grants
17
Compensation for independent personal services
2
54
Substitute payments—interest from certain actively traded
1
or publicly offered securities
18
Compensation for dependent personal services
2
06
19
2
Dividends paid by U.S. corporations—general
Compensation for teaching
07
Dividends qualifying for direct dividend rate
08
Dividends paid by foreign corporations
See back of Copy C for additional codes
1
This code should only be used if the income paid is described in Regulations section 1.1441-6(c)(2) and withholding agent has reduced the rate of withholding under an
income tax treaty without the recipient providing a U.S. or foreign TIN.
2
If compensation that otherwise would be covered under Income Codes 17 through 20 is directly attributable to the recipient's occupation as an artist or athlete, use
Income Code 42 or 43 instead.
2019
1042-S
Foreign Person’s U.S. Source Income Subject to Withholding
OMB No. 1545-0096
Form
Copy C
Go to www.irs.gov/Form1042S for instructions and the latest information.
for Recipient
Department of the Treasury
Attach to any Federal tax return you file
Internal Revenue Service
UNIQUE FORM IDENTIFIER
AMENDED
AMENDMENT NO.
1 Income
2 Gross income 3 Chapter indicator. Enter “3” or “4”
13e Recipient's U.S. TIN, if any
13f Ch. 3 status code
code
13g Ch. 4 status code
3a Exemption code
4a Exemption code
13h Recipient's GIIN
13i Recipient's foreign tax identification
13j LOB code
3b Tax rate
.
4b Tax rate
.
number, if any
5 Withholding allowance
6 Net income
13k Recipient's account number
7a Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because
escrow procedures were applied (see instructions) .
.
.
.
.
.
13l Recipient's date of birth (YYYYMMDD)
7c Check if withholding occurred in subsequent year with respect to a
partnership interest .
.
.
.
.
.
.
.
.
.
.
.
.
.
14a Primary Withholding Agent's Name (if applicable)
8 Tax withheld by other agents
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
14b Primary Withholding Agent's EIN
(
)
15 Check if pro-rata basis reporting
10 Total withholding credit (combine boxes 7a, 8, and 9)
15a Intermediary or flow-through entity's EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code
11 Tax paid by withholding agent (amounts not withheld) (see instructions)
15d Intermediary or flow-through entity's name
12a Withholding agent's EIN
12b Ch. 3 status code 12c Ch. 4 status code
15e Intermediary or flow-through entity's GIIN
15f Country code
15g Foreign tax identification number, if any
12d Withholding agent's name
12e Withholding agent's Global Intermediary Identification Number (GIIN)
15h Address (number and street)
12f Country code
12g Foreign tax identification number, if any
15i City or town, state or province, country, ZIP or foreign postal code
12h Address (number and street)
16a Payer's name
16b Payer's TIN
12i City or town, state or province, country, ZIP or foreign postal code
16c Payer's GIIN
16d Ch. 3 status code 16e Ch. 4 status code
13a Recipient's name
13b Recipient's country code
17a State income tax withheld
17b Payer's state tax no. 17c Name of state
13c Address (number and street)
13d City or town, state or province, country, ZIP or foreign postal code
1042-S
Form
(2019)
Explanation of Codes (continued)
06
QI that assumes primary withholding responsibility
20
Compensation during studying and training
2
07
WFP or WFT
23
08
Other income
U.S. branch treated as U.S. Person
09
Territory FI treated as U.S. Person
24
Qualified investment entity (QIE) distributions of capital
gains
10
QI represents that income is exempt
25
11
Trust distributions subject to IRC section 1445
QSL that assumes primary withholding responsibility
12
Payee subjected to chapter 4 withholding
26
Unsevered growing crops and timber distributions by a trust
subject to IRC section 1445
22
QDD that assumes primary withholding responsibility
23
27
Publicly traded partnership distributions subject to IRC
Exempt under section 897(l)
section 1446
Chapter 4
28
Gambling winnings
3
13
Grandfathered payment
32
Notional principal contract income
4
14
Effectively connected income
35
15
Substitute payment—other
Payee not subject to chapter 4 withholding
36
Capital gains distributions
16
Excluded nonfinancial payment
37
Return of capital
17
Foreign Entity that assumes primary withholding
responsibility
38
Eligible deferred compensation items subject to IRC section
877A(d)(1)
18
U.S. Payees—of participating FFI or registered deemed-
compliant FFI
39
Distributions from a nongrantor trust subject to IRC section
877A(f)(1)
7
19
Exempt from withholding under IGA
41
Guarantee of indebtedness
20
Dormant account
8
21
Other—payment not subject to chapter 4 withholding
42
Earnings as an artist or athlete—no central withholding
agreement
5
Boxes 12b, 12c, 13f, 13g, 15b, 15c, 16d, and 16e. Withholding
Agent, Recipient, Intermediary, and Payer Chapter 3 and Chapter
43
Earnings as an artist or athlete—central withholding
4 Status Codes.
agreement
5
44
Specified federal procurement payments
Type of Recipient, Withholding Agent, Payer, or Intermediary
50
6
Code
Income previously reported under escrow procedure
55
Taxable death benefits on life insurance contracts
Chapter 3 Status Codes
01
U.S. Withholding Agent—FI
Boxes 3a and 4a. Exemption Code (applies if the tax rate entered
in box 3b or 4b is 00.00).
02
U.S. Withholding Agent—Other
Code
Authority for Exemption
03
Territory FI—treated as U.S. Person
Chapter 3
04
Territory FI—not treated as U.S. Person
01
Effectively connected income
05
U.S. branch—treated as U.S. Person
06
02
Exempt under IRC (other than portfolio interest)
U.S. branch—not treated as U.S. Person
03
07
U.S. branch—ECI presumption applied
Income is not from U.S. sources
04
Exempt under tax treaty
08
Partnership other than Withholding Foreign Partnership
05
09
Portfolio interest exempt under IRC
Withholding Foreign Partnership
See back of Copy D for additional codes
2
If compensation that otherwise would be covered under Income Codes 17 through 20 is directly attributable to the recipient's occupation as an artist or athlete, use
Income Code 42 or 43 instead.
3
Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.
4
Use appropriate Interest Income Code for embedded interest in a notional principal contract.
5
Income Code 43 should only be used if Letter 4492, Venue Notification, has been issued by the Internal Revenue Service (otherwise use Income Code 42 for earnings
as an artist or athlete). If Income Code 42 or 43 is used, Recipient Code 22 (artist or athlete) should be used instead of Recipient Code 16 (individual), 15 (corporation),
or 08 (partnership other than withholding foreign partnership).
6
Use only to report gross income the tax for which is being deposited in the current year because such tax was previously escrowed for chapters 3 and 4 and the
withholding agent previously reported the gross income in a prior year and checked the box to report the tax as not deposited under the escrow procedure. See the
instructions to this form for further explanation.
7
Use only to report a U.S. reportable account or nonconsenting U.S. account that is receiving a payment subject to chapter 3 withholding.
8
Use only if applying the escrow procedure for dormant accounts under Regulations section 1.1471-4(b)(6). If tax was withheld and deposited under chapter 3, do not
check box 7b (“tax not deposited with IRS pursuant to escrow procedure”). You must instead enter “3” in box 3 and complete box 3b.
ADVERTISEMENT