Form 1042-S

Department of the Treasury 

Internal Revenue Service

Foreign Person’s U.S. Source Income Subject to Withholding

Go to www.irs.gov/Form1042S for instructions and the latest information. 2024

UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.

OMB No. 1545-0096

Copy A for 

Internal Revenue Service

1 Income 

code

2 Gross income 3 Chapter indicator. Enter “3” or “4”

3a Exemption code

3b Tax rate .

4a Exemption code

4b Tax rate .

5 Withholding allowance

6 Net income

7a Federal tax withheld

7b Check if federal tax withheld was not deposited with the IRS because 

 escrow procedures were applied (see instructions) . . . . . .

7c Check if withholding occurred in subsequent year with respect to a 

 partnership interest . . . . . . . . . . . . . .

8 Tax withheld by other agents 

9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)

( )

10 Total withholding credit (combine boxes 7a, 8, and 9)

11 Tax paid by withholding agent (amounts not withheld) (see instructions)

12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code

12d Withholding agent’s name

12e Withholding agent’s Global Intermediary Identification Number (GIIN)

12f Country code 12g Foreign tax identification number, if any

12h Address (number and street)

12i City or town, state or province, country, ZIP or foreign postal code

13a Recipient’s name 13b Recipient’s country code

13c Address (number and street)

13d City or town, state or province, country, ZIP or foreign postal code

13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code

13g Ch. 4 status code

13h Recipient’s GIIN 13i Recipient’s foreign tax identification 

number, if any

13j LOB code 

13k Recipient’s account number

13l Recipient’s date of birth (YYYYMMDD)

14a Primary Withholding Agent’s Name (if applicable)

14b Primary Withholding Agent’s EIN

15 Check if pro-rata basis reporting 

15a Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

15d Intermediary or flow-through entity’s name

15e Intermediary or flow-through entity’s GIIN

15f Country code 15g Foreign tax identification number, if any

15h Address (number and street)

15i City or town, state or province, country, ZIP or foreign postal code

16a Payer’s name 16b Payer’s TIN

16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code

17a State income tax withheld 17b Payer’s state tax no. 17c Name of state

For Privacy Act and Paperwork Reduction Act Notice, see instructions. Cat. No. 11386R Form 1042-S (2024)
Form 1042-S

Department of the Treasury 

Internal Revenue Service

Foreign Person’s U.S. Source Income Subject to Withholding

Go to www.irs.gov/Form1042S for instructions and the latest information. 2024

UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.

OMB No. 1545-0096

Copy B 

for Recipient

1 Income 

code

2 Gross income 3 Chapter indicator. Enter “3” or “4”

3a Exemption code

3b Tax rate .

4a Exemption code

4b Tax rate .

5 Withholding allowance

6 Net income

7a Federal tax withheld

7b Check if federal tax withheld was not deposited with the IRS because 

 escrow procedures were applied (see instructions) . . . . . .

7c Check if withholding occurred in subsequent year with respect to a 

 partnership interest . . . . . . . . . . . . . .

8 Tax withheld by other agents 

9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)

( )

10 Total withholding credit (combine boxes 7a, 8, and 9)

11 Tax paid by withholding agent (amounts not withheld) (see instructions)

12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code

12d Withholding agent’s name

12e Withholding agent’s Global Intermediary Identification Number (GIIN)

12f Country code 12g Foreign tax identification number, if any

12h Address (number and street)

12i City or town, state or province, country, ZIP or foreign postal code

13a Recipient’s name 13b Recipient’s country code

13c Address (number and street)

13d City or town, state or province, country, ZIP or foreign postal code

13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code

13g Ch. 4 status code

13h Recipient’s GIIN 13i Recipient’s foreign tax identification 

number, if any

13j LOB code 

13k Recipient’s account number

13l Recipient’s date of birth (YYYYMMDD)

14a Primary Withholding Agent’s Name (if applicable)

14b Primary Withholding Agent’s EIN

15 Check if pro-rata basis reporting 

15a Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

15d Intermediary or flow-through entity’s name

15e Intermediary or flow-through entity’s GIIN

15f Country code 15g Foreign tax identification number, if any

15h Address (number and street)

15i City or town, state or province, country, ZIP or foreign postal code

16a Payer’s name 16b Payer’s TIN

16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code

17a State income tax withheld 17b Payer’s state tax no. 17c Name of state

(keep for your records) Form 1042-S (2024)
U.S. Income Tax Filing Requirements

Generally, every nonresident alien individual, nonresident alien 

fiduciary, and foreign corporation with U.S. income, including income 

that is effectively connected with the conduct of a trade or business in 

the United States, must file a U.S. income tax return. However, no 

return is required to be filed by a nonresident alien individual, 

nonresident alien fiduciary, or foreign corporation if such person was 

not engaged in a trade or business in the United States at any time 

during the tax year and if the tax liability of such person was fully 

satisfied by the withholding of U.S. tax at the source. Corporations file 

Form 1120-F; all others file Form 1040-NR. You may get the return 

forms and instructions at IRS.gov, at any U.S. Embassy or consulate, 

or by writing to: Internal Revenue Service, 1201 N. Mitsubishi 

Motorway, Bloomington, IL 61705-6613.

En règle générale, tout étranger non-résident, tout organisme 

fidéicommissaire étranger non-résident et toute société étrangère 

percevant un revenu aux Etats-Unis, y compris tout revenu dérivé, en 

fait, du fonctionnement d’un commerce ou d’une affaire aux EtatsUnis, doit produire une déclaration d’impôt sur le revenu auprès des 

services fiscaux des Etats-Unis. Cependant aucune déclaration 

d’impôt sur le revenu n’est exigée d’un étranger non-résident, d’un 

organisme fidéicommissaire étranger non-résident, ou d’une société 

étrangère s’ils n’ont pris part à aucun commerce ou affaire aux EtatsUnis à aucun moment pendant l’année fiscale et si les impôts dont ils 

sont redevables, ont été entièrement acquittés par une retenue à la 

source sur leur salaire. Les sociétés doivent faire leur déclaration 

d’impôt en remplissant le formulaire 1120-F; tous les autres 

redevables doivent remplir le formulaire 1040-NR. On peut se procurer 

les formulaires de déclarations d’impôts et les instructions y afférentes 

à IRS.gov et dans toutes les ambassades et tous les consulats des 

Etats-Unis. L’on peut également s’adresser pour tout renseignement 

à: Internal Revenue Service, 1201 N. Mitsubishi Motorway, 

Bloomington, IL 61705-6613.

Por regla general, todo extranjero no residente, todo organismo 

fideicomisario extranjero no residente y toda sociedad anónima 

extranjera que reciba ingresos en los Estados Unidos, incluyendo 

ingresos relacionados con la conducción de un negocio o comercio 

dentro de los Estados Unidos, deberá presentar una declaración 

estadounidense de impuestos sobre el ingreso. Sin embargo, no se 

requiere declaración alguna a un individuo extranjero, una sociedad 

anónima extranjera u organismo fideicomisario extranjero no 

residente, si tal persona no ha efectuado comercio o negocio en los 

Estados Unidos durante el año fiscal y si la responsabilidad con los 

impuestos de tal persona ha sido satisfecha plenamente mediante 

retención del impuesto de los Estados Unidos en la fuente. Las 

sociedades anónimas envían el Formulario 1120-F; todos los demás 

contribuyentes envían el Formulario 1040-NR. Se podrá obtener 

formularios e instrucciones en IRS.gov y en cualquier Embajada o 

Consulado de los Estados Unidos o escribiendo directamente a: 

Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington, 

IL 61705-6613.

Im allgemeinen muss jede ausländische Einzelperson, jeder 

ausländische Bevollmächtigte und jede ausländische Gesellschaft mit 

Einkommen in den Vereinigten Staaten, einschliesslich des 

Einkommens, welches direkt mit der Ausübung von Handel oder 

Gewerbe innerhalb der Staaten verbunden ist, eine 

Einkommensteuererklärung der Vereinigten Staaten abgeben. Eine 

Erklärung, muss jedoch nicht von Ausländern, ausländischen 

Bevollmächtigten oder ausländischen Gesellschaften in den 

Vereinigten Staaten eingereicht werden, falls eine solche Person 

während des Steuerjahres kein Gewerbe oder Handel in den 

Vereinigten Staaten ausgeübt hat und die Steuerschuld durch 

Einbehaltung der Steuern der Vereinigten Staaten durch die 

Einkommensquelle abgegolten ist. Gesellschaften reichen den 

Vordruck 1120-F ein; alle anderen reichen das Formblatt 1040-NR ein. 

Einkommensteuererklärungen und Instruktionen können unter IRS.gov 

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

Box 1. Income Code.

Code Types of Income Interest

01 Interest paid by U.S. obligors—general

02 Interest paid on real property mortgages

03 Interest paid to controlling foreign corporations

04 Interest paid by foreign corporations

05 Interest on tax-free covenant bonds

22 Interest paid on deposit with a foreign branch of a domestic 

corporation or partnership 

29 Deposit interest

30 Original issue discount (OID)

31 Short-term OID

33 Substitute payment—interest

51 Interest paid on certain actively traded or publicly offered 

securities1

54 Substitute payments—interest from certain actively traded 

or publicly offered securities1

Dividend06 Dividends paid by U.S. corporations—general

07 Dividends qualifying for direct dividend rate

08 Dividends paid by foreign corporations

Dividend

34 Substitute payment—dividends

40 Other dividend equivalents under IRC section 871(m) 

52 Dividends paid on certain actively traded or publicly offered 

securities1

53 Substitute payments-dividends from certain actively traded or 

publicly offered securities1

56 Dividend equivalents under IRC section 871(m) as a result of 

applying the combined transaction rules

Other

09 Capital gains

10 Industrial royalties

11 Motion picture or television copyright royalties

12 Other royalties (for example, copyright, software, 

broadcasting, endorsement payments)

13 Royalties paid on certain publicly offered securities1

14 Real property income and natural resources royalties

15 Pensions, annuities, alimony, and/or insurance premiums

16 Scholarship or fellowship grants

17 Compensation for independent personal services2

18 Compensation for dependent personal services2

19 Compensation for teaching2

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 the 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.
Form 1042-S

Department of the Treasury 

Internal Revenue Service

Foreign Person’s U.S. Source Income Subject to Withholding

Go to www.irs.gov/Form1042S for instructions and the latest information. 2024

UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.

OMB No. 1545-0096

Copy C for Recipient 

Attach to any Federal tax return you file

1 Income 

code

2 Gross income 3 Chapter indicator. Enter “3” or “4”

3a Exemption code

3b Tax rate .

4a Exemption code

4b Tax rate .

5 Withholding allowance

6 Net income

7a Federal tax withheld

7b Check if federal tax withheld was not deposited with the IRS because 

 escrow procedures were applied (see instructions) . . . . . .

7c Check if withholding occurred in subsequent year with respect to a 

 partnership interest . . . . . . . . . . . . . .

8 Tax withheld by other agents 

9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)

( )

10 Total withholding credit (combine boxes 7a, 8, and 9)

11 Tax paid by withholding agent (amounts not withheld) (see instructions)

12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code

12d Withholding agent’s name

12e Withholding agent’s Global Intermediary Identification Number (GIIN)

12f Country code 12g Foreign tax identification number, if any

12h Address (number and street)

12i City or town, state or province, country, ZIP or foreign postal code

13a Recipient’s name 13b Recipient’s country code

13c Address (number and street)

13d City or town, state or province, country, ZIP or foreign postal code

13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code

13g Ch. 4 status code

13h Recipient’s GIIN 13i Recipient’s foreign tax identification 

number, if any

13j LOB code 

13k Recipient’s account number

13l Recipient’s date of birth (YYYYMMDD)

14a Primary Withholding Agent’s Name (if applicable)

14b Primary Withholding Agent’s EIN

15 Check if pro-rata basis reporting 

15a Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

15d Intermediary or flow-through entity’s name

15e Intermediary or flow-through entity’s GIIN

15f Country code 15g Foreign tax identification number, if any

15h Address (number and street)

15i City or town, state or province, country, ZIP or foreign postal code

16a Payer’s name 16b Payer’s TIN

16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code

17a State income tax withheld 17b Payer’s state tax no. 17c Name of state

Form 1042-S (2024)
Explanation of Codes (continued) Other

20 Compensation during studying and training2

23 Other income

24 Qualified investment entity (QIE) distributions of capital 

gains

25 Trust distributions subject to IRC section 1445

26 Unsevered growing crops and timber distributions by a trust 

subject to IRC section 1445

27 Publicly traded partnership distributions subject to IRC 

section 1446(a)

28 Gambling winnings3

32 Notional principal contract income4

35 Substitute payment—other

36 Capital gains distributions

37 Return of capital

38 Eligible deferred compensation items subject to IRC section 

877A(d)(1)

39 Distributions from a nongrantor trust subject to IRC section 

877A(f)(1)

41 Guarantee of indebtedness

42 Earnings as an artist or athlete—no central withholding 

agreement5

43 Earnings as an artist or athlete—central withholding 

agreement5

44 Specified federal procurement payments

50 Income previously reported under escrow procedure6

55 Taxable death benefits on life insurance contracts

57 Amount realized under IRC section 1446(f)

58 Publicly traded partnership distributions—undetermined

Boxes 3a and 4a. Exemption Code (applies if the tax rate entered 

in box 3b or 4b is 00.00).

Code Authority for Exemption

Chapter 3

01 Effectively connected income

02 Exempt under IRC7

03 Income is not from U.S. sources

04 Exempt under tax treaty

05 Portfolio interest exempt under IRC

06 QI that assumes primary withholding responsibility

07 WFP or WFT

08 U.S. branch treated as U.S. Person

10 QI represents that income is exempt

11 QSL that assumes primary withholding responsibility

12 Payee subjected to chapter 4 withholding

22 QDD that assumes primary withholding responsibility

23 Exempt under section 897(l)

24 Exempt under section 892

Chapter 4

13 Grandfathered payment

14 Effectively connected income

15 Payee not subject to chapter 4 withholding

16 Excluded nonfinancial payment

17 Foreign Entity that assumes primary withholding 

responsibility

18 U.S. Payees—of participating FFI or registered deemedcompliant FFI

19 Exempt from withholding under IGA8

20 Dormant account9

21 Other—payment not subject to chapter 4 withholding

Boxes 12b, 12c, 13f, 13g, 15b, 15c, 16d, and 16e. Withholding 

Agent, Recipient, Intermediary, and Payer Chapter 3 and Chapter 

4 Status Codes.

Type of Recipient, Withholding Agent, Payer, or Intermediary

Code

Chapter 3 Status Codes

05 U.S. branch—treated as U.S. Person10

06 U.S. branch—not treated as U.S. Person11

07 U.S. branch—ECI presumption applied

08 Partnership other than Withholding Foreign Partnership or 

Publicly Traded Partnership

09 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 or publicly traded 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 This code should only be used if no other specific chapter 3 exemption code applies. 

8 Use only to report a U.S. reportable account or nonconsenting U.S. account that is receiving a payment subject to chapter 3 withholding. 

9 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.

10 This code can be used by a Territory FI that is treated as a U.S. person.

11 This code can be used by a Territory FI that is not treated as a U.S. person.
Form 1042-S

Department of the Treasury 

Internal Revenue Service

Foreign Person’s U.S. Source Income Subject to Withholding

Go to www.irs.gov/Form1042S for instructions and the latest information. 2024

UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.

OMB No. 1545-0096

Copy D for Recipient 

Attach to any state tax return you file

1 Income 

code

2 Gross income 3 Chapter indicator. Enter “3” or “4”

3a Exemption code

3b Tax rate .

4a Exemption code

4b Tax rate .

5 Withholding allowance

6 Net income

7a Federal tax withheld

7b Check if federal tax withheld was not deposited with the IRS because 

 escrow procedures were applied (see instructions) . . . . . .

7c Check if withholding occurred in subsequent year with respect to a 

 partnership interest . . . . . . . . . . . . . .

8 Tax withheld by other agents 

9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)

( )

10 Total withholding credit (combine boxes 7a, 8, and 9)

11 Tax paid by withholding agent (amounts not withheld) (see instructions)

12a Withholding agent’s EIN 12b Ch. 3 status code 12c Ch. 4 status code

12d Withholding agent’s name

12e Withholding agent’s Global Intermediary Identification Number (GIIN)

12f Country code 12g Foreign tax identification number, if any

12h Address (number and street)

12i City or town, state or province, country, ZIP or foreign postal code

13a Recipient’s name 13b Recipient’s country code

13c Address (number and street)

13d City or town, state or province, country, ZIP or foreign postal code

13e Recipient’s U.S. TIN, if any 13f Ch. 3 status code

13g Ch. 4 status code

13h Recipient’s GIIN 13i Recipient’s foreign tax identification 

number, if any

13j LOB code 

13k Recipient’s account number

13l Recipient’s date of birth (YYYYMMDD)

14a Primary Withholding Agent’s Name (if applicable)

14b Primary Withholding Agent’s EIN

15 Check if pro-rata basis reporting 

15a Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

15d Intermediary or flow-through entity’s name

15e Intermediary or flow-through entity’s GIIN

15f Country code 15g Foreign tax identification number, if any

15h Address (number and street)

15i City or town, state or province, country, ZIP or foreign postal code

16a Payer’s name 16b Payer’s TIN

16c Payer’s GIIN 16d Ch. 3 status code 16e Ch. 4 status code

17a State income tax withheld 17b Payer’s state tax no. 17c Name of state

Form 1042-S (2024)
Explanation of Codes (continued)

10 Trust other than Withholding Foreign Trust

11 Withholding Foreign Trust

12 Qualified Intermediary

13 Qualified Securities Lender—Qualified Intermediary

14 Qualified Securities Lender—Other

15 Corporation

16 Individual

17 Estate

18 Private Foundation

19 International Organization

20 Tax Exempt Organization (Section 501(c) entities)

21 Unknown Recipient

22 Artist or Athlete

23 Pension

24 Foreign Central Bank of Issue

25 Nonqualified Intermediary

26 Hybrid entity making Treaty Claim

35 Qualified Derivatives Dealer

36 Foreign Government—Integral Part

37 Foreign Government—Controlled Entity

38 Publicly Traded Partnership

39 Disclosing Qualified Intermediary

 Pooled Reporting Codes12

27 Withholding Rate Pool—General

28 Withholding Rate Pool—Exempt Organization

29 PAI Withholding Rate Pool—General

30 PAI Withholding Rate Pool—Exempt Organization

31 Agency Withholding Rate Pool—General

32 Agency Withholding Rate Pool—Exempt Organization

Chapter 4 Status Codes

01 U.S. Withholding Agent—FI

02 U.S. Withholding Agent—Other

03 Territory FI—not treated as U.S. Person

04 Territory FI—treated as U.S. Person

05 Participating FFI—Other

06 Participating FFI—Reporting Model 2 FFI

07 Registered Deemed-Compliant FFI—Reporting Model 1 FFI

08 Registered Deemed-Compliant FFI—Sponsored Entity

09 Registered Deemed-Compliant FFI—Other

10 Certified Deemed-Compliant FFI—Other

11 Certified Deemed-Compliant FFI—FFI with Low Value 

Accounts

12 Certified Deemed-Compliant FFI—Nonregistering Local 

Bank

13 Certified Deemed-Compliant FFI—Sponsored Entity

14 Certified Deemed-Compliant FFI—Investment Entity that 

does not maintain financial accounts

15 Nonparticipating FFI

16 Owner-Documented FFI

17 U.S. Branch—treated as U.S. person

18 U.S. Branch—not treated as U.S. person (reporting under 

section 1471)

19 Passive NFFE identifying Substantial U.S. Owners

20 Passive NFFE with no Substantial U.S. Owners

21 Publicly Traded NFFE or Affiliate of Publicly Traded NFFE

22 Active NFFE

23 Individual

24 Section 501(c) Entities

25 Excepted Territory NFFE

26 Excepted NFFE—Other

27 Exempt Beneficial Owner

28 Entity Wholly Owned by Exempt Beneficial Owners

29 Unknown Recipient

30 Recalcitrant Account Holder

31 Nonreporting IGA FFI

32 Direct reporting NFFE

33 U.S. reportable account

34 Nonconsenting U.S. account

35 Sponsored direct reporting NFFE

36 Excepted Inter-affiliate FFI

37 Undocumented Preexisting Obligation

38 U.S. Branch—ECI presumption applied

39 Account Holder of Excluded Financial Account13

40 Passive NFFE reported by FFI14

41 NFFE subject to 1472 withholding

50 U.S. Withholding Agent—Foreign branch of FI

 Pooled Reporting Codes

42 Recalcitrant Pool—No U.S. Indicia

43 Recalcitrant Pool—U.S. Indicia

44 Recalcitrant Pool—Dormant Account

45 Recalcitrant Pool—U.S. Persons

46 Recalcitrant Pool—Passive NFFEs

47 Nonparticipating FFI Pool

48 U.S. Payees Pool

49 QI-Recalcitrant Pool—GeneraI15

Box 13j. LOB Code (enter the code that best describes the 

applicable limitation on benefits (LOB) category that qualifies the 

taxpayer for the requested treaty benefits).

LOB Code LOB Treaty Category

02 Government – contracting state/political subdivision/local 

authority

03 Tax exempt pension trust/Pension fund

04 Tax exempt/Charitable organization

05 Publicly traded corporation

06 Subsidiary of publicly traded corporation

07 Company that meets the ownership and base erosion test

08 Company that meets the derivative benefits test

09 Company with an item of income that meets the active trade 

or business test

10 Discretionary determination

11 Other

12 No LOB article in treaty

12 Codes 27 through 32 should only be used by a QI, QSL, WP, or WT. A QI acting as a QDD may use only code 27 or 28.

13 This code should only be used if income is paid to an account that is excluded from the definition of financial account under Regulations section 1.1471-5(b)(2) or 

under Annex II of the applicable Model 1 IGA or Model 2 IGA.

14 This code should only be used when the withholding agent has received a certification on the FFI withholding statement of a participating FFI or registered deemedcompliant FFI that maintains the account that the FFI has reported the account held by the passive NFFE as a U.S. account (or U.S. reportable account) under its 

FATCA requirements. The withholding agent must report the name and GIIN of such FFI in boxes 15d and 15e.

15 This code should only be used by a withholding agent that is reporting a payment (or portion of a payment) made to a QI with respect to the QI’s recalcitrant account holders.