Contract Coverage Under Title II OMB No. 1545-0137

of the Social Security Act

Form 2032

(Rev. July 1998)

File three copies (For use by an American employer to extend social security coverage to of this form U.S. citizens and residents employed by its foreign affiliates.) Department of the Treasury

Internal Revenue Service

Name of American employer Employer identification number

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

This Form 2032 is filed as (check applicable box(es)):

An original (new) agreement.

This agreement is effective for services performed on and after (for original agreements only, check one):

The first day of the calendar quarter in which the service center director signs this agreement.

The first day of the calendar quarter following the calendar quarter in which the service center director signs this agreement.

An amendment to an agreement previously entered into.

An election to apply the rules in effect after April 20, 1983, to agreements in effect on that date. By making this election,

U.S. resident aliens as well as U.S. citizens will be covered by social security.

If this is an amended election or agreement, provide the following information:

on

(Location where previous Form 2032 was filed) (Date service center director signed original agreement on Form 2032)

This agreement extends the Federal insurance system under Title II of the Social Security Act to certain services performed outside the

United States by U.S. citizens and resident aliens employed by any of the foreign affiliates listed below. For an amendment to an agreement

without making the election to apply the post-April 20, 1983, rules, this amendment extends Title II social security coverage to certain

services performed outside the United States by U.S. citizens employed by any of the foreign affiliates listed below.

1 Name and address of foreign affiliate 3 Name and address of foreign affiliate

2 Name and address of foreign affiliate 4 Name and address of foreign affiliate

Note: If this agreement includes more than four foreign affiliates, attach a separate sheet of paper identified as a part of this agreement

with the name and address of each additional foreign affiliate.

Estimated number of employees to be initially covered by this agreement, amendment, or election:

Nonagricultural employees © Agricultural employees ©

This agreement applies to all services performed outside the United States by each U.S. citizen or resident employed by any of the foreign

affiliates named. However, the agreement applies to such services only to the extent that payments to each employee for the services would be

considered wages if paid by the employer for services performed in the United States. This agreement does not apply to any service that is

considered employment for purposes of the employee tax and the employer tax under the Federal Insurance Contributions Act.

For an original agreement, an amendment to an agreement that was entered into after April 20, 1983, or an election to apply the rules in effect after

April 20, 1983, to agreements in effect on that date, the American employer declares that it owns at least a 10% interest (directly or through one or

more entities) in the voting stock or profits of each foreign entity named above. It also declares that Code section 3121(l) does not prevent this agreement.

For an amendment to an agreement in effect on April 20, 1983, without making the election to apply the new rules in effect after that date, the

domestic corporation declares that (a) it owns at least 20% of the voting stock of each foreign corporation named above, or (b) it owns at least

20% of the voting stock of a foreign corporation that owns more than 50% of the voting stock of each foreign corporation named above. It also

declares that Code section 3121(l) does not prevent this agreement.

The American employer agrees:

1. To pay amounts equal to the taxes that would be imposed by Code sections 3101 and 3111 if the payment for the services were considered

wages;

2. To pay, on written notification and demand, amounts equal to the interest, additions to taxes, and penalties that would apply if the payment

for the services were considered wages; and

3. To comply with all regulations under Code section 3121(l).

This agreement (or amended agreement or election) is entered into under the provisions of section 3121(l) of the Internal Revenue Code and the

applicable regulations.

Signature of individual authorized to enter into this Title Date

agreement for American employer

Director, Internal Revenue Service Center Location Date

For Privacy Act and Paperwork Reduction Act Notice, see back of form. Cat. No. 49954D Form 2032 (Rev. 7-98)
Form 2032 (Rev. 7-98) Page 2

Privacy Act and Paperwork Reduction Act

Notice. We ask for the information on this form

to carry out the Internal Revenue laws of the

United States. We need it to figure and collect

the right amount of tax. Section 6109 requires

you to provide your taxpayer identification

number (SSN or EIN). Section 3121 of the

Internal Revenue Code allows employees of

foreign affiliates to be covered under social

security. Routine uses of this information include

giving it to the Social Security Administration for

use in calculating social security benefits, the

Department of Justice for civil and criminal

litigation, and cities, states and the District of

Columbia for use in administering their tax laws.

We may also give the information to foreign

countries under tax treaties. If you want this

coverage, you are required to give us this

information. If you fail to provide this information

in a timely manner, or you provide incorrect or

fraudulent information, you may be denied this

coverage and you may be liable for penalties

and interest.

Completing Form 2032

Complete Form 2032 in triplicate. Each copy of

the form must be signed and dated by the

individual authorized to enter into the agreement,

amendment, or election. Attach to each form

evidence showing the authority for the individual

to sign the form. Corporations must include a

certified copy of the minutes of the board of

directors’ meeting.

For this agreement, an American employer is

an employer that is (a) the United States or any

of its agencies, (b) an individual who is a

resident of the United States, (c) a partnership if

two-thirds or more of the partners are residents

of the United States, (d) a trust if all the trustees

are residents of the United States, or (e) a

corporation organized under the laws of the

United States or of any state.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time is:

Recordkeeping 2 hr., 9 min.; Learning about

the law or the form 24 min.; Preparing and

sending the form to the IRS 27 min. If you

have comments concerning the accuracy of

these time estimates or suggestions for making

this form simpler, we would be happy to hear

from you. You can write to the Tax Forms

Committee, Western Area Distribution Center,

Rancho Cordova, CA 95743-0001. DO NOT

send the form to this address. Instead, see

Where To File above.

After the director of the Internal Revenue

Service Center signs and dates the form, it

constitutes the agreement, amendment, or

election authorized by section 3121(l). The IRS

will return one copy of Form 2032 to the

American employer, send one copy to the Social

Security Administration, and keep one copy with

all related papers.

Where To File

Original agreements. Check the box for an

original (new) agreement. Also check the

applicable box to designate when the agreement

will take effect.

File three copies of this form with the Internal

Revenue Service Center shown below for the

state where the American employer’s principal

place of business is located. (An American

employer already filing Form 941, Employer’s

Quarterly Federal Tax Return, should file Form

2032 with the Internal Revenue Service Center

where the employer files Form 941.)

Amending agreements. You may amend an

agreement at any time to extend coverage to

any foreign affiliate not covered by an existing

agreement. File Form 2032 in triplicate, and

check the box on the form to signify an

amendment. If you amend an agreement entered

into on or before April 20, 1983, without making

the election to apply the rules in effect after that

date, the agreement and amendments will

continue to be governed by the rules in effect

before April 21, 1983.

General Instructions

Section references are to the Internal Revenue

Code.

Effective date. If you file an amendment to an

agreement on Form 2032 to include foreign

affiliates not previously covered, and if the

service center director signs the amendment

during the quarter for which the original

agreement is first effective or during the first

month following that quarter, the amendment will

be effective as of the effective date of the

original agreement. But if the amendment is

signed by the service center director after the

end of the 4th month for which the original

agreement is in effect, the amendment will not

be effective until the 1st day of the quarter

following the one in which the service center

director signed the amendment.

After April 20, 1983, any American employer (no

longer limited to a domestic corporation) can

enter into this agreement to cover U.S. resident

aliens as well as U.S. citizens employed by a

foreign affiliate. For this agreement, a foreign

affiliate is any foreign entity (no longer limited to

a foreign corporation) in which the American

employer owns at least a 10% interest in the

voting stock or profits. This interest must be

owned directly or through one or more entities.

Election to apply post-April 20, 1983, rules. A

domestic corporation having an agreement in

effect that was entered into before April 21,

1983 (old agreement), may elect to have the

rules in effect after April 20, 1983, apply to the

old agreement. File Form 2032 in triplicate, and

check the box that applies.

A domestic corporation having an agreement

in effect that was entered into before April 21,

1983, can now elect to apply the post-April 20,

1983, rules to such agreements. See

Completing Form 2032 below.

Alaska, Arizona, California

(counties of Alpine, Amador,

Butte, Calaveras, Colusa,

Contra Costa, Del Norte, El

Dorado, Glenn, Humboldt,

Lake, Lassen, Marin,

Mendocino, Modoc, Napa,

Nevada, Placer, Plumas,

Sacramento, San Joaquin,

Shasta, Sierra, Siskiyou,

Solano, Sonoma, Sutter,

Tehama, Trinity, Yolo, and

Yuba), Colorado, Idaho,

Montana, Nebraska, Nevada,

North Dakota, Oregon, South

Dakota, Utah, Washington,

Wyoming

If you make this election, it will be effective for

all foreign entities covered by the agreement. By

making the election, U.S. resident alien

employees as well as U.S. citizen employees will

be covered by the agreement.

Ogden, UT 84201

To extend coverage to any foreign entity not

covered by an agreement, indicate the name and

address of the foreign entity on the form in the

space provided and check the box for the

election and the box for the amended agreement. California (all other counties),

Hawaii Fresno, CA 93888

Note: The United States has social security

(totalization) agreements with several countries

so that social security taxes are paid to only one

country. These agreements may affect the

withholding requirements resulting from filing

Form 2032. See Social Security and Medicare

Taxes in Pub. 54, Tax Guide for U.S. Citizens

and Resident Aliens Abroad.

Alabama, Arkansas,

Louisiana, Mississippi, North

Carolina, Tennessee

Effective date. Generally, the election will be

effective on the day following the quarter in

which the election is signed by the service

center director.

Memphis, TN 37501

American employers in Guam, American

Samoa, the Virgin Islands, or Puerto Rico should

file this form with the U.S. Internal Revenue

Service Center, Philadelphia, PA 19255.

No Termination of Agreement

Once you enter into an agreement, it cannot be

terminated. This provision applies to agreements

in effect on or after June 15, 1989, for which no

notice of termination was in effect on that date.

Purpose of form. An American employer should

use this form to (a) enter into the agreement

specified in section 3121(l) to extend coverage

under Title II of the Social Security Act to U.S.

citizens and resident aliens employed abroad by

foreign affiliates, (b) amend a previous

agreement, or (c) elect to apply the rules in

effect after April 20, 1983, to agreements in

effect on that date.

You are not required to provide the

information requested on a form that is subject

to the Paperwork Reduction Act unless the form

displays a valid OMB control number. Books or

records relating to a form or its instructions must

be retained as long as their contents may

become material in the administration of any

Internal Revenue law. Generally, tax returns and

return information are confidential, as required

by Code section 6103.

Use the following

Internal Revenue

Service Center address

If your principal

place of business

is located in

Florida, Georgia, South

Carolina Atlanta, GA 39901

New Jersey, New York (New

York City and counties of

Nassau, Rockland, Suffolk,

and Westchester)

Holtsville, NY 00501

New York (all other counties),

Connecticut, Maine,

Massachusetts, New

Hampshire, Rhode Island,

Vermont

Andover, MA 05501

Illinois, Iowa, Minnesota,

Missouri, Wisconsin Kansas City, MO 64999

Delaware, District of

Columbia, Maryland,

Pennsylvania, Virginia

Philadelphia, PA 19255

Indiana, Kentucky, Michigan,

Ohio, West Virginia Cincinnati, OH 45999

Kansas, New Mexico,

Oklahoma, Texas Austin, TX 73301

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