n OMB No. 1545-0137
2032 Contract Coverage Under Title Il anes. 30.98
Form ¥ by
Rev, May 1990) of the Social Security Act
ee (For use by an American employer to extend social security coverage to File three copies
or f
Peon Revo seen United States citizens and residents employed by its foreign affiliates.) of this form.

Name of American employer Employer identification number

Address (number and street)

City, state, and ZIP code

This Form 2032 is filed as (please check applicable box(es)):
OO An original (new) agreement.

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

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

O The first day of the calendar quarter following the calendar quarter in which the service center director signs this agreement.
(1 Anamendment to an agreement previously entered into.

C1 An election to apply the rules in effect after April 20, 1983, to current agreements in effect on that date. By making this election, U.S.
resident aliens as well as citizens will be covered by social security.

If this is an election or an amendment to a previously filed agreement, please give the following information:

on
(Location where previous Form 2032 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 social security coverage to
certain services performed outside the U.S. 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: /f 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:
weeee ects eee nonagricultural; _.................._ agricultural.

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(|) 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 (1) it owns at least 20% of the voting stock of each foreign corporation named above, or (2) 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() 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(I).

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

Signature of mdividual authorized to enter into this agreement for Title Date
‘American employer

Director, Internal Revenue Service Center Location Date
For Paperwork Reduction Act Notice, see back of form. Form 2032 (Rev. 5-90)



Form 2032 (Rev. 5-90)

Page 2

Paperwork Reduction Act Notice.—We ask
for this information to carry out the Internal
Revenue laws of the United States. We need it
to ensure that taxpayers are complying with
these laws and to allow us to figure and collect
the right amount of tax. If you want the
employees of your foreign affiliate to be
covered under social security, you are required
to give us this information:

The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is:
Recordkeeping 2 hrs., 9 mins.; Learning
about the law or the form 18 mins.;
Preparing and sending the form to IRS 20
mins. If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form more simple,
we would be happy to hear from you. You can
write to both the Internal Revenue Service,
Washington, DC 20224, Attention: IRS
Reports Clearance Officer, T:FP; and the
Office of Management and Budget,
Paperwork Reduction Project (1545-0137),
Washington, DC 20503.

General Instructions

(Section references are to the Internal
Revenue Code.)

Before April 21, 1983, only domestic
corporations could enter into this agreement
to cover only U.S. citizens employed by foreign
subsidiaries. A foreign subsidiary, for purposes
of the agreement, was defined as (1) a foreign
corporation in which at least 20% of the voting
stock was owned by the domestic corporation,
or (2) a foreign corporation in which more than
50% of the voting stock was owned by another
foreign corporation in which the domestic
corporation owned at least 20% of the voting
stock.

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. A
foreign affiliate, for purposes of this
agreement, 1s any foreign entity (no longer
limited to a foreign corporation) in which the
American employer owns at least a 10%
interest (directly or through one or more
entities) in the voting stock or profits.

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. If a domestic corporation makes
this election, social security coverage will be
extended to U.S. resident alien employees of
any foreign subsidiary for which U.S. citizens
are currently covered by an existing
agreement. In addition, the election allows a
domestic corporation to extend social security
coverage to U.S. citizens and resident aliens
employed by a foreign entity that did not
qualify for coverage under the old 20%
ownership rules, but that now qualifies under
the 10% ownership rules.

Note: The U.S. 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. For more information,
see Social Security Taxes in Publication 54,
Tax Guide for U.S. Citizens and Resident
Aliens Abroad.

Purpose of Form.—An American employer

should use this form to (1) enter into the
agreement specified in section 3121(I) to

extend coverage under the Social Security Act
to U.S. citizens and resident aliens employed
abroad by foreign affiliates, (2) amend a
previous agreement, or (3) elect to apply the
rules in effect after April 20, 1983, to
agreements in effect on that date.

‘An American employer, for purposes of this
agreement, 1s an employer that 1s (1) the
United States or any instrumentality thereof,
(2) an individual who is a resident of the
United States, (3) a partnership if two-thirds
or more of the partners are residents of the
United States, (4) a trust if all the trustees are
residents of the United States, or (5) a
corporation organized under the laws of the
United States or of any state.

Where To File

File three copies of this form with the Internal
Revenue Service Center for the state where
the American employer's principal place of
business in the United States 1s located as
listed below. (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 and should enter on
Form 2032 its employer identification number
as shown on Form 941.)

If your principal

place of business is
located in

v

Florida, Georgia,
South Carolina

Use the following
Internal Revenue
Service Center address

Atlanta, GA 39901

New Jersey, New York (New
York City and counties of
Nassau, Rockiand, Suffolk, and
Westchester)

New York (all other counties),
Connecticut, Maine,
Massachusetts, New
Hampshire, Rhode Island,
Vermont

Holtsville, NY 00501

Andover, MA 05501

Illinois, lowa, Minnesota,

Missoun, Wisconsin Kansas City, MO 64999

Delaware, District of
Columbia, Maryland,

Philadelphia, PA 19255
Pennsylvania, Virginia

Indiana, Kentucky, Michigan,

Onio, West Virgins Cincinnati, OH 45999

Kansas, New Mexico,

Oklahoma, Texas Austin, TX 73301

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

Ogden, UT 84201

California (all other counties),

Fresno, CA 93888
Hawaii

Alabama, Arkansas, Louisiana,
Mississippi, North Carolina,
Tennessee

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.

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
the form evidence showing the authority for
such individual to sign the form. Corporations
must include a certified copy of the minutes of
the meeting of the board of directors.

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(I). The
Internal Revenue Service 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.
Original Agreements.—Check the box for an
original (new) agreement. Also check the box
to designate when the agreement is to take
effect.

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.

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 fourth month for
which the original agreement is in effect, the
amendment will not be effective until the first
day of the quarter following the one in which
the service center director signed the
amendment
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 for an
election.

If you make the election to apply the
post-April 20, 1983, rules to existing
agreements entered into on or before that
date, the election 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.

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.

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.

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.