rom 2032 Contract Coverage Under Title Il
of the Social Security Act | __OMB No. 1545-0157 __

. File three copies
of this form

(Rev. July 1983)

Department of the Treasury | _ (For use by an American employer to extend social security coverage to United States citizens and
Internal Revenue Service | residents employed by its foreign affiliates or to amend an agreement on a previously filed Form 2032)

This agreement (or amended agreement) is entered into under the provisions of section 3121(!) of the Intesnal Revenue Code and the

applicable regulations between __

(Name and address, including ZIP code)

an American employer, and the Director of the Internal Revenue Service Center __

(Location of Service Center)
If this is an amendment to a previously filed agreement, please give the following information:

(Location where previous Form 2032 filed) ” (Date Director signed original agreement on Form 2032)

This agreement extends the Federal insurance system under Title !I of the Social Security Act to certain services performed outside the
United States by U.S. citizens and residents employed by any of the following foreign affiliates of the American employer:

1 Name and address 4 Name and address
2 Name and address 5 Name and address
3 Name and address 6 Name and address

Note: /f this agreement includes more than six 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.

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.

This agreement is effective for services performed on and after (please check the appropriate box):

OO the first day of the calendar quarter in which the Director signs this agreement.
C1 the first day of the calendar quarter following the calendar quarter in which the Director signs this agreement

C1 This is an amendment to a previously filed agreement and, if the Director signs this amendment after the 4th month for which
the original agreement is effective, the agreement will apply to the foreign affiliates above only for services performed in and after the calen-
dar quarter following the calendar quarter in which the Director signs this agreement.

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(I) 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 con-
sidered wages; and

(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(\).
The American employer’s employer identification number is __ _

The estimated number of employees to be initially covered by this agreement or amendment is ______nonagricultural;

ual authorized to enter into this agree’

For Paperwork Reduction Act Notice, see back of this page Form 2032 (Rev.7-83)


Form 2032 (Rev. 7 83)

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 tax-
Payers 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.

Purpose

Use this form to extend coverage under
the Social Security Act to U.S. citizens
and residents employed abroad by
foreign affiliates of an American
employer.

An American employer, for the pur-
poses of this agreement, is an employer
which is (1) the United States or any in-
strumentality 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 of the
trustees are residents of the United
States, or (5) a corporation organized
under the laws of the United States or
of any state.

A foreign affiliate of an American
employer, for purposes of this agree-
ment, is a foreign entity in which the
American employer owns at least 10%
interest (directly or through one or
more entities) in the voting stock or pro-
fits.

Instructions

Completing Form 2032

Each copy of the form must be signed
and dated by the officer or other in-
dividual authorized to enter into the
agreement or amendment. After the
Director of the Internal Revenue Ser-
vice Center signs and dates the form, it
constitutes the agreement authorized
by section 3121(I) of the Internal
Revenue Code. The Internal Revenue
Service will return one copy of Form
2032 to the American employer, send
one copy to the Social Security Ad-
ministration, and keep one copy.

Where to File

File 3 copies of this form with the Inter-
nal Revenue Service Center for the
State where the American employer's
principal place of business in the
United States is 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 File with the

place of business Internal Revenue
isin Service Center at
4 Vv

New Jersey, New York City and
counties of Nassau, Rockland,
Suffolk, and Westchester

Holtsville, NY 00501

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

Andover, MA 05501

District of Columbia, Delaware

Maryland, Pennsylvania Philadelphia, PA 19255

Alabama, Florida, Georgia
Mississippt, South Carolina

Atlanta, GA 31101

Michigan, Ohio Cincinnati, OH 45999

Arkansas, Kansas, Loutsiana

New Mexico, Oklahoma, Texas Austin, TA 73301

Alaska, Arizona, Colorado, Idaho
Minnesota, Montana, Nebraska,
Nevada, North Dakota, Oregon
South Dakota, Utah, Washington,
Wyoming

Ogden, UT 84201

lulinors, lowa, Missouri,

Wisconsin Kansas City, MO 64999

California, Hawaii Fresno, CA 93888

Indiana, Kentucky, North
Carolina, Tennessee,
Virginia, West Virginia

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.

Amending this Agreement
During the period that this agreement

is in effect for one or more foreign af-
filiates of an American employer, it may
be amended by the American employer
at any time to include any of its foreign
affiliates not previously included by fil-
ing another Form 2032 in triplicate
(Form 2032 Supplement, previously us-
ed to amend Form 2032, is obsolete.)

Terminating this Agreement
Once this agreement has been in effect
for 8 or more years, the American
employer can revoke it by giving 2 years
notice (in accordance with Code sec-
tion 3121(I) and the applicable
regulations).

s U.S. Government Printing Office: 1983~381-108/201