Box 8, Amount Repaid to Recipient

This box should be completed only if:

• You repaid a recipient an amount that was overwithheld and
• You are going to reimburse yourself by reducing, by the amount of tax actually repaid, the amount of any deposit made for a payment period in the calendar year following the calendar year of withholding.

You must also state on a timely filed Form 1042 for the calendar year of overwithholding that the filing of the Form 1042 constitutes a claim for refund.

Box 9, Withholding Agent's Employer Identification Number (EIN)

You are required to enter your EIN. However, if you are filing Form 1042-S as a QI, withholding foreign partnership, or withholding foreign trust, enter your QI-EIN. Enter the number and check the applicable box.

If you do not have an EIN, you should apply for one on Form SS-4, Application for Employer Identification Number. You can get Form SS-4 by calling 1-800-TAX-FORM (1-800-829-3676) or from the IRS Web Site at www.irs.gov. File corrected Forms 1042-S when you receive your EIN.

To get a QI-EIN, submit Form SS-4 with your Application for QI Status (completed in accordance with Section 3 of the preamble of Rev. Proc. 2000-12. You can find Rev. Proc. 2000-12 on page 387 of Internal Revenue Bulletin 2000-4 at www.irs.gov.) Do not send an application for a QI-EIN to the Philadelphia Service Center; it will not be processed.

Box 10, Withholding Agent's Name and Address

Enter your name and address. Include the suite, room, or other unit number after the street address. If your post office does not deliver mail to the street address and you have a P.O. box, show the box number instead of the street address.

Note:   On statements furnished to Canadian recipients of U.S. source deposit interest, in addition to your name and address, you must include the telephone number of a person to contact. This number must provide direct access to an individual who can answer questions about the statement. The telephone number is not required on Copy A of paper forms or on magnetic media filed with the IRS. You must also include a statement that the information on the form is being furnished to the United States Internal Revenue Service and may be furnished to Canada.

Box 11, Recipient's Account Number

You may use this box to enter the account number assigned by you to the recipient.

Box 12, Recipient Code

Enter the recipient code from the list on page 13.

Income codes, Exemption Codes, and Recipient Codes

Income Codes, Exemption Codes, and Recipient Codes

Box 1. Enter the appropriate income code.		Box 6. If the tax rate entered in box 5 is 0%, you must generally enter the appropriate exemption code from the list below (but see the Caution below).
Code	Interest Income	Code	Authority for Exemption
01	Interest paid by U.S. obligors - general	01	Income effectively connected with a U.S. trade or business
02	Interest paid on real property mortgages	02	Exempt under an Internal Revenue Code section (income other than portfolio interest)
03	Interest paid to controlling foreign corporations	03	Income is not from U.S. sources 4
04	Interest paid by foreign corporations	04	Exempt under tax treaty
05	Interest on tax-free covenant bonds	05	Portfolio interest exempt under an Internal Revenue Code section
29	Deposit interest	06	Qualified intermediary that assumes primary withholding responsibility
30	Original issue discount (OID)	07	Withholding foreign partnership or withholding foreign trust
31	Short-term OID	08	U.S. branch treated as a U.S. person
Code	Dividend Income	09	Qualified intermediary represents income is exempt
06	Dividends paid by U.S. corporations - general	Caution: See the instructions for box 6 on page 12 for information on additional codes (00 and 99) that may be required.
07	Dividends qualifying for direct dividend rate	Box 12. Enter the appropriate recipient code.
08	Dividends paid by foreign corporations	Code	Type of Recipient
Code	Other Income	01	Individual 2
09	Capital gains	02	Corporation 2
10	Industrial royalties	03	Partnership other than a withholding foreign partnership 2
11	Motion picture or television copyright royalties	04	Withholding foreign partnership or withholding foreign trust
12	Other royalties (e.g., copyright, recording, publishing)	05	Trust
13	Real property income and natural resources royalties	06	Government or international organization
14	Pensions, annuities, alimony, and/or insurance premiums	07	Tax-exempt organization (IRC section 501(a))
15	Scholarship or fellowship grants	08	Private foundation
16	Compensation for independent personal services 1	09	Artist or athlete 2
17	Compensation for dependent personal services 1	10	Estate
18	Compensation for teaching 1	11	U.S. branch treated as U.S. person
19	Compensation during studying and training 1	12	Qualified intermediary
20	Earnings as an artist or athlete 2	13	Private arrangement intermediary withholding rate pool - general 5
24	Real estate investment trust (REIT) distributions of capital gains	14	Private arrangement intermediary withholding rate pool - exempt organizations 5
25	Trust distributions subject to IRC section 1445	15	Qualified intermediary withholding rate pool - general 5
26	Unsevered growing crops and timber distributions by a trust subject to IRC section 1445	16	Qualified intermediary withholding rate pool - exempt organizations 5
27	Publicly traded partnership distributions subject to IRC section 1446	17	Authorized foreign agent
28	Gambling winnings	20	Unknown recipient
32	Notional principal contract income 3
50	Other income
1 If compensation that otherwise would be covered under Income Codes 16-19 is directly attributable to the recipient's occupation as an artist or athlete, use Income Code 20 instead.
2 If Income Code 20 is used, Recipient Code 09 (artist or athlete) should be used instead of Recipient Code 01 (individual), 02 (corporation), or 03 (partnership other than withholding foreign partnership).
3 Use appropriate Interest Income Code for embedded interest in a notional principal contract.
4 Non-U.S. source income paid to a nonresident alien is not subject to U.S. tax. Use Exemption Code 03 when entering an amount for information reporting purposes only
5 May be used only by a qualified intermediary.

• If applicable, use recipient code 09 (artist or athlete) instead of recipient code 01 (individual), 02 (corporation), or 03 (partnership other than a withholding foreign partnership).
• Use recipient code 12 if you are making a payment to a QI and 04 if you are making a payment to a withholding foreign partnership or a withholding foreign trust.
• If you are making a payment to an NQI or flow-through entity, you generally must use the recipient code that applies to the type of recipient who receives the income from the NQI or flow-through entity.
• Use recipient code 03 (partnership other than a withholding foreign partnership) only if you are reporting a payment of income that is effectively connected with the conduct of a trade or business of a nonwithholding foreign partnership in the United States. Otherwise, follow the rules that apply to payments to flow-through entities.
• Use recipient code 20 (unknown recipient) only if you have not received a withholding certificate or other documentation for a recipient or you cannot determine how much of a payment is reliably associated with a specific recipient. Do not use this code because you cannot determine the recipient's status as an individual, corporation, etc. The regulations under Chapter 3 of the Code provide rules on how to determine a recipient's status when a withholding agent does not have the necessary information.
• Only QIs may use recipient codes 13 (private arrangement intermediary withholding rate pool-general), 14 (private arrangement intermediary withholding rate pool-exempt organizations), 15 (qualified intermediary withholding rate pool-general), and 16 (qualified intermediary withholding rate pool-exempt organizations). A QI should only use recipient code 14 or 16 for pooled account holders that have claimed an exemption based on their tax exempt status and not some other exemption (e.g., treaty or other Code exception). A U.S. withholding agent making a payment to a QI should use recipient code 12.

Box 13, Recipient's Name and Address

Name.   Enter the complete name of the recipient.

• If you do not know the name of the recipient, enter Unknown Recipient.
• If Form 1042-S is being completed by a QI for a withholding rate pool, enter Withholding rate pool in box 13. No address is necessary.
• A QI reporting payments made to a PAI on a withholding rate pool basis must include the name and address of the PAI in box 13.

Address.   For addresses outside the United States or its possessions or territories, enter the complete address in the following order: street address, city or town, province or state, and country. Follow the foreign country's practice for entering the postal code. Do not abbreviate the country name.

For addresses within the United States, enter the address in the following order: street address (number, street, apartment number, or rural route), city or town, state, and ZIP code. Use the U.S. Postal Service 2-letter abbreviation for the state name. Do not enter United States or U.S.

Box 14, Recipient's U.S. Taxpayer Identification Number (TIN)

You must obtain and enter a U.S. taxpayer identification number (TIN) for:

• Any recipient whose income is effectively connected with the conduct of a trade or business in the United States.

  Note:   For these recipients, exemption code 01 should be entered in box 6.

• Any foreign person claiming a reduced rate of, or exemption from, tax under a tax treaty between a foreign country and the United States, unless the income consists of dividends and interest from stocks and debt obligations that are actively traded; dividends from any redeemable security issued by an investment company registered under the Investment Company Act of 1940; dividends, interest, or royalties from units of beneficial interest in a unit investment trust that are (or were, upon issuance) publicly offered and are registered with the Securities and Exchange Commission under the Securities Act of 1933, and amounts paid with respect to loans of such securities.
• Any nonresident alien individual claiming exemption from tax under section 871(f) for certain annuities received under qualified plans.
• A foreign organization claiming an exemption from tax solely because of its status as a tax-exempt organization under section 501(c) or as a private foundation.
• Any QI.
• Any withholding foreign partnership or withholding foreign trust.
• Any nonresident alien individual claiming exemption from withholding on compensation for independent personal services.
• Any foreign grantor trust with five or fewer grantors.
• Any U.S. branch of a foreign bank or foreign insurance company that is treated as a U.S. person.

If a foreign person provides a TIN on a Form W-8, but is not required to do so, the withholding agent must include the TIN on Form 1042-S.

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