DO NOT STAPLE
                                                                                                                        OMB No. 1545-0096
Form 1042-T                          Annual Summary and Transmittal of  
                                                      Forms 1042-S
Department of the Treasury                                                                                              2024
Internal Revenue Service                      Go to www.irs.gov/Form1042T for the latest information.
Name of withholding agent                                                                  Ch. 4 status code      Employer identification number
                                                                                           Ch. 3 status code 
Number, street, and room or suite no.

City or town, state or province, country, and ZIP or foreign postal code 

1    Type of paper Forms 1042-S attached:

a    Choose only one:                Chapter 4 or chapter 3 (enter 4 or 3)

b    Check only one box:             Original Amended

c    Check if pro rata 

d    Enter the number of paper Forms 1042-S attached 

e    Check if you are a partnership reporting withholding that occurred in the subsequent year. See instructions. 

f    Check if you are a Qualified Intermediary, Withholding Foreign Partnership, or Withholding Foreign Trust revising its reporting 
     on Form 1042-S to report to a specific recipient. See instructions.

2    Total gross income reported on all paper Forms 1042-S (box 2) attached  .               . . . .    .    . .  . . $

3    Total federal tax withheld on all paper Forms 1042-S attached:

a    Total federal tax withheld under chapter 4   . .                    . .   . . . . . . . . $

b    Total federal tax withheld under chapter 3  .  .                    . .   . . . . . . . . $

Caution: If you have already filed a Form 1042 and an attached Form 1042-S causes the gross income or tax withheld information 
shown on your previously filed Form 1042 to change, you must file an amended Form 1042. See the instructions on page 2.

                                     If this is your FINAL return, enter an “X” here. See instructions. 

                           Please return this entire page to the Internal Revenue Service.
     Under penalties of perjury, I declare that I have examined this return and accompanying documents and, to the best of my knowledge and 
     belief, they are true, correct, and complete.
Sign 
Here Your signature                                                      Title                               Date       Daytime phone number

For more information and the Privacy Act and Paperwork Reduction Act Notice, see Form 1042-S.           Cat. No. 28848W Form 1042-T (2024)

Form 1042-T (2024)                                                                                                            Page 2 
Instructions                                                        Line 1b. Check either the Original or Amended box (but not 
                                                                  both).
Future Developments                                                 Line 1c. Check the box on this line 1c if you are filing pro rata 
For the latest information about developments related to Form     Forms 1042‐ S. See the Form 1042‐S instructions.
1042-T and its instructions, such as legislation enacted after      Line 1e. Check the box on line 1e if you are a partnership 
they were published, go to www.irs.gov/Form1042T.                 reporting withholding that occurred in the subsequent year with 
                                                                  respect to a foreign partner’s share of undistributed income for 
Purpose of Form                                                   the prior year. The attached Form(s) 1042-S should have the 
Use this form to transmit paper Forms 1042-S, Foreign Person’s    checkbox checked in box 7c.
U.S. Source Income Subject to Withholding, to the Internal          As a result of the above rules, there are many possible types 
Revenue Service. Use a separate Form 1042-T to transmit each      of Form 1042‐S that may be transmitted, and each type requires 
type of Form 1042-S. See the instructions for line 1 below.       a separate Form 1042‐T. For example:
          Do not use Form 1042-T if you submit Forms 1042-S         • Chapter 4, original, pro rata.
          electronically. See the Instructions for Form 1042-S      • Chapter 4, original, non‐pro rata.
CAUTION
▲!        for the electronic filing requirements for Form 1042-S.   • Chapter 4, amended, pro rata.
Filing Forms 1042 and 1042-S                                        • Chapter 4, amended, non‐pro rata.
                                                                    • Chapter 4, original, pro rata, partnership.
Use of this form to transmit paper Forms 1042-S does not affect 
your obligation to file Form 1042, Annual Withholding Tax           • Chapter 4, original, non-pro rata, partnership.
Return for U.S. Source Income of Foreign Persons.                   • Chapter 4, amended, pro rata, partnership.
If you have not yet filed a Form 1042 for 2024, you may send        • Chapter 4, amended, non-pro rata, partnership.
in more than one Form 1042-T to submit paper Forms 1042-S           • Chapter 3, original, pro rata.
prior to filing your Form 1042. You may submit amended Forms        • Chapter 3, original, non‐pro rata.
1042-S even though changes reflect differences in gross 
income and tax withheld information of Forms 1042-S                 • Chapter 3, amended, pro rata.
previously submitted with a Form 1042-T.                            • Chapter 3, amended, non‐pro rata.
If you have already filed a Form 1042 for 2024 and an               • Chapter 3, original, pro rata, partnership.
attached Form 1042-S caused the gross income or tax withheld        • Chapter 3, original, non-pro rata, partnership.
information previously reported on line 62c or 63e of your Form     • Chapter 3, amended, pro rata, partnership.
1042 to change, you must file an amended Form 1042.
                                                                    • Chapter 3, amended, non-pro rata, partnership.
Where and When To File                                              Each type must be transmitted with a separate Form 1042-T. 
File Form 1042-T (and Copy A of the paper Forms 1042-S being      For example, you must transmit only chapter 3, original, pro rata 
transmitted) with the Ogden Service Center, P.O. Box 409101,      Forms 1042-S with one Form 1042-T.
Ogden, UT 84409, by March 17, 2025. Send the forms in a flat        Line 1f. This box should be checked only if a Qualified 
mailing (not folded).                                             Intermediary, Withholding Foreign Partnership, or Withholding 
                                                                  Foreign Trust originally filed a Form 1042-S to report an amount 
Line Instructions                                                 subject to withholding in a withholding rate pool and is reducing 
Identifying information at top of form. The name, address,        the amount reported by the amounts reported on one or more 
employer identification number, and chapter 4 and chapter 3       Forms 1042-S issued to one or more specific recipients in 
status codes of the withholding agent named on this form must     accordance with the provisions of the QI Agreement (Rev. Proc. 
be the same as those you enter on Forms 1042 and 1042-S.          2022-43) or the WP/WT Agreement (Rev. Proc. 2017-21).
See the Instructions for Form 1042 for the definition of          Line 2. Enter the total of the gross income amounts shown on 
withholding agent. See the Instructions for Form 1042-S for the   the Forms 1042-S (box 2) being transmitted with this Form 
withholding agent codes for the chapter 4 and chapter 3 status    1042-T.
codes. You must enter both a chapter 4 and a chapter 3 
withholding agent status code regardless of the type of payment   Line 3. Enter the total of the federal tax withheld amounts 
being made.                                                       shown on all Forms 1042-S (total of amounts reported in boxes 
                                                                  10 and 11) being transmitted with this Form 1042-T. On this 
Line 1. You must file a separate Form 1042‐ T for each type of    Form 1042-T, complete either line 3a or line 3b, but not both. If 
paper Form 1042‐ S you are transmitting.                          you indicated “chapter 4” on line 1a, complete line 3a to report 
Line 1a. Withholding agents are not permitted to file a single    the total amounts withheld pursuant to chapter 4. If you 
Form 1042‐ T to transmit both chapter 4 and chapter 3 amounts.    indicated “chapter 3” on line 1a, complete line 3b to report the 
Withholding agents must indicate either chapter 4 or chapter 3    total amounts withheld pursuant to chapter 3. 
to designate the chapter for which they are filing a given Form   Final return. If you will not be required to file additional Forms 
1042‐ T. The chapter you designate on this form must be the       1042-S, including amended Forms 1042-S for the 2024 year (on 
same as that on all attached Forms 1042‐ S. See Chapter           paper or electronically), enter an “X” in the FINAL return box.
indicator in the Form 1042‐ S instructions for additional         Paperwork Reduction Act Notice.The time needed to 
information.
                                                                  complete and file this form will vary depending on individual 
                                                                  circumstances. The estimated average time is 12 minutes.