Foreign Person’s U.S. Source Income Subject to Withholding                                                                               OMB No. 1545-0096
Form 1042-S                  Go to www.irs.gov/Form1042S for instructions and the latest information.                          2025                                                       for  
Department of the Treasury                                                                                                                                          Copy A 
Internal Revenue Service                                    UNIQUE FORM IDENTIFIER                            AMENDED          AMENDMENT NO.                        Internal Revenue Service
1 Income 2  Gross income    3   Chapter indicator.  Enter “3” or “4”                                     13d  City or town, state or province, country, ZIP or foreign postal code
  code
                            3a Exemption code           4a Exemption code
                            3b Tax rate          .      4b Tax rate         .                            13e  Recipient’s U.S. TIN, if any        13f  Ch. 3 status code
5  Withholding allowance                                                                                                                          13g Ch. 4 status code
6  Net income                                                                                            13h  Recipient’s GIIN 13i  Recipient ’sforeign tax identification            13j  LOB code 
                                                                                                                                           number, if any
7a  Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because 
   escrow procedures were applied (see instructions)  .   . .     .      .  .                            13k  Recipient’s account number
7c Check if withholding occurred in subsequent year with respect to a 
   partnership interest  . .    . . .   .      .   . .    . .     .      .  .                            13l  Recipient’s date of birth (YYYYMMDD)

7d 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  . .   . .    . .     .      .  .                            14a  Primary withholding agent’s name (if applicable)
8  Tax withheld by other agents 
9  Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)             14b  Primary withholding agent’s EIN
                                                                                                                                                  15  Check if pro-rata basis reporting 
   (                                                                                                    )
10  Total withholding credit (combine boxes 7a, 8, and 9)                                                15a  Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

11  Tax paid by withholding agent (amounts not withheld) (see instructions)                              15d  Intermediary or flow-through entity’s name

12a  Withholding agent’s EIN        12b  Ch. 3 status code12c  Ch. 4 status code15e  Intermediary or flow-through entity’s GIIN
                                                                                                         15f  Country code     15g  Foreign tax identification number, if any
12d  Withholding agent’s name
                                                                                                         15h  Address (number and street)
12e  Withholding agent’s global intermediary identification number (GIIN)
                                                                                                         15i  City or town, state or province, country, ZIP or foreign postal code
12f  Country code        12g  Foreign tax identification number, if any
                                                                                                         16a  Payer’s name                                          16b  Payer’s TIN
12h  Address (number and street)
                                                                                                         16c  Payer’s GIIN                        16d Ch. 3 status code  16e Ch. 4 status code
12i  City or town, state or province, country, ZIP or foreign postal code
                                                                                                         17a  State income tax withheld    17b  Payer’s state tax no.    17c  Name of state
13a  Recipient’s name                          13b  Recipient’s country code

13c  Address (number and street)

For Privacy Act and Paperwork Reduction Act Notice, see instructions.                                                      Cat. No. 11386R                               Form 1042-S (2025)

                           Foreign Person’s U.S. Source Income Subject to Withholding                                                                               OMB No. 1545-0096
Form 1042-S                   Go to www.irs.gov/Form1042S for instructions and the latest information.                         2025
Department of the Treasury                                                                                                                                          Copy B   
Internal Revenue Service                                    UNIQUE FORM IDENTIFIER                            AMENDED          AMENDMENT NO.                        for Recipient
1 Income 2  Gross income   3   Chapter indicator.  Enter “3” or “4”                                      13d  City or town, state or province, country, ZIP or foreign postal code
  code
                           3a Exemption code            4a Exemption code
                           3b Tax rate           .      4b Tax rate         .                            13e  Recipient’s U.S. TIN, if any        13f  Ch. 3 status code
5  Withholding allowance                                                                                                                          13g Ch. 4 status code
6  Net income                                                                                            13h  Recipient’s GIIN 13i  Recipient ’sforeign tax identification13j  LOB code 
                                                                                                                                           number, if any
7a  Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because 
   escrow procedures were applied (see instructions)  .   . .     .      .  .                            13k  Recipient’s account number
7c Check if withholding occurred in subsequent year with respect to a 
   partnership interest  . .    . . .  .       .   . .    . .     .      .  .                            13l  Recipient’s date of birth (YYYYMMDD)

7d 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  . .   . .    . .     .      .  .                            14a  Primary withholding agent’s name (if applicable)
8  Tax withheld by other agents 
9  Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)             14b  Primary withholding agent’s EIN
                                                                                                                                                  15  Check if pro-rata basis reporting 
   (                                                                                                    )
10  Total withholding credit (combine boxes 7a, 8, and 9)                                                15a  Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

11  Tax paid by withholding agent (amounts not withheld) (see instructions)                              15d  Intermediary or flow-through entity’s name

12a  Withholding agent’s EIN        12b  Ch. 3 status code  12c  Ch. 4 status code                       15e  Intermediary or flow-through entity’s GIIN
                                                                                                         15f  Country code     15g  Foreign tax identification number, if any
12d  Withholding agent’s name
                                                                                                         15h  Address (number and street)
12e  Withholding agent’s global intermediary identification number (GIIN)
                                                                                                         15i  City or town, state or province, country, ZIP or foreign postal code
12f  Country code        12g  Foreign tax identification number, if any
                                                                                                         16a  Payer’s name                                          16b  Payer’s TIN
12h  Address (number and street)
                                                                                                         16c  Payer’s GIIN                        16d Ch. 3 status code  16e Ch. 4 status code
12i  City or town, state or province, country, ZIP or foreign postal code
                                                                                                         17a  State income tax withheld    17b  Payer’s state tax no.    17c  Name of state
13a  Recipient’s name                          13b  Recipient’s country code

13c  Address (number and street)

(keep for your records)                                                                                                                                                  Form 1042-S (2025)

U.S. Income Tax Filing Requirements                                                Por lo general, toda persona que es un extranjero no residente, 
Generally, every nonresident alien individual, nonresident alien                todo fiduciario extranjero no residente, y toda sociedad anónima 
fiduciary, and foreign corporation with U.S. income, including income           extranjera que perciba ingresos estadounidenses, inclusive de los 
that is effectively connected with the conduct of a trade or business in        ingresos que son efectivamente conectados con la operación de un 
the United States, must file a U.S. income tax return. However, a               comercio o negocio ubicado en los Estados Unidos, debe presentar 
return is generally not required to be filed by a nonresident alien             una declaración del impuesto estadounidense sobre los ingresos. Sin 
individual, nonresident alien fiduciary, or foreign corporation if such         embargo, por lo general no se requiere que un individuo extranjero no 
person was not engaged in a trade or business in the United States at           residente, una sociedad anónima extranjera u organismo 
any time during the tax year and if the tax liability of such person was        fideicomisario extranjero no residente presenten una declaración si 
fully satisfied by the withholding of U.S. tax at the source. See the           dicha persona no participaba en ningún comercio o negocio ubicado 
instructions for Forms 1120-F and 1040-NR for more information.                 en los Estados Unidos en ningún momento durante el año tributario, y 
Corporations file Form 1120-F; all others file Form 1040-NR. You may            la responsabilidad tributaria de dicha persona fuera liquidada 
get the return forms and instructions at IRS.gov, at any U.S. Embassy           completamente mediante la retención del impuesto estadounidense 
or consulate, or by writing to: Internal Revenue Service, 1201 N.               en la fuente del ingreso. Consulte las instrucciones de los Formularios 
Mitsubishi Motorway, Bloomington, IL 61705-6613.                                1120F y 1040-NR para obtener más información. Las sociedades 
                                                                                anónimas presentan el Formulario 1120-F, todos los demás presentan 
  En règle générale, toute personne physique étrangère non                      el Formulario 1040-NR. Puede obtener los formularios de declaración 
résidente, tout fi duciaire étranger non résident et toute société               y sus instrucciones en IRS.gov, en cualquier embajada o consulado 
étrangère ayant des revenus américains, y compris des revenus                   de los Estados Unidos, o al escribir al: Internal Revenue Service, 1201 
eff ectivement liés à la conduite d’un commerce ou d’une entreprise              N. Mitsubishi Motorway, Bloomington, IL 61705-6613.
aux États-Unis, doit déposer une déclaration d’impôt sur le revenu                 Grundsätzlich muss jede natürliche Person ohne Wohnsitz im Land, 
aux États-Unis. Toutefois, une déclaration n’est généralement pas               jeder Treuhänder ohne Wohnsitz im Land und jede ausländische 
requise de la part d’un particulier étranger non résident, d’un                 Gesellschaft mit Einkünften in den USA, einschließlich Einkünften, die 
fiduciaire étranger non résident ou d’une société étrangère si cette             tatsächlich mit der Ausübung einer gewerblichen oder geschäftlichen 
personne n’a pas exercé d’activité commerciale aux États-Unis à un              Tätigkeit in den Vereinigten Staaten in Zusammenhang stehen, eine 
moment quelconque de l’année fi scale et si l’obligation  scalefi de              US-Einkommensteuererklärung einreichen. Eine Steuererklärung muss 
cette personne a été entièrement satisfaite par la retenue à la source          jedoch von einem nicht in den USA ansässigen Ausländer, einem nicht 
de l’impôt américain. Voir les instructions des formulaires 1120F et            in den USA ansässigen Treuhänder oder einem ausländischen 
1040NR pour plus d’informations. Les sociétés déposent le formulaire            Unternehmen im Allgemeinen nicht eingereicht werden, wenn diese 
1120-F; toutes les autres déposent le formulaire 1040-NR. Vous                  Person zu keinem Zeitpunkt während des Steuerjahres in den 
pouvez obtenir les formulaires de déclaration et les instructions sur le        Vereinigten Staaten einer gewerblichen oder geschäftlichen Tätigkeit 
site IRS.gov, dans n’importe quel bureau de poste des États-Unis, ou            nachgegangen ist und die Steuerschuld dieser Person durch den 
en écrivant à l’ambassade ou au consulat de l’Union européenne:                 Einbehalt der US-Quellensteuer vollständig beglichen wurde. Weitere 
Internal Revenue Service, 1201 N. Mitsubishi Motorway, Bloomington,             Informationen finden Sie in den Anweisungen für die Formulare 1120F 
IL 61705-6613.                                                                  und 1040NR. Unternehmen reichen das Formular 1120-F ein, alle 
                                                                                anderen reichen das Formular 1040-NR ein. Sie können die 
                                                                                Rücksendeformulare und Anweisungen auf IRS.gov erhalten, auf jeder 
                                                                                US-Botschaft oder Konsulat oder schriftlich an: Internal Revenue 
                                                                                Service, 1201 N. Mitsubishi Motorway, Bloomington, IL 61705-6613.

Explanation of Codes                                                                  34          Substitute payment—dividends
Box 1. Income Code.                                                                   40          Other dividend equivalents under IRC section 871(m) 
  Code                           Types of Income                                      52          Dividends paid on certain actively traded or publicly offered 
     01       Interest paid by U.S. obligors—general                                              securities1
     02       Interest paid on real property mortgages                                Dividend 53 Substitute payments—dividends from certain actively traded 
     03       Interest paid to controlling foreign corporations                                   or publicly offered securities1
     04       Interest paid by foreign corporations                                   56          Dividend equivalents under IRC section 871(m) as a result of 
     05       Interest on tax-free covenant bonds                                                 applying the combined transaction rules
     22       Interest paid on deposit with a foreign branch of a domestic            09          Capital gains
              corporation or partnership                                              10          Industrial royalties
     29       Deposit interest                                                        11          Motion picture or television copyright royalties
  Interest 30 Original issue discount (OID)                                           12          Other royalties (for example, copyright, software, 
     31       Short-term OID                                                                      broadcasting, endorsement payments)
     33       Substitute payment—interest                                             13          Royalties paid on certain publicly offered securities1
     51       Interest paid on certain actively traded or publicly offered            Other 14    Real property income and natural resources royalties
              securities1                                                             15          Pensions, annuities, alimony, and/or insurance premiums
     54       Substitute payments—interest from certain actively traded               16          Scholarship or fellowship grants
              or publicly offered securities1                                         17          Compensation for independent personal services2
     06       Dividends paid by U.S. corporations—general                             18          Compensation for dependent personal services2
     07       Dividends qualifying for direct dividend rate                           19          Compensation for teaching2
  Dividend 08 Dividends paid by foreign corporations
                                                                                                                                 See back of Copy C for additional codes
1 This code should only be used if the income paid is described in Regulations section 1.1441-6(c)(2) and the withholding agent has reduced the rate of withholding under an 
  income tax treaty without the recipient providing a U.S. TIN or an FTIN.
2 If compensation that would otherwise be covered under Income Codes 17 through 20 is directly attributable to the recipient  occupation’sas an artist or athlete, use 
  Income Code 42 or 43 instead.

                           Foreign Person’s U.S. Source Income Subject to Withholding                                                                               OMB No. 1545-0096
Form 1042-S                   Go to www.irs.gov/Form1042S for instructions and the latest information.                         2025                                                   for Recipient 
Department of the Treasury                                                                                                                                         Copy C 
Internal Revenue Service                                    UNIQUE FORM IDENTIFIER                            AMENDED          AMENDMENT NO.                    Attach to any Federal tax return you file
1 Income 2  Gross income   3   Chapter indicator.  Enter “3” or “4”                                      13d  City or town, state or province, country, ZIP or foreign postal code
  code
                           3a Exemption code            4a Exemption code
                           3b Tax rate           .      4b Tax rate         .                            13e  Recipient’s U.S. TIN, if any        13f  Ch. 3 status code
5  Withholding allowance                                                                                                                          13g Ch. 4 status code
6  Net income                                                                                            13h  Recipient’s GIIN 13i  Recipient ’sforeign tax identification13j  LOB code 
                                                                                                                                           number, if any
7a  Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because 
   escrow procedures were applied (see instructions)  .   . .     .      .  .                            13k  Recipient’s account number
7c Check if withholding occurred in subsequent year with respect to a 
   partnership interest  . .    . . .  .       .   . .    . .     .      .  .                            13l  Recipient’s date of birth (YYYYMMDD)

7d 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  . .   . .    . .     .      .  .                            14a  Primary withholding agent’s name (if applicable)
8  Tax withheld by other agents 
9  Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)             14b  Primary withholding agent’s EIN
                                                                                                                                                  15  Check if pro-rata basis reporting 
   (                                                                                                    )
10  Total withholding credit (combine boxes 7a, 8, and 9)                                                15a  Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

11  Tax paid by withholding agent (amounts not withheld) (see instructions)                              15d  Intermediary or flow-through entity’s name

12a  Withholding agent’s EIN        12b  Ch. 3 status code  12c  Ch. 4 status code                       15e  Intermediary or flow-through entity’s GIIN
                                                                                                         15f  Country code     15g  Foreign tax identification number, if any
12d  Withholding agent’s name
                                                                                                         15h  Address (number and street)
12e  Withholding agent’s global intermediary identification number (GIIN)
                                                                                                         15i  City or town, state or province, country, ZIP or foreign postal code
12f  Country code        12g  Foreign tax identification number, if any
                                                                                                         16a  Payer’s name                                          16b  Payer’s TIN
12h  Address (number and street)
                                                                                                         16c  Payer’s GIIN                        16d Ch. 3 status code  16e Ch. 4 status code
12i  City or town, state or province, country, ZIP or foreign postal code
                                                                                                         17a  State income tax withheld    17b  Payer’s state tax no.    17c  Name of state
13a  Recipient’s name                          13b  Recipient’s country code

13c  Address (number and street)

                                                                                                                                                                         Form 1042-S (2025)

Explanation of Codes (continued)                                                       11     QSL that assumes primary withholding responsibility
          20 Compensation during studying and training2                                12     Payee subjected to chapter 4 withholding
          23 Other income                                                              22     QDD that assumes primary withholding responsibility
          24 Qualified investment entity (QIE) distributions of capital                23     Exempt under section 897(l)
             gains                                                                     24     Exempt under section 892
          25 Trust distributions subject to IRC section 1445                           Chapter 4
          26 Unsevered growing crops and timber distributions by a trust               13     Grandfathered payment
             subject to IRC section 1445                                               14     Effectively connected income
          27 Publicly traded partnership distributions subject to IRC                  15     Payee not subject to chapter 4 withholding
             section 1446(a)                                                           16     Excluded nonfinancial payment
          28 Gambling winnings3                                                        17     Foreign entity that assumes primary withholding 
          32 Notional principal contract income4                                              responsibility
          35 Substitute payment—other                                                  18     U.S. payees of participating FFI or registered deemed-
          36 Capital gains distributions                                                      compliant FFI
          37 Return of capital                                                         19     Exempt from withholding under IGA8
          38 Eligible deferred compensation items subject to IRC section               20     Dormant account9
             877A(d)(1)                                                                21     Other payment not subject to chapter 4 withholding
     Other
          39 Distributions from a nongrantor trust subject to IRC section              Boxes 12b, 12c, 13f, 13g, 15b, 15c, 16d, and 16e.  Withholding 
             877A(f)(1)                                                                Agent, Recipient, Intermediary, and Payer Chapter 3 and Chapter 
          41 Guarantee of indebtedness                                                 4 Status Codes.
          42 Earnings as an artist or athlete—no central withholding                   Type of Recipient, Withholding Agent, Payer, or Intermediary
             agreement5                                                                Code
          43 Earnings as an artist or athlete—central withholding                      Chapter 3  Status Codes
             agreement5                                                                05     U.S. branch—treated as U.S. person10
          44 Specified federal procurement payments                                    06     U.S. branch—not treated as U.S. person11
          50 Income previously reported under escrow procedure6                        07     U.S. branch—ECI presumption applied
          55 Taxable death benefits on life insurance contracts                        08     Partnership other than withholding foreign partnership,  
          57 Amount realized under IRC section 1446(f)                                        publicly traded partnership, or partnership QDD
          58 Publicly traded partnership distributions—undetermined                    09     Withholding foreign partnership
          59 Consent fees                                                              10     Trust other than withholding foreign trust
          60 Loan syndication fees                                                     11     Withholding foreign trust
          61 Settlement payments                                                       12     Qualified intermediary
Boxes 3a and 4a. Exemption Code (applies if the tax rate entered                       13     Qualified securities lender—qualified intermediary
in box 3b or 4b is 00.00).                                                             14     Qualified securities lender—other
   Code                 Authority for Exemption                                        15     Corporation
Chapter 3                                                                              16     Individual
          01 Effectively connected income                                              17     Estate
          02 Exempt under IRC7                                                         18     Private foundation
          03 Income is not from U.S. sources                                           19     International organization
          04 Exempt under tax treaty                                                   20     Tax Exempt organization (section 501(c) entities)
          05 Portfolio interest exempt under IRC                                       21     Unknown recipient
          06 QI that assumes primary withholding responsibility                        22     Artist or athlete
          07 WFP or WFT                                                                23     Pension
          08 U.S. branch treated as U.S. person                                        24     Foreign central bank of issue
          10 QI represents that income is exempt                                                                           See back of Copy D for additional codes
2 If compensation that would otherwise be covered under Income Codes 17 through 20 is directly attributable to the recipient’s occupation as an artist or athlete, use 
 Income Code 42 or 43 instead.
3 Subject to 30% withholding rate unless the recipient is from one of the treaty countries listed under Gambling winnings (Income Code 28) in Pub. 515.
4 Use appropriate Interest Income Code for embedded interest in a notional principal contract.
5 Income Code 43 should only be used if Letter 4492, Venue Notification, has been issued by the Internal Revenue Service (otherwise, use Income Code 42 for earnings 
 as an artist or athlete). If Income Code 42 or 43 is used, Recipient Code 22 (artist or athlete) should be used instead of Recipient Code 16 (individual), 15 (corporation), 
 or 08 (partnership other than withholding foreign partnership, publicly traded partnership, or partnership QDD).
6 Use only to report gross income the tax for which is being deposited in the current year because such tax was previously escrowed for chapters 3 and 4 and the 
 withholding agent previously reported the gross income in a prior year and checked the box to report the tax as not deposited under the escrow procedure. See the 
 instructions to this form for further explanation.
7 This code should only be used if no other specific chapter 3 exemption code applies. 
8 Use only to report a U.S. reportable account or nonconsenting U.S. account that is receiving a payment subject to chapter 3 withholding. 
9 Use only if applying the escrow procedure for dormant accounts under Regulations section 1.1471-4(b)(6). If tax was withheld and deposited under chapter 3, do not 
 check box 7b (“tax not deposited with IRS pursuant to escrow procedure”). You must instead enter “3” in box 3 and complete box 3b.
10 This code can be used by a territory FI that is treated as a U.S. person.
11 This code can be used by a territory FI that is not treated as a U.S. person.

                           Foreign Person’s U.S. Source Income Subject to Withholding                                                                               OMB No. 1545-0096
Form 1042-S                   Go to www.irs.gov/Form1042S for instructions and the latest information.                         2025                                                   for Recipient 
Department of the Treasury                                                                                                                                         Copy D 
Internal Revenue Service                                    UNIQUE FORM IDENTIFIER                            AMENDED          AMENDMENT NO.                       Attach to any state tax return you file
1 Income 2  Gross income   3   Chapter indicator.  Enter “3” or “4”                                      13d  City or town, state or province, country, ZIP or foreign postal code
  code
                           3a Exemption code            4a Exemption code
                           3b Tax rate           .      4b Tax rate         .                            13e  Recipient’s U.S. TIN, if any        13f  Ch. 3 status code
5  Withholding allowance                                                                                                                          13g Ch. 4 status code
6  Net income                                                                                            13h  Recipient’s GIIN 13i  Recipient ’sforeign tax identification13j  LOB code 
                                                                                                                                           number, if any
7a  Federal tax withheld
7b Check if federal tax withheld was not deposited with the IRS because 
   escrow procedures were applied (see instructions)  .   . .     .      .  .                            13k  Recipient’s account number
7c Check if withholding occurred in subsequent year with respect to a 
   partnership interest  . .    . . .  .       .   . .    . .     .      .  .                            13l  Recipient’s date of birth (YYYYMMDD)

7d 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  . .   . .    . .     .      .  .                            14a  Primary withholding agent’s name (if applicable)
8  Tax withheld by other agents 
9  Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)             14b  Primary withholding agent’s EIN
                                                                                                                                                  15  Check if pro-rata basis reporting 
   (                                                                                                    )
10  Total withholding credit (combine boxes 7a, 8, and 9)                                                15a  Intermediary or flow-through entity’s EIN, if any 15b Ch. 3 status code 15c Ch. 4 status code

11  Tax paid by withholding agent (amounts not withheld) (see instructions)                              15d  Intermediary or flow-through entity’s name

12a  Withholding agent’s EIN        12b  Ch. 3 status code  12c  Ch. 4 status code                       15e  Intermediary or flow-through entity’s GIIN
                                                                                                         15f  Country code     15g  Foreign tax identification number, if any
12d  Withholding agent’s name
                                                                                                         15h  Address (number and street)
12e  Withholding agent’s global intermediary identification number (GIIN)
                                                                                                         15i  City or town, state or province, country, ZIP or foreign postal code
12f  Country code        12g  Foreign tax identification number, if any
                                                                                                         16a  Payer’s name                                          16b  Payer’s TIN
12h  Address (number and street)
                                                                                                         16c  Payer’s GIIN                        16d Ch. 3 status code  16e Ch. 4 status code
12i  City or town, state or province, country, ZIP or foreign postal code
                                                                                                         17a  State income tax withheld    17b  Payer’s state tax no.    17c  Name of state
13a  Recipient’s name                          13b  Recipient’s country code

13c  Address (number and street)

                                                                                                                                                                         Form 1042-S (2025)

Explanation of Codes (continued)                                                           24   Section 501(c) entities
   25   Nonqualified intermediary                                                          25   Excepted territory NFFE
   26   Hybrid entity making treaty claim                                                  26   Excepted NFFE—other
   35   Qualified derivatives dealer                                                       27   Exempt beneficial owner
   36   Foreign government—integral part                                                   28   Entity wholly owned by exempt beneficial owners
   37   Foreign government—controlled entity                                               29   Unknown recipient
   38   Publicly traded partnership                                                        30   Recalcitrant account holder
   39   Disclosing qualified intermediary                                                  31   Nonreporting IGA FFI
   40   Partnership QDD12                                                                  32   Direct reporting NFFE
   41   U.S. government entity or tax exempt entity (other than                            33   U.S. reportable account
        section 501(c) entities)13                                                         34   Nonconsenting U.S. account
 Pooled Reporting Codes14                                                                  35   Sponsored direct reporting NFFE
   27   Withholding rate pool—general                                                      36   Excepted inter-affiliate FFI
   28   Withholding rate pool—exempt organization                                          37   Undocumented preexisting obligation
   29   PAI withholding rate pool—general                                                  38   U.S. branch—ECI presumption applied
   30   PAI withholding rate pool—exempt organization                                      39   Account holder of excluded financial account15
   31   Agency withholding rate pool—general                                               40   Passive NFFE reported by FFI16
   32   Agency withholding rate pool—exempt organization                                   41   NFFE subject to 1472 withholding
Chapter 4 Status Codes                                                                     50   U.S. withholding agent—foreign branch of FI
   01   U.S. withholding agent—FI                                                       Pooled Reporting Codes
   02   U.S. withholding agent—other                                                       42   Recalcitrant pool—no U.S. indicia
   03   Territory FI—not treated as U.S. person                                            43   Recalcitrant pool—U.S. indicia
   04   Territory FI—treated as U.S. person                                                44   Recalcitrant pool—dormant account
   05   Participating  FFI—other                                                           45   Recalcitrant pool—U.S. persons
   06   Participating  FFI—reporting Model 2 FFI                                           46   Recalcitrant pool—passive NFFEs
   07   Registered deemed-compliant FFI—reporting Model 1 FFI                              47   Nonparticipating FFI pool
   08   Registered deemed-compliant FFI—sponsored entity                                   48   U.S. payees pool
   09   Registered deemed-compliant FFI—other                                              49   QI-recalcitrant pool—generaI17
   10   Certified deemed-compliant FFI—other                                           Box 13j. LOB Code (enter the code that best describes the 
   11   Certified deemed-compliant FFI—FFI with low value                              applicable limitation on benefits (LOB) category that qualifies the 
        accounts                                                                       taxpayer for the requested treaty benefits).
   12   Certified deemed-compliant FFI—nonregistering local bank                       LOB Code                    LOB Treaty Category
   13   Certified deemed-compliant FFI—sponsored entity                                    02   Government—contracting state/political subdivision/local 
   14   Certified deemed-compliant FFI—investment entity that                                   authority
        does not maintain financial accounts                                               03   Tax exempt pension trust/pension fund
   15   Nonparticipating FFI                                                               04   Tax exempt/charitable organization
   16   Owner-documented FFI                                                               05   Publicly traded corporation
   17   U.S. branch—treated as U.S. person                                                 06   Subsidiary of publicly traded corporation
   18   U.S. branch—not treated as U.S. person (reporting under                            07   Company that meets the ownership and base erosion test
        section 1471)                                                                      08   Company that meets the derivative benefits test
   19   Passive NFFE identifying substantial U.S. owners                                   09   Company with an item of income that meets the active trade 
   20   Passive NFFE with no substantial U.S. owners                                            or business test
   21   Publicly traded NFFE or affiliate of publicly traded NFFE                          10   Discretionary determination
   22   Active NFFE                                                                        11   Other
   23   Individual                                                                         12   No LOB article in treaty

12 Status code 40 should only be used for the partnership’s allocations to its partners with respect to its (or its branch’s) QDD’s activities. The partnership should report 
   all other allocations with respect to its partners using status code 8, 9, or 38, as applicable. When the partnership is transacting in its QDD capacity, it should use 
   status code 35.
13 This includes a college, a university, or another U.S. entity exempt from tax under an Internal Revenue Code section other than section 501(c). This code is only 
   applicable for reporting the chapter 3 status of a withholding agent (box 12b).
14 Codes 27 through 32 should only be used by a QI, QSL, WP, or WT. A QI acting as a QDD may use only code 27 or 28.
15 This code should only be used if income is paid to an account that is excluded from the definition of financial account under Regulations section 1.1471-5(b)(2) or 
   under Annex II of the applicable Model 1 IGA or Model 2 IGA.
16 This code should only be used when the withholding agent has received a certification on the FFI withholding statement of a participating FFI or registered deemed-
   compliant FFI that maintains the account that the FFI has reported the account held by the passive NFFE as a U.S. account (or U.S. reportable account) under its 
   FATCA requirements. The withholding agent must report the name and GIIN of such FFI in boxes 15d and 15e.
17 This code should only be used by a withholding agent that is reporting a payment (or portion of a payment) made to a QI with respect to the QI’s recalcitrant account holders.