Annual Withholding Tax Return for U.S. Source                                                              OMB No. 1545-0096
Form 1042                                            Income of Foreign Persons
Department of the Treasury  
Internal Revenue Service         Go to www.irs.gov/Form1042 for instructions and the latest information.                                    2022
If this is an amended return, check here  .        . .  .  .             . . . .     . .   . . .      .  . .  . .   .    .  .    . .  .     .       . .   . .  
Name of withholding agent                                                  Employer identification number
                                                                                                                         For IRS Use Only
Ch. 3 Status Code                                  Ch. 4 Status Code                                       CC                        FD
Number, street, and room or suite no. (If a P.O. box, see instructions.)                                   RD                        FF
                                                                                                           CAF                       FP
City or town, state or province, country, and ZIP or foreign postal code                                   CR                        I
                                                                                                           EDC                       SIC
If you do not expect to file this return in the future, check here                     Enter date final income paid  
Section 1      Record of Federal Tax Liability (do not show federal tax deposits here)
                         Tax liability for period                              Tax liability for period                            Tax liability for period  
Line    Period    (including any taxes assumed     Line    Period            (including any taxes assumed  Line    Period        (including any taxes assumed  
No.  ending                 on Form(s) 1000)       No.    ending                     on Form(s) 1000)      No.  ending                on Form(s) 1000)
1              7                                   21                      7                               41              7
2              15                                  22                    15                                42             15
       Jan.    22                                  23      May           22                                43      Sept.  22
3
4              31                                  24                    31                                44             30
5    Jan. total                                    25   May total                                          45   Sept. total  
6              7                                   26                      7                               46              7
7              15                                  27                    15                                47             15
       Feb.    22                                  28      June          22                                48      Oct.   22
8
9              28                                  29                    30                                49             31
10   Feb. total                                    30   June total                                         50   Oct. total  
11             7                                   31                      7                               51              7
12             15                                  32                    15                                52             15
       Mar.    22                                  33      July          22                                53      Nov.   22
13
14             31                                  34                    31                                54             30
15   Mar. total                                    35   July total                                         55   Nov. total  
16             7                                   36                      7                               56              7
17             15                                  37                    15                                57             15
       Apr.    22                                  38      Aug.          22                                58      Dec.   22
18
19             30                                  39                    31                                59             31
20   Apr. total                                    40   Aug. total                                         60   Dec. total  
Note: The totals from the above table are to be entered on lines 64b through 64d (as indicated in the instructions for those lines).
61      No. of Forms 1042-S filed:  a On paper                                                        b Electronically
62      Total gross amounts reported on all Forms 1042-S and 1000:
  a     Total U.S. source FDAP income (other than U.S. source substitute payments) reported  .                      .    .     . .   62a
  b     Total U.S. source substitute payments reported: 
        (1) Total U.S. source substitute dividend payments reported  .                 .   . . .      .  . .  . .   .    .     . . 62b(1)
        (2) Total U.S. source substitute payments reported other than substitute dividend payments  .                          . . 62b(2)
  c     Total gross amounts reported (add lines 62a–b)                     . . .     . .   . . .      .  . .  . .   .    .  .    .   62c
  d     Enter gross amounts actually paid if different from gross amounts reported  .                    . .  . .   .    .     . .   62d
               Do you want to allow another person to discuss this return with the IRS? See instructions.Yes.                  Complete the following.       No
Third Party 
Designee       Designee’s                                                      Phone                                Personal identification 
               name                                                            no.                                  number (PIN)            
               Under  penalties  of  perjury,  I  declare  that  I  have  examined  this  return,  including  accompanying  schedules  and  statements,  and  to  the  best  of  my 
               knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than withholding agent) is based on all information of which preparer 
Sign           has any knowledge.
                                                                                       Date
Here           Your                                                                                   Capacity in which acting 
               signature                                                                              Daytime phone number  
               Print/Type preparer’s name                  Preparer’s signature                               Date               Check          if    PTIN
Paid                                                                                                                             self-employed 
Preparer 
               Firm’s name                                                                                                       Firm’s EIN 
Use Only
               Firm’s address                                                                                                    Phone no. 
For Privacy Act and Paperwork Reduction Act Notice, see instructions.                                    Cat. No. 11384V                            Form 1042 (2022) 

Form 1042 (2022)                                                                                                               Page 2 
63  Total tax reported as withheld or paid by withholding agent on all Forms 1042-S and 1000: 
 a  Tax withheld by withholding agent        . . .  . . . .      . . . . . . . .  .           . . . . .    .      63a
 b  Tax withheld by other withholding agents:
    (1) For payments other than substitute dividends  . . .      . . . . . . . .  .           . . . . .    .    63b(1)
    (2) For substitute dividends  . . .      . . .  . . . .      . . . . . . . .  .           . . . . .    .    63b(2)
 c  Adjustments to withholding:
    (1) Adjustments to overwithholding       . . .  . . . .      . . . . . . . .  .           . . . . .    .    63c(1) (                          )
    (2) Adjustments to underwithholding  .     . .  . . . .      . . . . . . . .  .           . . . . .    .    63c(2)
 d  Tax paid by withholding agent  .  .      . . .  . . . .      . . . . . . . .  .           . . . . .    .      63d
 e  Total tax reported as withheld or paid (add lines 63a–d) .     . . . . . . .  .           . . . . .    .      63e
                 Computation of Tax Due or Overpayment
64  Total net tax liability
 a  Adjustments to total net tax liability  .  . .  . . . .      . . . . . . . .  .           . . . . .    .      64a
 b  Total net tax liability under chapter 3  . . .  . . . .      . . . . . . . .  .           . . . . .    .      64b
 c  Total net tax liability under chapter 4  . . .  . . . .      . . . . . . . .  .           . . . . .    .      64c
 d  Excise tax on specified federal procurement payments (total payments made x 2% (0.02))  .       . .    .      64d
 e  Total net tax liability (add lines 64a–d)  . .  . . . .      . . . . . . . .  .           . . . . .    .      64e
65  Total paid by electronic funds transfer (or with a request for extension of time to file):
 a  Total paid during calendar year . .      . . .  . . . .      . . . . . . . .  .           . . . . .    .      65a
 b  Total paid during subsequent year .      . . .  . . . .      . . . . . . . .  .           . . . . .    .      65b
66  Enter overpayment applied as credit from 2021 Form 1042        . . . . . . .  .           . . . . .    .      66
67  Credit for amounts withheld by other withholding agents:
 a  For payments other than substitute dividend payments .       . . . . . . . .  .           . . . . .    .      67a
 b  For substitute dividend payments  .      . . .  . . . .      . . . . . . . .  .           . . . . .    .      67b
68  Total payments. Add lines 65 through 67  .      . . . .      . . . . . . . .  .           . . . . .    .      68
69  If line 64e is larger than line 68, enter balance due here . . . . . . . . .  .           . . . . .    .      69
70a Enter overpayment attributable to overwithholding on U.S. source income of foreign persons  .     .    .      70a
 b  Enter overpayment attributable to excise tax on specified federal procurement payments        . . .    .      70b
71  Apply overpayment (sum of lines 70a and 70b) to (check one):
       Credit on 2023 Form 1042 or          Refund
Section 2        Reconciliation of Payments of U.S. Source FDAP Income
1   Total U.S. source FDAP income required to be withheld upon under chapter 4  . .           . . . . .    .      1
2   Total  U.S.  source  FDAP  income  required  to  be  reported  under  chapter  4  but  not  required  to  be
    withheld upon under chapter 4 because:
 a  Amount of income paid to recipients whose chapter 4 status established no withholding is required  .          2a
 b  Amount of excluded nonfinancial payments.       . . . .      . . . . . . . .  .           . . . . .    .      2b
 c  Amount of income paid with respect to grandfathered obligations    . . . . .  .           . . . . .    .      2c
 d  Amount of income effectively connected with the conduct of a trade or business in the United States           2d
 e  Total  U.S.  source  FDAP  income  required  to  be  reported  under  chapter  4  but  not  required  to  be
    withheld upon under chapter 4 (add lines 2a–d)    . . .      . . . . . . . .  .           . . . . .    .      2e
3   Total U.S. source FDAP income reportable under chapter 4 (add lines 1 and 2e) .           . . . . .    .      3
4   Total U.S. source FDAP income reported on all Forms 1042-S (from lines 62a, 62b(1), and 62b(2))        .      4
5   Total variance, subtract line 3 from line 4; if amount other than zero, provide explanation on line 6. .      5
6

Section 3        Potential Section 871(m) Transactions
Check  here  if  any  payments  (including  gross  proceeds)  were  made  by  the  withholding  agent  under  a  potential  section  871(m) 
transaction, including a notional principal contract or other derivatives contract that references (in whole or in part) a U.S. stock or 
other underlying security. See instructions  . . .  . . . .      . . . . . . . .  .           . . . . .    .    . .   . . .  . .
Section 4        Dividend Equivalent Payments by a Qualified Derivatives Dealer (QDD)
Check here if any payments were made by a QDD .     . . . .      . . . . . . . .  .           . . . . .    .    . .   . . .  . .
If box is checked, you must do the following.
(1) Attach Schedule Q (Form 1042). See instructions.
(2) Enter the EIN (not the QI-EIN) of the QDD 
                                                                                                                        Form 1042 (2022)