Statement of Specified Foreign Financial Assets                                         OMB No. 1545-2195
Form  8938                     ▶ Go to www.irs.gov/Form8938 for instructions and the latest information. 
Department of the Treasury                              ▶ Attach to your tax return.                                  2020
                                                                                                                     Attachment  
Internal Revenue Service    For calendar year 2020 or tax year beginning       , 2020, and ending         , 20       Sequence No. 938
     If you have attached continuation statements, check here                  Number of continuation statements

1       Name(s) shown on return                                                         2    Taxpayer identification number (TIN)

3      Type of filer
        a   Specified individual          b        Partnership               c      Corporation         d   Trust
4      If you checked box 3a, skip this line 4. If you checked box 3b or 3c, enter the name and TIN of the specified individual who closely holds 
       the partnership or corporation. If you checked box 3d, enter the name and TIN of the specified person who is a current beneficiary of the 
       trust. (See instructions for definitions and what to do if you have more than one specified individual or specified person to list.)
        a   Name                                                                        b TIN
Part I      Foreign Deposit and Custodial Accounts Summary
1      Number of deposit accounts (reported in Part V)  .   .   .        . . . . .  . . . .     . . .   . . .   ▶
2      Maximum value of all deposit accounts  .       . . . .   .        . . . . .  . . . .     . . .   . . .   .  $
3      Number of custodial accounts (reported in Part V)    .   .        . . . . .  . . . .     . . .   . . .   ▶
4      Maximum value of all custodial accounts        . . . .   .        . . . . .  . . . .     . . .   . . .   .  $
5      Were any foreign deposit or custodial accounts closed during the tax year?  .    . .     . . .   . . .   .     Yes                  No
Part II     Other Foreign Assets Summary
1      Number of foreign assets (reported in Part Vl)  .  . .   .        . . . . .  . . . .     . . .   . . .     ▶
2      Maximum value of all assets (reported in Part Vl)  . .   .        . . . . .  . . . .     . . .   . . .   .  $
3      Were any foreign assets acquired or sold during the tax year?         . . .  . . . .     . . .   . . .   .     Yes                  No
Part III    Summary of Tax Items Attributable to Specified Foreign Financial Assets (see instructions)
                                                            (c) Amount reported on                      Where reported
       (a) Asset     category         (b) Tax     item         form or schedule         (d) Form and line       (e) Schedule and line
1  Foreign deposit and           a   Interest             $
       custodial accounts        b   Dividends            $
                                 c   Royalties            $
                                 d   Other income         $
                                 e   Gains (losses)       $
                                 f   Deductions           $
                                 g   Credits              $
2  Other foreign assets          a   Interest             $
                                 b   Dividends            $
                                 c   Royalties            $
                                 d   Other income         $
                                 e   Gains (losses)       $
                                 f   Deductions           $
                                 g   Credits              $
Part IV     Excepted Specified Foreign Financial Assets (see instructions)
If you reported specified foreign financial assets on one or more of the following forms, enter the number of such forms filed. You do 
not need to include these assets on Form 8938 for the tax year. 
1.  Number of Forms 3520                       2.  Number of Forms 3520-A                         3.  Number of Forms 5471
4.  Number of Forms 8621                       5.  Number of Forms 8865

Part V      Detailed Information for Each Foreign Deposit and Custodial Account Included in the Part I Summary 
            (see instructions) 
If you have more than one account to report in Part V, attach a continuation statement for each additional account. See instructions.
1      Type of account                Deposit             Custodial                  2   Account number or other designation

3      Check all that apply    a      Account opened during tax year           b    Account closed during tax year 
                               c      Account jointly owned with spouse        d    No tax item reported in Part III with respect to this asset
4      Maximum value of account during tax year  .      . . .   .        . . . . .  . . . .     . . .   . . .   .  $
5      Did you use a foreign currency exchange rate to convert the value of the account into U.S. dollars?  .   .     Yes                  No
6      If you answered “Yes” to line 5, complete all that apply.
       (a)  Foreign currency in which         (b)  Foreign currency exchange rate used       (c)  Source of exchange rate used if not from U.S. 
       account is maintained                  to convert to U.S. dollars                     Treasury Department’s Bureau of the Fiscal Service

For Paperwork Reduction Act Notice, see the separate instructions.                      Cat. No. 37753A               Form 8938 (2020) 

Form 8938 (2020)                                                                                                                  Page 2 
Part V   Detailed Information for Each Foreign Deposit and Custodial Account Included in the Part I Summary 
         (see instructions) (continued) 
7 a Name of financial institution in which account is maintained     b  Global Intermediary Identification Number (GIIN) (Optional)
                                                                                 .         .     .
8   Mailing address of financial institution in which account is maintained. Number, street, and room or suite no.

9   City or town, state or province, and country (including postal code)

Part VI  Detailed Information for Each “Other Foreign Asset” Included in the Part II Summary (see instructions) 
If you have more than one asset to report in Part VI, attach a continuation statement for each additional asset. See instructions.
1   Description of asset                                             2  Identifying number or other designation

3   Complete all that apply. See instructions for reporting of multiple acquisition or disposition dates.
a   Date asset acquired during tax year, if applicable . .   . . .   .  . . . .  .  .    . .   . .       . .
b   Date asset disposed of during tax year, if applicable .  . . .   .  . . . .  .  .    . .   . .       . .
c       Check if asset jointly owned with spouse         d       Check if no tax item reported in Part III with respect to this asset
4   Maximum value of asset during tax year (check box that applies)
a       $0–$50,000       b      $50,001–$100,000         c       $100,001–$150,000         d     $150,001–$200,000
e   If more than $200,000, list value  . .   . .    . .  .   . . .   .  . . . .  .  .    . .   . .       . . . $
5   Did you use a foreign currency exchange rate to convert the value of the asset into U.S. dollars?  .   . .     Yes            No
6   If you answered “Yes” to line 5, complete all that apply.
    (a)  Foreign currency in which asset (b)  Foreign currency exchange rate used     (c)  Source of exchange rate used if not from U.S. 
    is denominated                       to convert to U.S. dollars                   Treasury Department’s Bureau of the Fiscal Service

7   If asset reported on line 1 is stock of a foreign entity or an interest in a foreign entity, enter the following information for the asset.
a   Name of foreign entity                                             b GIIN (Optional)         .             .   .
c   Type of foreign entity      (1) Partnership          (2)   Corporation    (3)        Trust           (4) Estate
d   Mailing address of foreign entity. Number, street, and room or suite no.

e   City or town, state or province, and country (including postal code)

8   If asset reported on line 1 is not stock of a foreign entity or an interest in a foreign entity, enter the following information for the 
    asset.
    Note: If this asset has more than one issuer or counterparty, attach a continuation statement with the same information for 
    each additional issuer or counterparty. See instructions.
a   Name of issuer or counterparty
    Check if information is for              Issuer                  Counterparty

b   Type of issuer or counterparty
    (1)   Individual                     (2)   Partnership       (3)    Corporation        (4)   Trust              (5)  Estate

c   Check if issuer or counterparty is a       U.S. person              Foreign person
d   Mailing address of issuer or counterparty. Number, street, and room or suite no.

e   City or town, state or province, and country (including postal code)

                                                                                                                    Form 8938 (2020)

Form 8938 (2020)                                                                                                   Page  

                                               (Continuation Statement)
Name(s) shown on return                                                           TIN

Part V   Detailed Information for Each Foreign Deposit and Custodial Account Included in the Part I Summary 
         (see instructions) 
1   Type of account                 Deposit           Custodial             2   Account number or other designation

3   Check all that apply    a       Account opened during tax year      b   Account closed during tax year 
                            c       Account jointly owned with spouse   d   No tax item reported in Part III with respect to this asset
4   Maximum value of account during tax year  .     . .  .   . . .    . . . . .   .    .  . .   . .      . . .  $
5   Did you use a foreign currency exchange rate to convert the value of the account into U.S. dollars?  .   .    Yes     No
6   If you answered “Yes” to line 5, complete all that apply.
    (a)  Foreign currency in which       (b)  Foreign currency exchange rate used      (c)  Source of exchange rate used if not from U.S. 
    account is maintained                to convert to U.S. dollars                    Treasury Department’s Bureau of the Fiscal Service

7 a Name of financial institution in which account is maintained      b GIIN (Optional)
                                                                              .             .   .
8   Mailing address of financial institution in which account is maintained. Number, street, and room or suite no.

9   City or town, state or province, and country (including postal code)

Part VI  Detailed Information for Each “Other Foreign Asset” Included in the Part II Summary (see instructions) 
1   Description of asset                                         2  Identifying number or other designation

3   Complete all that apply. See instructions for reporting of multiple acquisition or disposition dates.
a   Date asset acquired during tax year, if applicable . .   . . .    . . . . .   .    .  . .   . .      . .
b   Date asset disposed of during tax year, if applicable .  . . .    . . . . .   .    .  . .   . .      . .
c       Check if asset jointly owned with spouse         d       Check if no tax item reported in Part III with respect to this asset
4   Maximum value of asset during tax year (check box that applies)
a       $0–$50,000       b      $50,001–$100,000         c       $100,001–$150,000              d        $150,001–$200,000
e   If more than $200,000, list value  . .   . .    . .  .   . . .    . . . . .   .    .  . .   . .      . . . $
5   Did you use a foreign currency exchange rate to convert the value of the asset into U.S. dollars?  .   . .    Yes     No
6   If you answered “Yes” to line 5, complete all that apply.
    (a)  Foreign currency in which asset (b)  Foreign currency exchange rate used      (c)  Source of exchange rate used if not from U.S. 
    is denominated                       to convert to U.S. dollars                    Treasury Department’s Bureau of the Fiscal Service

7   If asset reported on line 1 is stock of a foreign entity or an interest in a foreign entity, enter the following information for the asset.
a   Name of foreign entity                                              b GIIN (Optional)         .            .  .
c   Type of foreign entity      (1) Partnership          (2)    Corporation         (3)     Trust          (4)   Estate
d   Mailing address of foreign entity. Number, street, and room or suite no.

e   City or town, state or province, and country (including postal code)

8   If asset reported on line 1 is not stock of a foreign entity or an interest in a foreign entity, enter the following information for the 
    asset.
a   Name of issuer or counterparty
    Check if information is for              Issuer                   Counterparty

b   Type of issuer or counterparty
    (1)   Individual                     (2)   Partnership       (3)     Corporation        (4)   Trust            (5)  Estate

c   Check if issuer or counterparty is a       U.S. person               Foreign person
d   Mailing address of issuer or counterparty. Number, street, and room or suite no.

e   City or town, state or province, and country (including postal code)

                                                                                                                   Form 8938 (2020)