Transcription of 2021 Form 8966 - IRS tax forms
1 form 8966 Department of the Treasury Internal Revenue Service FATCA Report Go to for instructions and the latest No. 1545-22462019If you are filing paper forms 8966 , enter the three-digit identifier number used to identify this form 8966 filing (see instructions) .. Check if report is being corrected, amended, voided, or there are no accounts to report:Corrected reportAmended reportVoided reportCheck if no accounts to report (see instructions)Part I Identification of Filer1a Name of filer 1b Enter the filer category (see instructions) 2 Number, street, and room or suite no.
2 (if box, see instructions)3a City or town 3b State, province, or region3c Country, including postal code 4 Global intermediary identification number (GIIN)..5 TIN6 Name of sponsored entity or intermediary, if applicable7 Number, street, and room or suite no. (if box, see instructions)8a City or town8b State, province, or region 8c Country, including postal code 9 TINPart II Account Holder or Payee Information1a Name of account holder or payee1b Indicate whether account holder or payee is an individual or entityIndividualEntity2 Number, street, and room or suite no.
3 (if box, see instructions)3a City or town3b State, province, or region3c Country, including postal code 4 TIN5 If account holder or payee is an entity, check applicable box to specify the entity type:Owner-Documented FFI with specified Owner(s)Passive NFFE with substantial Owner(s)Non-Participating FFIS pecified PersonPart III Owner Information (File a separate report for each Owner that is a specified Person.)1 Name of owner2 Number, street, and room or suite no. (if box, see instructions)3a City or town3b State, province, or region3c Country, including postal code 4 TIN of ownerPart IV Financial Information1 Account number2 Currency code (see instructions)3a Account balance3b Check if account closed during the year (see instructions)4a Interest4b Dividends4c Gross proceeds/Redemptions4d OtherFor Paperwork Reduction Act Notice, see separate instructions.
4 Cat. No. 55748F form 8966 (2019) form 8966 (2019)Page 2 Part V Pooled Reporting Type1 Check applicable pooled reporting type (check only one):Recalcitrant account holders with IndiciaDormant accountsRecalcitrant account holders that are PersonsRecalcitrant account holders without IndiciaNon-Participating FFIR ecalcitrant account holders that are passive NFFEs2 Number of accounts3 Aggregate payment amount4 Aggregate account balance5 Currency codeForm 8966 (2019)
