Get the legal form you need right now

Information Statement by United Kingdom Withholding Agents Paying Dividends (United States)

This form records dividends paid by a U.S. corporation to a nominee in the United Kingdom. The form provided here is simply a sample of what the actual Form 3206 looks like.

Information Statement by United Kingdom Withholding Agents Paying Dividends From U.S. Corporations to Residents of the United States and Certain Treaty Countries
Department of the Treasury
Internal Revenue Service

OMB No. 1545-0153

1 Name and address of United Kingdom bank or institution

__________________________________

__________________________________

__________________________________


3a Name of corporation paying dividend 4a Payment date 5a Gross dividend __________________________________

4a Payment date __________________________________

5a Gross dividend __________________________________


3b Name of corporation paying dividend 4a Payment date 5a Gross dividend __________________________________

4b Payment date __________________________________

5b Gross dividend __________________________________


3c Name of corporation paying dividend 4a Payment date 5a Gross dividend __________________________________

4c Payment date __________________________________

5c Gross dividend __________________________________


2 Name and address of dividend recipient (show country)

__________________________________

__________________________________

__________________________________

3d Name of corporation paying dividend __________________________________

4d Payment date __________________________________

5d Gross dividend __________________________________

5e Total __________________________________

We declare that we have received the above dividend(s) after deduction of U.S. tax of 15% at source in the United States and that we have distributed it, without deducting further U.S. tax, to the individual or entity shown in box 2 whose address is as shown in our records.

Signature __________________________________

Date __________________________________


-----------------------------
INSTRUCTIONS FOR FILLING OUT THIS FORM
-----------------------------

Information for United Kingdom Withholding Agents

Use boxes 3, 4, and 5 on Form 3206 to report up to four dividends paid to a dividend recipient. If two or more dividends are shown, enter a total for this form only in box 5e. If more than four dividends were paid to a recipient, complete additional Forms 3206 as needed. Send Copies A and B to the Internal Revenue Service Center, Philadelphia, PA 19255, USA. Keep Copy C for your records. Contact the United Kingdom Bureau of Inland Revenue for more information.

Information for Tax Authorities of Country Designated in Box 2

This form reports dividends paid by a U.S. corporation to a nominee with a United Kingdom address. According to the records of the nominee, the income recipient or beneficial owner is a resident of your country. If the income recipient or beneficial owner is not a resident of your country for tax purposes, under the exchange of information provisions of the income tax treaty between your country and the United States, please complete the information below and return this form to the Internal Revenue Service, Philadelphia, PA 19255, USA. The name and address of the income recipient is:

__________________________________

__________________________________

__________________________________

____ The address of the income recipient is not known.

____ Other information that may be helpful:

__________________________________

__________________________________

__________________________________

Paperwork Reduction Act Notice

We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is 4 hr., 6 min. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Tax Forms Committee, Western Area Distribution Center, Rancho Cordova, CA 95743-0001. DO NOT send this form to this address. Instead, send this form to Internal Revenue Service, Philadelphia, PA 19255, USA.

Legal Forms Categories

Recently Added Forms

Library Of Legal Forms