Dokumendiregister | Rahandusministeerium |
Viit | 7-1.1/1775-1 |
Registreeritud | 09.04.2025 |
Sünkroonitud | 10.04.2025 |
Liik | Sissetulev kiri |
Funktsioon | 7 RIIGI FINANTSVARADE JA -KOHUSTUSTE HALDAMINE |
Sari | 7-1.1 Raha- ja kapitalituru dokumendid (tehingukinnitused, maksekorraldused jne) ja kirjavahetus |
Toimik | 7-1.1/2025 |
Juurdepääsupiirang | Avalik |
Juurdepääsupiirang | |
Adressaat | State Street Bank International GmbH |
Saabumis/saatmisviis | State Street Bank International GmbH |
Vastutaja | Kaja Kannerma (Rahandusministeerium, Kantsleri vastutusvaldkond, Eelarvepoliitika valdkond, Riigikassa osakond) |
Originaal | Ava uues aknas |
SEINE & Cl STATE STREET BANK AND TRUST Cl
P0 BOX 5010
BOSTON, MA 02206-5010
002014 90065373432 7 0301 0 0000 0 000 0139 MINISTRY 0F FINANCE OF THE REPUBLIC OF SUUR AMEERIKA 1
- TALLINN, 10122 ESTONIA
iiIIIIiiIIiIIIIIiIiIiiiII,IIiIiI,III,IIIIIiIIIIIiiIIIiIIiIiiIiIiI
1 042S 1 F0rejn Peison’s U.S. Source Income SubJect To Withholding ©24I Go to www.trs.govlFom,1042S for instructlons and the tateat Infoiniation. Departn,ent of the Treasury Internat Revenue Service 0 1 0 1 0 1 0 1 9 1 4 1 0 1 01 0 1 21 UNIQUE FORM IDENTIFIER [•] AMENDED Ei AMENDMENT NO.
OMB No 1545-0096
Copy B
for Recpient
1 tnme 2 Grosa income • 3 Chapterindicator. Enter 3” or 3 13e Recipients U.S. TIN. 4 any 131 Ch.3 statua code 36
code
01 $82618 00 3a Exemption code 24 4a Exemption code 15 13g Ch.4 status code 27
3b Tax rate 00.00 4b Tax rate 0000 13h Recipient’s GIIN 131 Recipients foreign las iderititicatiori 1 LOB code number, if any
5 Withhotding allowance
6 Net income
7a Federal tax withheld $0.00 13k Recipient’s account number
0139 7b Check 4 federal tax withheld was not deposited with the tRS because
escrow procedures were applied (see instructions) 131 Recipient’a date of birth (YYYYMMDD)
7c Checl 4 withholdirlg occurred in aubsequent year with respect 10 a partnorship interest
8 Tax withheld by other agents $0.00 14a Primary Withholding Agents Name (4 applicable)
9 Overwithhetd tax repaid to recipient pursuant to adjustment procedures (see inatructions)
($0.00) 14b Primary Withhotding Agents EtN
10 Total withhotding credit (combine boxes 7a. 8, and 9) 15 Check 4 pro-rata basis reporting EI $0 00 15a tntermedtary or ftow-through entitys EtN, 1 any 15b Ch.3 status code ISo Ch.4 status code
11 Tax paid by withholding ageflt (amounts fbI withheld)(see instructions)
15d tntermediary or ftow-through entitys name
12a Wthholding agents EIN 12b Ch.3 status code 12c Ch.4 status code
04-6288081 15 01 .
15e Intermediary ortlow-through entitys GItN
12d Withhotding agents name 1Sf Country code ISg Foreign las identification number, if any SEINE & C0 STATE STREET BANK AND TRUST CO
12e Wthhotding agents Giobat tntermediary tdentitication Number (GttN) 15h Addresa (number and street)
12f Country code 129 Foreign tax dentitication number, 4 any 151 City or town. state or province, country, ZtP or foreign postat code
12h Address (number and street) 16a Payejs name 18b Payers TtN P0 BOX 5010
121 City or town, state or province, country, ZIP or foreign postal code ISo Payers GttN 16d Ch. 3 atatua codo 16e Ch. 4 status code
BOSTON MA 02206-5010
13a Recipients name 13b Recipient’s country code 17a State income tax withheld 17b Payers state tax no. 17c Name of state MINtSTRY OF FtNANCE OF THE REPUBLIC OF
EN
13c Addreas (number and atreet)
SUUR AMEERIKA 1
13d City or town, state or province, country, ZIP or foreign postat code
TALLtNN, EN 10122
(keep for your records) Form 1 042-S (2024)
Page 1 of 5
002014 90065373432 703 01 0 0000 0 000
_____________________
1
Explanation of Godes Box 1. Income Code. Code Types of Inconie
Interest 01 Interest paid by U.S. obligors-generel 02 lnterest peid on reel property mortgeges 03 lnterest peid to controlling foreign corporatioes 04 lnterest peict by foreign corporetions 05 lnterest on tex-free covenent bonds 22 Interest peid on deposit with e foreign branch ota clomestic corporetion or
partnership 29 Deposit interest 30 Originel issue discount (OlD) 31 Short-term OlD 33 Substitute payment-interest 51 lnterest peid on certain ectively treded or publicly offered secorities)1) 54 Substitute peyments-ieterest frore certain actively traded or poblicly otterect
securities[1] Dividend
06 Dividends paid by It.S. corporations-generat 07 Dividends quelifying for direot dividend rate 08 Dividends paid by foreign corporations 34 Substitute payment-dividends 40 Oiher dividend equivalents under IRC section 871(m) 52 Dividends paid on certein aotively treded or publicly offered securities[1j 53 Substitute peyments-dividends from oertain ectively freded or pubhoIy offered
securitiesf 11 56 Dividend equivelents under IRC section 871(m) ase resuit of spplying the
oombined transeolion rules Ofher
09 Capitel gains 10 lndustriel royelties 11 Motion pioture or television oopyright royalties 12 Other royelties (for essmple, oopynght, softwere, brosdcesting, endorsement
peyments) 13 Royelties peid on oertsin publioly olfered securities[1j 14 Reel property inoome sed neturel resouroes royelties 15 Pensions, ennuities, elimony, end/or insurenoe premiums 16 Soholership or fellomship grents 17 Compensetion for independent personel servioes[2] 18 Compensetion for dependent personel services[21 19 Compensstion for teeohing[2j 20 Compenxxtion during xtudying and treining[2j 23 Other inoome 24 Ouelified invextment entity (OlE) distributionx of cxpitel geins 25 Truxt dixtribufionx xubject to IRC seotion 1445 26 Unxevered groming oropx and timber dixtributionx by e truxt xubject to
IRC xection 1445 27 Publicly treded pertnerxhip dixtribulionx xub)eot to lEO seotion 1446(e) 28 Gembling minningx[3J 32 Notionei prinoipal oontrxot inoome[4] 35 Subxtitute peyment-ofher 36 Cepitei geinx dixtribulionx 37 Return of oepitel 38 Eligible deferred compeexetion itemx xubject to lEO xeotion 877A(dfll) 39 Dixtributionx from e nongrentor truxt xubject to lEO seofion 877A(f))1) 41 Guerentee of indebtednexx 42 Eerningx es en ertiet or ethlete-no centrel wilhholding egreement[5] 43 Eerningx es en ertist or ethlete-centrei withholding egreement[5) 44 Specitied federel procurement paymenlx 50 tnoome previouxly reported under escrow prooedure[6j 55 Texeble deeth benefitx on life inxurence oontrects 57 Amount reelized under lEO seotion 1446(f) 58 Publioly treded pertnerxhip dixtributions-undetermined
Boxes 3a and 4a. Exernpt)on Code (applles if the tsx rate entared in box 3b or 4b ts 00.00).
Gode Authority for Exentpt)on Ghapter 3
01 Effeotiveiy conneoted inoome 02 Exempt under 1110)7) 03 lncome ix not from U.S. xourcex 04 Exempt under tee treety 05 Portfolio interest exempt ender lEO 06 01 thet essumes primery withhoiding responsibility 07 WFP or WFT 08 U.S. brench treeted ex U.S. Perxon 10 01 reprexents thxt inoome ix exempt 11 OSL Ihat esxumes primery mifhholding responsibility 12 Peyee xubjected to ohepter 4 withholding 22 ODD ihet essumes primary mithhoiding rexponxibilify 23 Esempt under seotion 897(i) 24 Exempt under seotion 892
See beck of Copy C for additionel oodes
U.S. Income Tax FiIing Requirements Generelty, every nonresident elien individuel, nonresident elien fiduciery, and foreign corporation mith U.S. inoome, inoluding inoome thet ix eifeotively oonneoted mith the oonduct of e iredo or buxinexs in the United Stetes, muxt file x U.S. income tex retum. l-lowever, no return ix required lo be filed by e nonresident elien individuel, nonresident elien tiduoiery, or foreign oorporetion if suoh person wes not engeged in e trede or business in the United Stetes xl eny time during the tex yeer and if the lex liebitity of such person wes fully safixfied by the withholding of U.S. lex eI the xouroe Corporationx lue Form 1 120-F; eli others fite Form 1040-NE. You mey get the retum formx and inxtruotionx eI tRS.gov, eI any U 5. Embessy or conxulete, or by mriting to: Inlernal Revenue Service, 1201 N. Mitxubixhi Motorwey, Bloomington, IL 61705-6613.
En rrtgle gönörele, tout dtrenger non-räsident, tout orgenisme fiddioommisseire dtrxnger non-rdsident eI toute sooiötd dtrengdre peroevent un revenu eus Etetx-Unix, y oompris tout revenu ddried, en feit, du fonolionnement d’un oommerce ou d’une effeire eux Etetx-Unis, doit produire une ddoIaretion d’impöt sur le rexenu euprrts des servioes fisoaux des Etets-Unis. Copendent euoune ddoieretion d’impöt sur le revenu n’est exigde d’un dlrenger non-rdsident, d’un orgenisme fidrtioommissxire ötrenger non-räsident, ou d’une sooirttä dtrangöre siis n’ont pris perI ä euoun oommeroe ou effeire eux Eteis-Unis 4 euoun moment pendxnt l’annde fisoale eI si lex impåts dont ilx sont redesebies, onl dtrt entirtremenl eoquittdx per une retenue 4 le souroe sur leur saleire. Lex xooidlds doiveni feire leur döolerxtion d’impöt en remplixsent le formuieire 1 120-F, fous lex eutres redesebles doixent remplir le formuleire 1040-NE. On peut se proourer iex formulsires de ddoleretions d’imp8tx ei lex insfruolions y effdrentes 4 IRS.gox eI dens toutes lex embessedes eI tous lex oonxuletx des Etetx-Unix. Von peut ögeiement x’edrexxer poer toul renxeignement 4: tnternei Revenue Servioe, 1201 N. Mitxubixhi Motorwey, Oloominglon, tL 61705-6813.
Por regix general, lodo extrenjero no residenle, lodo orgenixmo fideioomixerio extrxn)ero no residente y tode xooieded xnönime extrenjere que reoibe ingrexox en los Extxdox Unidox, inoiuyendo ingrexox releoionedox oon lx oonduooiön de un negooio 0 oomeroio dentro de los Estedox Unidos, deberå presentar une deoixreoiön extedounidense de impuestox xobre ei ingrexo Sin embergo, no se requiere deolereoiån elgune e un indixiduo exiren)ero, ene xooieded anönima extran)era u orgenixmo fideioomixerio extrenjero no residente, xi tel perxone no he efeoiuedo oomeroio o negooio en los Exfedox Unidox durente ei arto fixcal y eila rexponxebiiided oon los impueslos de tel persone he xido setixfeohe plenemente mediente retenoiön del impuesto de los Extadox Unidox en ix fuente. Las xooiadedex anönimex envian ei Formulerio 1120-F; todos los demåx oontribuyentex enxien ei Formuixrio 1040-NE. Se podrä obtener formularios e inxlruooionex en IES.gov y en ouxlquier Embajeda o Oonxuiado de lox Exiadox Unidox 0 exoribiando direotamente e: Inlernel Revenue Servioe, 1201 N. Mitxubixhi Motorwey, Bloominglon, IL 61705-6613.
Im aligemeinen muxs )ede xuxiendixohe Einzelperxon, )eder auxlendixohe Bevolimeohtigte ued lede auxlandixohe Gexeluxohxft mit Einkommen in den Vereinigten SIssIen, einxohliexxlioh des Einkommenx, melohes direkt mit der Auxöbung von Nendal oder Gxmerbe innerhxlb der Stxaten verbunden ixt, eine Einkommanxteuererklärung der Vereinigten SIssIen ebgeben. Eine Erkierung, muxx jedooh nioht von Ausiändem, axxlendixohen Bexoilmäohtigten oder euxländixohen Gexelixoheflen in den Vereinigten Staelen eingereioht merden, felix eine xolohe Perxon mährend des Sleuer)ahrex kein Gemerbe oder 1-landel in den Vereinigten Staeten auxgeuibt heI und die Steuerxohuld duroh Einbeheitung der Steuern der Vereinigten Staaten duroh die Einkommenxquelie abgegoiten xl. Geseilsoheften reiohen den Vordruok 11 20-F ein; alle anderen reiohen dxx Formbixlt 1040-NE ein. Einkommenxteuererklerungen und Instruktionen können unter IRS.gox und bei den Botxohxften und Konxulxlen der Vereinigfen Steeten eingehoit werden. Um weitere Informationen mende man xioh bitte en lnternxi Eevenue Servioe, 1201 N Milxubixhi Motorwey, Eloomington, IL 6170S-661 3.
)1) Thix oode xhould oniy be uxed 8 the unoome peid ix dexoribed in Reguletionx seotion 1.1441 -6(o)(2) and the withhoiding egenl hes reduoed the rete of mithhoiding under en inoome lex Ireety mithout the reoipient proxiding e U 5 or foreign TIN. )2) lf oompenxetion thxt otherwixe mould be ooxered under Inoome Oodex 17 through 20 ix direoily altributebie to the reoipient’x oooupetion xx en artixt or ethiele, use Inoome lode 42 or 43 inxtead.
Page 2 of 5
1 042—S 1 Foreign Person’s U.S. Source Income SubJect To Wlthholding 1 OMB No. 1545-0096
I Go 10 w*w.irs.govIFormlO42S for iflatnJCtionS and the tatest flfOfmatlOn. Gopy C for Recipient Department of the Treasury
! n 1 o 0 1 0 9 1 4 1 1 1 o 1 2 1 UNIQUE FORM IDENTIFIER 11 AMENDED AMENDMENT NO. Attach to any Fecteral tax return you file
Internal Revenue Service
1 Income 2 Gross income 3Chapterindicator.Enter “ or “4” 3 13e Recipent’s U.S. TIN, if any 13f Ch.3 status code 36 code
01 $82618.00 3a Exemption code 24 4a Exemption code 15 13g Ch.4 status code 27
3b Tax rate 00 00 4b Tax rate 00 00 13h Recipient’s GIIN 131 Recipient’s foreign tax identification 13J LOB code number, 4 any
5 V6thhotding allowance
6 Net incon,e
7a Federat las withheld $000 13I Recipient’s account number
0139
7b Check 4 federal tee withheld was rtot depositecl with the IRS because escrow procedures were applied (see iflStructiofls) 131 Recipient’s date of birth (YYYYMMDD)
7c Check if withholding occurred jo subsequent year with respect to a partnership interest
8 Tax withhetct by other agents $0.00 14a Primary Wthholding Agent’s Name (if appticable)
9 Overwithheld tax repaid to recipient pursuant to adjustment procedures (see instructions)
($0.00) 14b Primary Wthholding Agent’s EIN
10 Total withholding credit (combine boxes 7a, 8, and 9) 15 Check 4 pro-rata basis reporting jj $0.00 15a Intermediary or tlow-through entitys EIN, if any 15b Ch.3 status code 5c Ch.4 status code
11 Tax paid by withholding agent (amounts not withheld)(see instructions)
15d Intermediary or flow-through entitys name
12a Wthholding agent’s EIN 12b Ch.3 status code 12c Ch.4 status code
04-6288081 15 01 1 Se Intermediary or flow-through entity s GIIN
12d Wthholding agent’s name 1Sf Country code 15g Foreign las identification number, 4 any SEINE & CO STATE STREET BANK AND TRUST CO
12e Withholding agent’s Gtobal Interrnediary Identification Number (GIIN) 151t Address (number and street)
12f Country code 12g Foreign tax identification number, 4 any 151 City or town, state or provlnce. country, ZIP or foreign postal code
12h Address (number and street) 16a Payefs name 16b Payers TIN P0 BOX 5010
121 City or town, state or province, country, ZIP orforeign postal code 16c Payers GIIN 16d Ch 3 status code 16e Ch. 4 status code
BOSTON MA 02206-5010
13a Recipient’s name 13b Recipient’s country code 17a State income las withheld 17b Payers state las no. 17c Name of state MINISTRY OF FINANCE OF THE REPUBLIC 0F
EN
13c Address (number and street) SUUR AMEERIKA 1
13d City or town, state or province, country, ZtP or foreign postal code
TALLINN, EN 10122
Form 1042-3 (2024)
Page 3 of 5
002014 90065373432 703 02 00000 0000
Explanatiori of Codes (conlinued)
Chapter 4 13 Grandfalhered payment 14 Effeclively connected income 15 Payee nol subjecl to chapler 4 wilhholding 16 Excluded nonhinancial payment 17 Foreign Enlily Ihal assumes primary wilhholding responsibilily 18 U.5• Payees-of participaling FF1 or reg’slered deemed-compliant FF1 19 Exempt kom wilhholdirig under IGA[8J 20 Dormant accounI[9 21 Other-paymenl nol subjecl lo chapler 4 wilhholding
Boxes 12b, 12c, 13t, 13g, 151,, 15c, ISd, and 16e. WthholdingAgant, Racipient, Intermadiy, and Payer Chapter 3 and Chapter 4 Statua Godea.
Code
05 06 07 08
09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 35 36 37 38 39
27 28 29 30 31 32
Type of Raciplent, WtflioIdIng Agent, Payer, or Intermediaiy Chapter 3 Statu8 Codes
li 5 branch-treated asU 5. Person(10( U 5. branch-not lrealed as U & Person[1 ii 115. branchECI presumptiori applied Partnership olher Ihan Wlhholding Fcreign Parlnership or Publicly Traded Partnerah’p Wilhholding Foreign Parlnerahip Trusl olher Ihan WlhhoIdng Foreign Tnisl Wilhholding Foreign Trual Qualilied Inlermediary Oualilied Securilies Lender-Qualilied Inlermediary Qualilied Securilies Lender-Olher Corporation Individual Estate Privale Foundalion International Organizalion Tas Exempl Organization (Seclion 501(c) enliliea) Unknown Recipienl Artist or Athlete Pension Foreign Cenlral Bank of lasue Nonqualitied Inlermediary Hybrid enlity niaking Treaty Claim Oualitied Derivalives Dealer Foreign Governmenl-Integral Part Foreign Government-Conlrolled Enlily Publicly Traded Partnership Diaclosing lualified Inlermediary
Pooled Reporting Codes(12 Wlhholding Rale Pool-General Withholding Rale Pool-Esempl Organization PAI Wlhholding Rale Pool-General PAI Wlhholding Rale PooI-Exempl Organizalion Agency Wilhholding Rale Pool-General Agency Wlhholding Rale Pool-Esempl Organiralion
Chapter 4 Status Godes 01 U.S Wlhholding Agenl-FI 02 lis. Wlhholding Agenl-Olher 03 Terrilonj FI-not trealed as liS. Person 04 Territory FI-lrealed as li 5. Person 05 Participaling FFI-Olher 06 Participaling FFI-Reporting Model 2 FF1 07 Registered Deemed-Complianl FFI-Reporting Model 1 FF1 08 Regiatered Deemed-Complianl FFI-Sponsored Enlily
09 Regiatered Deemed-Compl’ant FFI-Olher 10 Certitied Deemed-Complianl FFI-Olher 11 Certified Deemed-Compliant FFI-FFI with Low Value Accounts 12 Cerlified Deemed-Complianl FFI-Nonregislering Local Bank 13 Certified Dnemed-Complianl FFI-Sponnored Entity 14 Certitied Deemed-Complianl FFI-Inveslmenl Entily Ihat doen not maintain
financial accounls 15 Nonpartic’paling FF1 16 Owner-Documented FF1 17 lis. Branch-Ireated as liS. person 18 lis. Branch-not trealed as lis. person (reporting under aection 1471) 19 Passive NFFE idenlifying Subslanlial lis. Owners 20 Fansive NFFE wilh no Subslanlial U.5 Owners 21 Publicly Traded NFFE or Aifiliale of Pubticly Traded NFFE 22 Aclive NFFE 23 Indiaidual 24 Snction 501(c) Entilies 25 Escepted Terrilory NFFE 26 Escepted NFFE-Other 27 Exempt Beneficial Ownnr 28 Enlily Wtrolly Owned by Enempl Bennficial Owners 29 Unknown Recipinnl 30 Recalcilranl Account Holder 31 Nonreporting IGA FF1 32 Direct reporting NFFE 33 liS. reportahle accounl 34 Nonconnenting liS. accounl 35 5ponnored direct reporting NFFE 36 Excnplnd Inler-atfilialn FF1 37 lindocumenled Preexisling Ohligation 38 liS. Branch-ECI presumplion applind 39 Account Holder of Excluded Financial Account[13[ 40 Pannive NFFE reported by FFI[14[ 41 NFFE nubject to 1472 wilhholding 50 liS. Withholding Agent-Foreign branch of FI
Pooted Reponting Codes 42 Recalcilranl Pool-No liS. lndicia 43 Recalcilrant PooI-li.S Indicia 44 Recalcilrant Pool-Dormanl Accounl 45 Recalcitranl PooI-li.S Pernonn 46 Recalcilrant Pool-Pannive NFFEn 47 Nonparticipating FF1 Pool 48 li 5. Payees Pool 49 0t-Recalcilrant Pool-General[15[
Box 13]. LOS Gode (enter the code that best desatbes the applicable Iimttation on benefita (LOS) categoiy that quattftes the taxpayer for the requested treaty benetlte). LOS Code LOS Treaty Cetegoty 02 Governmenl - conlracling stalefpolilical nubdivisiorntlocal aulhority 03 Taa esempt pension lruntlFennion tund 04 Tee exemptlCharilable organiaalion 05 Publicly lraded corporalcon 06 Subnidiary ot publicly traded corporalion 07 Company Ihat meels the ownership and bane eronion teet 08 Company Ihat menIn the derivalive benefitn teet 09 Company wilh ao item ot ncome Ihat menIn the actine trade or buninenn tenI 10 Dincretionary determmnation 11 Other 12 No LOS artmcle in treaty
[3] Sub)ecl to 30% wmthholdmng rate untesn the recipient in kom one of the treaty countrien linted under Gambling winmngn (Income Code 28) in Puh 515 [4] Use approprmale Intereat Income Code tor embedded inlerent in a nolional prmncipal contract. [5] Income Code 43 nhoutd only he uned if Leller 4492, Venue Notificalion, haa been innued by the tnlernal Renenue Servmce (olherwiae. une tncome Code 42 for eamingn en an arlint or alhlete). lf tncome Code 42 or 43 me uned, Recmpienl Code 22 (artiat or athtete) nhould be uned inntead of Recipient Code 15 (mndmaidual). 15 (corporalion), or 08 (partnarnhmp olher Ihan withhotding foreign parlnernhip or publicly lraded partnernhip) [6] line only to report grosa income the las for whmch me being deponited in the current year hecause such las waa previounly encrowed for chaptern 3 and 4 and the withholding agent previounly reported the gronn income in a prior year and checked the bos to report the tee an not deponited under Ihe escrow procedure See the inntructiona lo thin form for further espianalmon. [7] Thin code nhould only he uned 4 no other specif mc chapter 3 exemplmon code applies. [8] line only to report a li 5. reporlabte account or nonconnenting li.S account that in receining a payment nubject to chapler 3 wmlhholding [9] line only it applymng the encrow procedure for dormanl accounts under Regulatmonn nection 1.1471-4(b)(6) If tas wan withheld and deposited under chapter 3, do not check box 7b (“las not deponited wmth tRS purnuant to encrow Frocedure”(. You muet inntead enter “3” in hos 3 and complele bos 3b [10] Thin code can he used by a Terrmtory FI thal is trealed an a liS. pernon. [11] This code can he uned by a Territory Ft Ihat in nol treated an a liS. pernon. [12] Codes 27 through 32 should only he uned hy a II, OSL, WP, or WT. Ali acting as a ODD may uno only code 27 or 28. [13] Thin code nhouid only he uned if income in paid to an accounl thal in escluded from the defmnitron of tinancmal account under Regulationn nectmon 1.1471 -5(b))2) or under Annos II of the applicable Modet 1 IGA or Model 2 IGA. [14] Thin code nhouid only he uned when the wilhholdmng agent han receiaed a certitication on the FF1 withhoiding ntatement of a partmcipating FF1 or regintered dnnmed-complianl FF1 that maintainn the account Ihat the FF1 han reported the accounl held by the pannmne NFFE an a li.S. accouot (o li.S reportahle account) under iln FATCA requirementn. The withholding agenl munt report the name and GIIN of nuch FF1 in bonen 15d and iSo. [15] Thin code nhould only he uned by a wmlhholdirl9 ageni Ihat in reportmng a payment (or porlmon ota payment) made to a II wmth renpect to the lI’n recatcitrant accouni holdern.
Page4of 5
1 042—S 1 Forei9n Person’s U.S. Source Income Subject To Vvithholding ©24 1 DM6 No. 1545-0096
1 Go 10 www.irs.gov/FormIO42S for lnstructions and ftte lateat information. Copy D for Recipient Department ot the Treasury Internal Revenue Service 0 1 0 1 0 1 0 1 9 4 1 0 1 0 1 0 1 21 UNIQUE FORM IDENTIFIER AMENDED AMENDMENT NO.
Allach 10 any stale tax return you tie
1 inoome 2 Gross ineome 3 Chapterinditor. Enter “3 or OO4O 3 13e Recipient’s U.S. TIN, if any 13f Ch.3 status code 36
code 01 $82618 00
3. Exemplion code 24 4. Exemplion coda 15 13g Ch.4 status code 27
3b Tax rata 00 00 4b Tax rate 0000 13tt Recipient’s GIIN 131 Recipienl’s foreign tax idenlification 13 LOB code nuniber, 1 any
5 Withholding aliowance
6 Nel income
7. Federal tax withheid $0.00 13tt Recipienrs account number
0139 7b Check if federal tax withheld was fbI deposited with the IRS because
escrow procedures were appliecl (see instructions) 131 Recipienrs date of birlh (YYYYMMDD)
7c Check if withholding occurred in subsequent year wilh respeot 10 a parlnership interest . . .
8 Tax withheld by other agenls $0.00 14. Primary iMthhotding Agenl’s Name (it applicable)
9 Overwithheid tax repaid 10 recipient pursuanl to adjuslmenl procedures (see instructions)
($0.00) 14b Primary tMlhholding Agenl’s EIN
10 Total wilhhotding credit (combine boxes 7a, 8, and 9) 15 Check if pro-rata basis reporting
$0.00 15a intermediary or flow-through entily’s EIN, if any 150 Ch.3 slalus code 150 Ch.4 status code
11 Tax paid by wilhholding agent (amounls fbI withheld)(see inslruClions)
15d Inlermediary or fiow-lhrough entity’s name
12a Wlhholding agenls EIN 12b Ch.3 slatus code 12c Ch.4 slatus code
04-6288081 15 01 ___________________________________________________________________________ 15. Intermediary orflow-through enlitys GIIN
12d tMlhholding agent’s name 15f Country code 15g Foreign tax identificalion number, if any
SEINE & Cl STATE STREET 8ANK AND TRUST Cl
12. Withhotding agenrs Giobal Inlermediary Idenlificalion Number (GIIN) 151i Address (number and slreel)
121 Country Code 12g Foreign lex dentification number, if any 151 City or town, state or province, country, ZIP or foreign poslal code
12tt Adctress (number and street) 16. Payer’s name 160 Payer’s TIN P0 BOX 5010
121 lily or lown, stale or provinoe, country, ZIP or foreign postal code 150 Payer’s GIIN 16d Ch. 3 slalus code 16. Ch 4 slatus code
BOSTON MA 02206-5010
MiNSRYOFFiNANCE 0F THE REPUBLIC OF 130 Recipienl’s Country code 17a SIale income lex wilhheld 17b Payes state lex no. 17c Name 01 stale
EN
13c Address (number and streel)
SUUR AMEERIKA 1
13d lily or lown, stale or province, Country, ZIP or foreign poslal Code
TALLINN, EN 10122
Form 1042-S (2024)
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