Form 1042 (2018)
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 63d
e
Tax paid by withholding agent . . . . . . . . . . . . . . . . . . . . . . . .
63e
Total tax reported as withheld or paid (Add lines 63a–d) . . . . . . . . . . . . . . .
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 2017 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 2019 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 U.S. . . . 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 line 62a, (b)(1), and (b)(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:
(1) Attach a statement (see instructions for requirements).
(2) Enter the EIN (not the QI-EIN) of the QDD
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Form 1042 (2018)