This form contains 62 fields organized into 11 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Account Holder Information
topmostSubform[0].Page1[0].Line9GIIN[0].Comb9GIIN[0].GIIN_1[0].f1_18[0 Text
Enter the first part of the Global Intermediary Identification Number (GIIN) for the account holder. This is a 6-character alphanumeric code.
Max length: 6 characters
topmostSubform[0].Page1[0].Line9GIIN[0].Comb9GIIN[0].GIIN_2[0].f1_19[0 Text
Enter the second part of the Global Intermediary Identification Number (GIIN) for the account holder. This is a 5-character alphanumeric code.
Max length: 5 characters
Account Holder or Payee Information
10 TIN Text
Enter the Taxpayer Identification Number (TIN) of the account holder or payee. This is an 11-character field.
Max length: 11 characters
1a Name of account holder or payee Text
Enter the name of the account holder or payee.
2 Number, street, and room or suite no. (if P.O. box, see instructions) Text
Enter the number, street, and room or suite number of the account holder or payee. If using a P.O. box, refer to the instructions.
3a City or town Text
Enter the city or town of the account holder or payee.
3b State, province, or region Text
Enter the state, province, or region of the account holder or payee.
3c Country, including postal code Text
Enter the country, including postal code, of the account holder or payee.
Account Information
1 Account number Text
Enter the account number associated with the financial asset.
2 Currency code (see instructions) Text
Enter the currency code for the account. Refer to the form instructions for the list of acceptable currency codes.
Additional Information
4d Other Text
Provide any other relevant information that does not fit into the specified categories.
Checkboxes
topmostSubform[0].Page2[0].Col1[0].c2_1[0]_1 CheckBox
Check this box if the condition specified in the form applies.
topmostSubform[0].Page2[0].Col1[0].c2_1[1]_2 CheckBox
Check this box if the condition specified in the form applies.
topmostSubform[0].Page2[0].Col1[0].c2_1[2]_3 CheckBox
Check this box if the condition specified in the form applies.
topmostSubform[0].Page2[0].c2_1[0]_4 CheckBox
Check this box if the condition specified in the form applies.
topmostSubform[0].Page2[0].c2_1[1]_5 CheckBox
Check this box if the condition specified in the form applies.
topmostSubform[0].Page2[0].c2_1[2]_6 CheckBox
Check this box if the condition specified in the form applies.
Filer Address
2 Number, street, and room or suite no. (if P.O. box, see instructions) Text
Enter the number, street, and room or suite number of the filer's address. If using a P.O. box, refer to the instructions.
3a City or town Text
Enter the city or town of the filer's address.
3b State, province, or region Text
Enter the state, province, or region of the filer's address.
3c Country, including postal code Text
Enter the country and postal code of the filer's address.
Filer Information
topmostSubform[0].Page1[0].IDNumber[0].f1_1[0 Text
Enter the identification number of the filer. This is a short numeric code used to uniquely identify the filer.
Max length: 3 characters
topmostSubform[0].Page1[0].c1_1[0]_1 CheckBox
Check this box if the filer is a U.S. financial institution.
topmostSubform[0].Page1[0].c1_1[1]_2 CheckBox
Check this box if the filer is a foreign financial institution.
topmostSubform[0].Page1[0].c1_1[2]_3 CheckBox
Check this box if the filer is a direct reporting NFFE (Non-Financial Foreign Entity).
topmostSubform[0].Page1[0].c1_1[3]_4 CheckBox
Check this box if the filer is a sponsored direct reporting NFFE.
1a Name of filer Text
Enter the full name of the filer. This should be the legal name of the entity or individual filing the form.
topmostSubform[0].Page1[0].FilerCategory[0].f1_3[0 Text
Enter the category of the filer. This is a short code that indicates the type of filer (e.g., 'FI' for financial institution).
Max length: 2 characters
topmostSubform[0].Page1[0].Line4GIIN[0].Comb4GIIN[0].GIIN_1[0].f1_8[0 Text
Enter the Global Intermediary Identification Number (GIIN) of the filer. This is a unique identifier assigned to financial institutions.
Max length: 6 characters
Financial Information
3a Account balance Text
Enter the account balance as of the reporting date.
4b Dividends Text
Enter the total amount of dividends received.
4c Gross proceeds/Redemptions Text
Enter the gross proceeds or redemptions amount.
2 Number of accounts Text
Enter the total number of accounts being reported.
3 Aggregate payment amount Text
Enter the aggregate payment amount for the accounts being reported.
4 Aggregate account balance Text
Enter the aggregate account balance for the accounts being reported.
5 Currency code Text
Enter the currency code for the amounts reported.
General Information
topmostSubform[0].Page1[0].c1_3[0]_1 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].c1_3[1]_2 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].c1_4[0]_1 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].c1_4[1]_2 CheckBox
Check this box if applicable.
topmostSubform[0].Page1[0].c1_4[2]_3 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions under which this box should be checked.
topmostSubform[0].Page1[0].c1_4[3]_4 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions under which this box should be checked.
topmostSubform[0].Page1[0].f1_30[0 Text
Enter the required information as specified in the form instructions.
topmostSubform[0].Page1[0].c1_5[0]_Check2 CheckBox
Check this box if applicable. Refer to the form instructions for specific conditions under which this box should be checked.
topmostSubform[0].Page1[0].Lines4ab[0].f1_38[0 Text
Enter the required information as specified in the form instructions.
Identification Details
topmostSubform[0].Page1[0].Line4GIIN[0].Comb4GIIN[0].GIIN_2[0].f1_9[0 Text
Enter the second part of the Global Intermediary Identification Number (GIIN). This is a 5-character alphanumeric code.
Max length: 5 characters
topmostSubform[0].Page1[0].Line4GIIN[0].Comb4GIIN[0].GIIN_3[0].f1_10[0 Text
Enter the third part of the Global Intermediary Identification Number (GIIN). This is a 2-character alphanumeric code.
Max length: 2 characters
topmostSubform[0].Page1[0].Line4GIIN[0].Comb4GIIN[0].GIIN_4[0].f1_11[0 Text
Enter the fourth part of the Global Intermediary Identification Number (GIIN). This is a 3-character alphanumeric code.
Max length: 3 characters
5 TIN Text
Enter the Taxpayer Identification Number (TIN) of the filer. This is an 11-character numeric code.
Max length: 11 characters
topmostSubform[0].Page1[0].f1_13[0 Text
Enter the name of the filer.
7 Number, street, and room or suite no. (if P.O. box, see instructions) Text
Enter the number, street, and room or suite number of the filer's address. If using a P.O. box, refer to the instructions.
topmostSubform[0].Page1[0].f1_15[0 Text
Enter the city or town of the filer's address.
8b State, province, or region Text
Enter the state, province, or region of the filer's address.
8c Country, including postal code Text
Enter the country and postal code of the filer's address.
topmostSubform[0].Page1[0].Line9GIIN[0].Comb9GIIN[0].GIIN_3[0].f1_20[0 Text
Enter the third part of the Global Intermediary Identification Number (GIIN). This is a 2-character field.
Max length: 2 characters
topmostSubform[0].Page1[0].Line9GIIN[0].Comb9GIIN[0].GIIN_4[0].f1_21[0 Text
Enter the fourth part of the Global Intermediary Identification Number (GIIN). This is a 3-character field.
Max length: 3 characters
Owner Information
4 TIN Text
Enter the Taxpayer Identification Number (TIN) of the owner. This is an 11-character field.
Max length: 11 characters
1 Name of owner Text
Enter the full name of the owner of the account or financial asset.
3a City or town Text
Enter the city or town where the owner resides.
3b State, province, or region Text
Enter the state, province, or region where the owner resides.
3c Country, including postal code Text
Enter the country and postal code where the owner resides.
4 TIN of owner Text
Enter the Taxpayer Identification Number (TIN) of the owner. This should be a maximum of 11 characters.
Max length: 11 characters