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Federal Free Printable Form 14454 (Rev. 12-2017) for 2019 Federal Attachment to Offshore Voluntary Disclosure Letter

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Attachment to Offshore Voluntary Disclosure Letter
Form 14454 (Rev. 12-2017)

14454 Form (December 2017) Department of the Treasury–Internal Revenue Service Attachment to Offshore Voluntary Disclosure Letter OMB Number 1545-2241 (One attachment is required for each financial institution) Please ensure all pages of Form 14454 include your name, the last four digits of your taxpayer identification number, the name of the foreign financial institution, and the account number for which you are responding. For each foreign financial account of which you have control or are a beneficial owner, provide the following information. Taxpayer Name Last Four Digits of Taxpayer Identification Number 1a. Foreign Financial Institution Name 1b. Account Number 2. Address, including country, where the account was established (If different, address, 3. Date the account was opened DO NOT LEAVE BLANK (if unsure, please estimate) including country, where account is currently located) 4a. Is the account still open? Yes No 4b. If “No,” when was the account closed 5. Identify the individual(s), affiliates and/or organization(s) (e.g., banks, independent financial advisors, trust or corporate service providers) who advised or assisted you in opening and using/maintaining the account. Include contact information for individual(s), affiliates, and/or organization(s) 6a. Explain all communications you had regarding the opening and use/maintenance of the account. Identify the individuals (whether affiliated with the foreign financial institution or independent from the financial institution), dates, and form (e.g., face-to-face meeting, phone, email, fax, etc.) of the communication. 6b. Any meetings, phone calls, faxes, emails, or any other communications from these individuals to you in the U.S.? Taxpayer Yes No Spouse Yes No Related entities Yes No If “Yes,” where 6c. Are any of the individuals a business person (advisor), accountant, attorney, or return preparer in the U.S.? Taxpayer Yes No Spouse Yes No Related entities Yes No If “Yes,” identify which organization(s) 7. With respect to communications you had about your foreign financial account, provide the following: 7a. Did a representative of the foreign financial institution or advisor visit you in the United States regarding the offshore account? Taxpayer Yes No Spouse Yes No Related entities Yes No 7b. Did a representative of the foreign financial institution or advisor suggest to you the use of offshore accounts, offshore investments, offshore entities, or particular foreign countries as a way of avoiding the disclosure of your ownership of the account or avoiding taxes? Taxpayer Yes No Spouse Yes No Related entities Yes No If “Yes,” provide the dates and locations for all meetings Catalog Number 61606G www.irs.gov Form 14454 (Rev. 12-2017) Page 2 Taxpayer Name Last Four Digits of Taxpayer Identification Number 1a. Foreign Financial Institution Name 1b. Account Number 7c. Did a representative of the foreign financial institution or advisor suggest to you the use of practices, such as holding mail at the institution, using prepaid phone cards, using credit or debit cards, communicating via fax or email, bank storage of account documentation, or conducting face-toface-meetings, to avoid the disclosure of your ownership of the account? Taxpayer Yes No Spouse Yes No Related entities Yes No 7d. Did a representative of the foreign financial institution, one of its U.S. subsidiaries, or advisor provide services in the U.S. related to offshore accounts (e.g., facilitating opening accounts, reviewing account activity, forwarding account statements, providing investment and/or tax advice, etc.)? Taxpayer Yes No Spouse Yes No Related entities Yes No 7e. Did a representative of the foreign financial institution or advisor suggest you meet in a jurisdiction outside the U.S. and other than where the institution is located? Taxpayer Yes No Spouse Yes No Related entities Yes No If “Yes,” provide the dates and locations for all meetings 7f. Did a representative of the foreign financial institution or advisor suggest you either not file a voluntary disclosure with the IRS or repatriate the foreign funds into the U.S.? Taxpayer Yes No Spouse Yes No Related entities Yes No 7g. Did an advisor or other person attempt to influence you to move funds from one foreign financial institution to another or from one foreign country to another? Taxpayer Yes No Spouse Yes No Related entities Yes No 8a. What documentation was received by or shown to you regarding opening and maintenance of the account (e.g., account statements, account opening documents, etc.)? 8b. Who showed you the documentation and when? 8c. Did you retain any of the documents? Taxpayer Yes No Spouse Yes No Related entities Yes No If “Yes,” identify the documents retained If “No,” explain why you did not retain them 9. Were you able to make deposits to or withdrawals from your account through the use of a U.S. domestic branch office of the foreign financial institution? Taxpayer Yes No Spouse Yes No Related entities Yes No Catalog Number 61606G www.irs.gov Form 14454 (Rev. 12-2017) Page 3 Taxpayer Name Last Four Digits of Taxpayer Identification Number 1a. Foreign Financial Institution Name 1b. Account Number 10a. Did you or someone on your behalf make deposits (beyond the initial opening deposit) to the account? Taxpayer Yes No Spouse Yes No Related entities Yes No Entity name Telephone number Address If “Yes,” respond to the following: 10b. How did you make a deposit (e.g., in person, online, phone, ATM, use of third-party, etc.)? 10c. What form were the deposits in (e.g., cash, check, wire, traveler’s check, etc.)? 10d. What documents did you receive when a deposit was made (e.g., receipt, credit memo, etc.)? 10e. If funds were transferred from other financial institutions, provide the following information (if more space is needed, attach additional pages) Financial Institution(s)/Location(s) Name on account(s) Amount of transfer(s) Date(s) of transfer 11a. Did you or someone on your behalf withdraw money from the account? Taxpayer Yes No Spouse Yes No Related entities Yes No Entity name Telephone number Address If “Yes,” respond to the following: 11b. How were the funds withdrawn (e.g., in person, online, phone, ATM, use of third-party, etc.)? 11c. What form were the withdrawals in (e.g., cash, check, wire, debit, etc.)? 11d. What documents were received when a withdrawal was made (e.g., receipt, debit memo, etc.)? 11e. If funds were transferred to other offshore financial institutions, provide the following information (if more space is needed, attach additional pages) Financial Institution(s)/Location(s) Name on account(s) Amount of transfer(s) Date(s) of transfer 12a. Did you move any funds into the United States during the life of the account? Taxpayer Yes No Spouse Yes No Related entities Yes No Entity name Telephone number Address If “Yes,” respond to the following: 12b. In what form did you move the funds (e.g., cash, check, wire, bank checks, etc.)? 12c. Did you engage in any transactions or series of transactions or use any third parties or other methods or schemes to move the money back into the United States (e.g. loans, business invoices, other entities, third parties, etc.)? If yes, explain and identify all individuals and entities involved Catalog Number 61606G www.irs.gov Form 14454 (Rev. 12-2017) Page 4 Taxpayer Name Last Four Digits of Taxpayer Identification Number 1a. Foreign Financial Institution Name 1b. Account Number 12d. Provide the following information about the U.S. Financial Institution(s) to which the funds were transferred (if more space is needed, attach additional pages) Financial Institution(s)/Location(s) Name on account(s) Amount of transfer(s) Date(s) of transfer 13a. Did you move any funds to a country outside the jurisdiction of the country where the account was held? Taxpayer Yes No Spouse Yes No Related entities Yes No Entity name Telephone number Address 13b. If funds were transferred to other financial institutions, provide the following information: Financial Institution(s)/Location(s) Name on account(s) Amount of transfer(s) Date(s) of transfer 14a. Are there other individuals affiliated with the account(s)? Taxpayer Yes No Spouse Yes No 14b. If “Yes,” identify each person affiliated with each account, including the nature of their relationship to the account (e.g., owner, beneficial owner, power of attorney, signatory authority, etc.) 15a. Is an entity affiliated with the account(s)? Taxpayer Yes No Spouse Yes No If “Yes,” respond to the following for each entity: 15b. Identify the entity, including the nature of its relationship to the account (e.g., nominee owner, beneficial owner, power of attorney, parent entity of corporate account holder, etc.) 15c. Identify the entity’s formal structure (e.g., corporation, foundation, trust, etc.) 15d. Identify the country where the entity was organized 15e. Identify the individual(s) and/or organization(s) (e.g., the foreign bank, an outside professional, etc.) who suggested forming the entity and who formed the entity 15f. Identify the individual(s) or organization(s) that managed the entity 15g. Is the entity still in existence? Taxpayer Yes No Spouse Yes No Catalog Number 61606G www.irs.gov Form 14454 (Rev. 12-2017) Page 5 Taxpayer Name Last Four Digits of Taxpayer Identification Number 1a. Foreign Financial Institution Name 1b. Account Number 15h. Was a business person (advisor), accountant, attorney, or return preparer in the U.S. involved in setting up the entity or in advising its use? Taxpayer Yes No Spouse Yes No If “Yes,” identify the individual(s) 15i. Was a U.S. bank, brokerage firm or other financial services company involved in setting up the entity or in advising its use? Taxpayer Yes No Spouse Yes No If “Yes,” identify the bank, firm, or company Privacy Act and Paperwork Reduction Act Notice We ask for the information on this foreign account or asset statement to carry out the Internal Revenue laws of the United States. Our authority to ask for information is sections 6001, 6109, 7801, 7803 and the regulations thereunder. This information will be used to determine and collect the correct amount of tax under the terms of the offshore voluntary disclosure program. You are not required to apply for participation in the offshore voluntary disclosure program. However, if you choose to apply, you are required to provide all information requested on the offshore voluntary disclosure letter, as well as any necessary attachments. You are not required to provide the information requested on a document that is subject to the Paperwork Reduction Act unless the document displays a valid OMB control number. Books or records relating to a document 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 section 6103. Section 6103, however, allows or requires the Internal Revenue Service to disclose or give this information to others as described in the Internal Revenue Code. For example, we may disclose this information to the Department of Justice to enforce the tax laws, both civil and criminal, and to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Failure to provide this information may delay or prevent processing your application. Providing false information may subject you to penalties. The time needed to complete and submit the foreign account or asset statement will vary depending on individual circumstances. The estimated average time is: 2 hour. If you have comments concerning the accuracy of this time estimate or suggestions for making the foreign account or asset statement simpler, we would be happy to hear from you. Comments should be sent to the Internal Revenue Service, Attn: IRS Reports Clearance Officer, SE:W:CAR:MP:T:T: SP, Washington, DC 20224. Catalog Number 61606G www.irs.gov Form 14454 (Rev. 12-2017)
Extracted from PDF file 2018-federal-form-14454.pdf, last modified December 2017

More about the Federal Form 14454 Other TY 2018

We last updated the Attachment to Offshore Voluntary Disclosure Letter in February 2019, so this is the latest version of Form 14454, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 14454 directly from TaxFormFinder. You can print other Federal tax forms here.


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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 14454 from the Internal Revenue Service in February 2019.

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Historical Past-Year Versions of Federal Form 14454

We have a total of four past-year versions of Form 14454 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 14454

Form 14454 (Rev. 12-2017)

2017 Form 14454

Form 14454 (Rev. 12-2017)

2016 Form 14454

Form 14454 (Rev. 7-2014)

Attachment to Offshore Voluntary Disclosure Letter 2015 Form 14454

Form 14454 (Rev. 7-2014)


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