Offshore Asset Disclosure Form
Use this form to disclose offshore assets, ownership or control details, and related reporting information. Provide complete and accurate details for each offshore asset.
Filer Information
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Country of Residence
*
Please Select
United States
Canada
United Kingdom
Australia
India
Germany
France
Other
Taxpayer/Residency Status
*
Please Select
Resident Taxpayer
Non-Resident Taxpayer
Dual Resident
Temporary Resident
Other
Offshore Asset Details
Asset Type
*
Bank account
Securities
Real estate
Investment fund
Trust
Entity ownership interest
Cryptocurrency
Other
Held Directly or Indirectly
*
Directly
Indirectly
Description of Asset
*
Country or Jurisdiction
*
Please Select
United States
Canada
United Kingdom
Switzerland
Singapore
Cayman Islands
British Virgin Islands
Luxembourg
Hong Kong
Other
Institution or Intermediary Name
Ownership Percentage or Control Level
*
Acquisition Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Estimated Current Value
*
Currency
*
Please Select
USD
EUR
GBP
CAD
CHF
SGD
HKD
JPY
AUD
Other
Source of Funds or Asset Origin
*
Income or Distributions Received in Reporting Period
*
Yes
No
Total Income or Distribution Amount
Beneficial Ownership and Disclosure Notes
Beneficial Owner or Connected Party Name
Role or Relationship to Offshore Asset
Additional Disclosure Notes or Explanations
Confirmation: I certify that the information provided in this section is complete and accurate to the best of my knowledge.
*
I Confirm
Submit Disclosure
Should be Empty: