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follows. Attach a copy of the authorization to Form

organization or residence of the person to whom the

3520-A.

property was subsequently transferred.

The statement must also contain a description of the

AUTHORIZATION OF AGENT

trust ownership structure setting forth the name, U.S.

[ Name of foreign trust ] hereby expressly authorizes [ name of

taxpayer identification number (if any), and country of

U.S. agent ] to act as its agent solely for purposes of sections

7602, 7603, and 7604 of the Internal Revenue Code with respect to

organization of all entities in which the trust has an

any request to examine records or produce testimony related to the

ownership interest, including an ownership chart showing

proper treatment of amounts required to be taken into account

the trust's position in the chain of ownership and the

under the rules of section 6048(b)(1)(A) or to any summons for such

records or testimony. I certify that I have the authority to execute

percentages of ownership.

this authorization of agent to act on behalf of [ name of foreign

trust ].

Note. The term “person” includes an individual or an

entity, whether U.S. or foreign. See the definition of U.S.

person earlier. A foreign person is an individual or entity

Signature of trustee

(title)

(date)

(or other authorized person)

that is not a U.S. person.

Line 6. Enter the number of Foreign Grantor Trust

Owner Statements (page 3) included with this Form

Your Name (type or print)

3520-A.

Identification Number (if any)

Part II—Foreign Trust Income

Statement

Address

Include all income from U.S. and non-U.S. sources. This

[ Name of agent ] accepts this appointment to act as agent

for [ name of foreign trust ] for the above purpose. I certify that I

financial statement must reasonably reflect the trust's

have the authority to execute this authorization of agent to act on

income under U.S. income tax principles.

behalf of [ name of foreign trust ] and agree to accept service of

process for the above purposes.

Income

Line 1. Interest. Report all taxable interest income that

Signature of agent

(title)

(date)

was received during the tax year. Examples of taxable

interest include, but are not limited to, interest from the

following.

Your Name (type or print)

Accounts (including certificates of deposit and money

market accounts) with banks, credit unions, and thrift

Identification Number (if any)

institutions.

Address

Notes, loans, and mortgages.

U.S. Treasury bills, notes, and bonds.

Do not enter a PTIN on the authorization form.

U.S. savings bonds.

Original issue discount.

CAUTION

Income received as a regular interest holder of a real

Line 5. Attach a statement that provides the following

estate mortgage investment conduit (REMIC).

information concerning the transfer.

For taxable bonds acquired after 1987, amortizable

1. Name, U.S. taxpayer identification number (if any),

bond premium is treated as an offset to the interest

and country of organization or residence of the person to

income instead of as a separate interest deduction. See

whom the property was transferred.

Pub. 550, Investment Income and Expenses.

2. A general description of the transfer, and any

Line 2. Dividends. Report all ordinary dividends

broader transaction of which it forms a part, including a

received during the tax year.

chronology of the transfers involved and an identification

of the other parties to the transaction to the extent known.

Note. Report capital gain distributions on line 5.

3. A description of the property transferred, including

Line 4. Income (loss) from partnerships, fiduciaries,

the estimated FMV and the adjusted basis of the property.

etc. Enter the trust's share of income or (losses) from

4. A description of the consideration received by the

partnerships, S corporations, estates, other trusts, and

trust, including its estimated FMV, and for stock or

REMICs.

securities, the class or type, amount, and characteristics

If the trust received a Schedule K-1 from a partnership,

of the interest received. If no consideration was received

S corporation, or other flow-through entity, use the

by the trust, indicate whether the trust or a U.S. owner

corresponding lines on Form 3520-A to report the interest,

exercises any powers over the entity to which the property

dividends, capital gains, etc., from the flow-through entity.

was transferred (including a description of such powers),

Line 5. Capital gains (losses). For capital gains or

and identify the name, U.S. taxpayer identification number

(losses) attributable to a U.S. owner, use Schedule D

(if any), and country of organization or residence of all

(corporate or individual, whichever applies) and Form

beneficial owners of such entity.

8949, Sales and Other Dispositions of Capital Assets, if

5. To the extent known, a description of any

applicable.

subsequent transfer of the property, including the name,

U.S. taxpayer identification number (if any), and country of

-5-

Instructions for Form 3520-A (2016)

Instructions For Form 3520-A - Annual Information Return Of Foreign Trust With A U.s. Owner - 2016 Page 5

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