Additional Foreign Country Claim Forms

This section identifies the Foreign Claim Forms and countries not mentioned in the previous instructions.

These are additional countries for which the IRS has a formal agreement for certification.

The following forms are not required to be signed or sealed by an IRS official. Issuing the Form 6166 is all that is required of the IRS.

Denmark (U33), Claim to Relief from Danish Dividend Tax. This form requires self-statement by U.S. resident.

Germany DBA/U.S.A. 5000 - Applicant for refund states he had residence in the United States.

Netherlands - Applicant self-certifies as to U.S. residency.

Switzerland 82 series forms - Claim of refund of Swiss tax withheld at source on dividends and interest derived from sources within Switzerland. Requires notarized signature of claimant.

Ireland - All claim forms specifically state that all that is required for each year claimed is a Form 6166 from the Internal Revenue Service.

Finland - Form 6113a – Declaration Concerning Relief From Finland Tax at Source, no longer requires certification; the Form 6166 may be used to follow the new requirements.

Sign (stamp) and seal all foreign tax forms when requested (form specifies) by the foreign country and the Competent Authority has agreed to certify the form.

The following charts indicate additional foreign countries and their specific tax forms:

Belgium

These forms require that you stamp the date, the Director's signature, and the IRS seal.