0425 Form 3922 (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f3922.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

Plan Under Section 423(c)

an Employee Stock Purchase

Copy A

For Internal Revenue

Service Center

For filing information,

Privacy Act, and Paperwork Reduction

Act Notice, see the General Instructions

for Certain Information Returns .

www.irs.gov/Form1099

2626 VOID CORREC		CTED
CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	1 Date option granted	Form 3922 (Rev. April 2025) OMB No. 1545-2129
CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	2 Date option exercised	2 Date option exercised
CORPORATION’S federal identification number	EMPLOYEE’S identification number	3 Fair market value per share on grant date $	4 Fair market value per share on exercise date $
EMPLOYEE’S name	EMPLOYEE’S name	EMPLOYEE’S name	EMPLOYEE’S name
EMPLOYEE’S name	EMPLOYEE’S name	5 Exercise price paid per share $	6 No. of shares transferred
Street address (including apt. no.)	Street address (including apt. no.)	7 Date legal title transferred	7 Date legal title transferred
City or town, state or province, country, and ZIP or foreign postal code
City or town, state or province, country, and ZIP or foreign postal code	City or town, state or province, country, and ZIP or foreign postal code	8 Exercise price per share determined as if the option was exercised on the date shown in box 1 $	8 Exercise price per share determined as if the option was exercised on the date shown in box 1 $
Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	Account number (see instructions)

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Cat. No. 41180P

Department of the Treasury - Internal Revenue Service

CORRECTED

Plan Under Section 423(c)

an Employee Stock Purchase

Copy B

For Employee

This is important tax

information and is being furnished to the Internal Revenue

Service.

CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code		1 Date option granted	OMB No. 1545-2129 Form 3922 (Rev. April 2025)
CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	CORPORATION’S name, street address, city or town, state or province, country, and ZIP or foreign postal code	2 Date option exercised	2 Date option exercised
CORPORATION’S federal identification number	EMPLOYEE’S identification number	3 Fair market value per share on grant date $	4 Fair market value per share on exercise date $
EMPLOYEE’S name	EMPLOYEE’S name	EMPLOYEE’S name	EMPLOYEE’S name
EMPLOYEE’S name	EMPLOYEE’S name	5 Exercise price paid per share $	6 No. of shares transferred
Street address (including apt. no.)	Street address (including apt. no.)	7 Date legal title transferred	7 Date legal title transferred
City or town, state or province, country, and ZIP or foreign postal code
City or town, state or province, country, and ZIP or foreign postal code	City or town, state or province, country, and ZIP or foreign postal code	8 Exercise price per share determined as if the option was exercised on the date shown in box 1 $	8 Exercise price per share determined as if the option was exercised on the date shown in box 1 $
Account number (see instructions)	Account number (see instructions)	Account number (see instructions)	Account number (see instructions)

Department of the Treasury - Internal Revenue Service

Instructions for Employee

You have received this form because (1) your employer (or its transfer agent) has recorded a first transfer of legal title of stock you acquired pursuant to your exercise of an option granted under an employee stock purchase plan, and (2) the exercise price was less than 100% of the value of the stock on the date shown in box 1 or was not fixed or determinable on that date.

No income is recognized when you exercise an option under an employee stock purchase plan. However, you must recognize (report) gain or loss on your tax return for the year in which you sell or otherwise dispose of the stock. Keep this form and use it to figure the gain or loss. For more information, see Pub. 525. Account number. May show an account or other unique number your employer or transfer agent assigned to distinguish your account. Box 1. Shows the date the option to purchase the stock was granted to you. Box 2. Shows the date you exercised the option to purchase the stock.

Box 3. Shows the fair market value (FMV) per share on the date the option to purchase the stock was granted to you. Box 4. Shows the FMV per share on the date you exercised the option to purchase the stock. Box 5. Shows the price paid per share on the date you exercised the option to purchase the stock. Box 6. Shows the number of shares to which legal title was transferred by you. Box 7. Shows the date legal title of the shares was first transferred by you. Box 8. If the exercise price per share was not fixed or determinable on the date entered in box 1, box 8 shows the exercise price per share determined as if the option was exercised on the date in box 1. If the exercise price per share was fixed or determinable on the date shown in box 1, then box 8 will be blank. Future developments. For the latest information about developments related to Form 3922 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form3922 .