1121 Form 8938 (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f8938.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Form

(Rev. November 2021)

Department of the Treasury Internal Revenue Service

• Go to www.irs.gov/Form8938 for instructions and the latest information.

OMB No. 1545-2195

• Attach to your tax return. Attachment

For calendar year 20 or tax year beginning , 20 , and ending , 20 Sequence No. 938

If you have attached additional statements, check here Number of additional statements

1 Name(s) shown on return 2 Taxpayer identification number (TIN)

3 Type of filer

a Specified individual b Partnership c Corporation d Trust 4 If you checked box 3a, skip this line 4. If you checked box 3b or 3c, enter the name and TIN of the specified individual who

closely holds the partnership or corporation. If you checked box 3d, enter the name and TIN of the specified person who is a current beneficiary of the trust. (See instructions for definitions and what to do if you have more than one specified individual or specified person to list.)

a Name b TIN

If you reported specified foreign financial assets on one or more of the following forms, enter the number of such forms filed. You do not need to include these assets on Form 8938 for the tax year.

15 Number of Forms 3520 16 Number of Forms 3520-A 17 Number of Forms 5471 18 Number of Forms 8621 19 Number of Forms 8865

For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 37753A Form 8938 (Rev. 11-2021)

Form 8938 (Rev. 11-2021) Page 2 Part V Detailed Information for Each Foreign Deposit and Custodial Account Included in the Part I Summary (see instructions) If you have more than one account to report in Part V, attach a separate statement for each additional account. See instructions.

c Account jointly owned with spouse d No tax item reported in Part III with respect to this asset 23 Maximum value of account during tax year . . . . . . . . . . . . . . . . . . . . . $ 24 Did you use a foreign currency exchange rate to convert the value of the account into U.S. dollars? . . Yes No 25 If you answered “Yes” to line 24, complete all that apply. (a) Foreign currency in which (b) Foreign currency exchange rate (c) Source of exchange rate used if not from U.S.

(b) Foreign currency exchange rate

(c) Source of exchange rate used if not from U.S.

account is maintained

used to convert to U.S. dollars

Treasury Department’s Bureau of the Fiscal Service

26 a Name of financial institution in which account is maintained b Global Intermediary Identification Number (GIIN) (Optional)

. . . 27 Mailing address of financial institution in which account is maintained. Number, street, and room or suite no.

28 City or town, state or province, country, and ZIP or foreign postal code

Part VI Detailed Information for Each “Other Foreign Asset” Included in the Part II Summary (see instructions) If you have more than one asset to report in Part VI, attach a separate statement for each additional asset. See instructions.

29 Description of asset 30 Identifying number or other designation

31 Complete all that apply. See instructions for reporting of multiple acquisition or disposition dates. a Date asset acquired during tax year, if applicable . . . . . . . . . . . . . . . . . . b Date asset disposed of during tax year, if applicable . . . . . . . . . . . . . . . . . c Check if asset jointly owned with spouse d Check if no tax item reported in Part III with respect to this asset 32 Maximum value of asset during tax year (check box that applies) a $0–$50,000 b $50,001–$100,000 c $100,001–$150,000 d $150,001–$200,000 e If more than $200,000, list value . . . . . . . . . . . . . . . . . . . . . . . . $ 33 Did you use a foreign currency exchange rate to convert the value of the asset into U.S. dollars? . . . Yes No 34 If you answered “Yes” to line 33, complete all that apply. (a) Foreign currency in which asset (b) Foreign currency exchange rate (c) Source of exchange rate used if not from U.S.

(b) Foreign currency exchange rate

(c) Source of exchange rate used if not from U.S.

is denominated

used to convert to U.S. dollars

Treasury Department’s Bureau of the Fiscal Service

35 If asset reported on line 29 is stock of a foreign entity or an interest in a foreign entity, enter the following information for the asset. a Name of foreign entity b GIIN (Optional)

. . . c Type of foreign entity (1) Partnership (2) Corporation (3) Trust (4) Estate d Mailing address of foreign entity. Number, street, and room or suite no.

e City or town, state or province, country, and ZIP or foreign postal code

36 If asset reported on line 29 is not stock of a foreign entity or an interest in a foreign entity, enter the following information for

the asset. Note: If this asset has more than one issuer or counterparty, attach a separate statement with the same information for each additional issuer or counterparty. See instructions. a Name of issuer or counterparty Check if information is for Issuer Counterparty b Type of issuer or counterparty (1) Individual (2) Partnership (3) Corporation (4) Trust (5) Estate c Check if issuer or counterparty is a U.S. person Foreign person d Mailing address of issuer or counterparty. Number, street, and room or suite no.

e City or town, state or province, country, and ZIP or foreign postal code

Form 8938 (Rev. 11-2021)