Appendix D-Federal Forms and Instructions Page 2 Form 1042 (2019) 63 a b c d e 64 a b c d e 65 a b 66 67 a b 68 69 70a b 71 Total tax reported as withheld or paid by withholding agent on all Forms 1042-S and 1000: Tax withheld by withholding agent . . . . . . . . . . . . . . . . . . . Tax withheld by other withholding agents: (1) For payments other than substitute dividends . . . . . . . . . . . . . . . (2) For substitute dividends . . . . . . . . . . . . . . . . . . . . . . Adjustments to withholding: (1) Adjustments to overwithholding . . . . . . . . . . . . . . . . . . . (2) Adjustments to underwithholding . . . . . . . . . . . . . . . . . . . Tax paid by withholding agent . . . . . . . . . . . . . . . . . . . . . Total tax reported as withheld or paid (Add lines 63a-d) . . . . . . . . . . . . Total net tax liability Adjustments to total net tax liability . . . . . . . . . . . . . . . . . . . Total net tax liability under chapter 3 . . . . . . . . . . . . . . . . . . . Total net tax liability under chapter 4 . . . . . . . . . . . . . . . . . . . Excise tax on specified federal procurement payments (Total payments made x 2% (0.02)) . Total net tax liability (Add lines 64a-d) . . . . . . . . . . . . . . . . . . Total paid by electronic funds transfer (or with a request for extension of time to file): Total paid during calendar year . . . . . . . . . . . . . . . . . . . . . Total paid during subsequent year . . . . . . . . . . . . . . . . . . . . Enter overpayment applied as credit from 2018 Form 1042 . . . . . . . . . . . Credit for amounts withheld by other withholding agents: For payments other than substitute dividend payments . . . . . . . . . . . . . For substitute dividend payments . . . . . . . . . . . . . . . . . . . . Total payments. Add lines 65 through 67 . . . . . . . . . . . . . . . . . If line 64e is larger than line 68, enter balance due here . . . . . . . . . . . . . Enter overpayment attributable to overwithholding on U.S. source income of foreign persons Enter overpayment attributable to excise tax on specified federal procurement payments . Apply overpayment (sum of lines 70a and 70b) to (check one): Credit on 2020 Form 1042 or Refund Section 2 . . . 63a . . . . . . 63b(1) 63b(2) . . . . . . . . . . . . 63c(1) ( 63c(2) 63d 63e . . . . . . . . . . . . . . . 64a 64b 64c 64d 64e . . . . . . . . . 65a 65b 66 . . . . . . . . . . . . . . . . . . 67a 67b 68 69 70a 70b . be 1 . . . . be . . . . 2a 2b 2c 2d Reconciliation of Payments of U.S. Source FDAP Income 1 2 Total U.S. source FDAP income required to be withheld upon under chapter 4 . . . . . . . Total U.S. source FDAP income required to be reported under chapter 4 but not required to withheld upon under chapter 4 because: a Amount of income paid to recipients whose chapter 4 status established no withholding is required b Amount of excluded nonfinancial payments . . . . . . . . . . . . . . . . . . . c Amount of income paid with respect to grandfathered obligations . . . . . . . . . . . d Amount of income effectively connected with the conduct of a trade or business in the U.S. . . e Total U.S. source FDAP income required to be reported under chapter 4 but not required to withheld upon under chapter 4 (Add lines 2a-d) . . . . . . . . . . . . . . . . . 3 Total U.S. source FDAP income reportable under chapter 4 (Add lines 1 and 2e) . . . . . . 4 Total U.S. source FDAP income reported on all Forms 1042-S (from line 62a, (b)(1), and (b)(2)) . . 5 Total variance, subtract line 3 from line 4, if amount other than zero, provide explanation on line 6 . 6 Section 3 ) 2e 3 4 5 Potential Section 871(m) Transactions Check here if any payments (including gross proceeds) were made by the withholding agent under a potential section 871(m) transaction, including a notional principal contract or other derivatives contract that references (in whole or in part) a U.S. stock or other underlying security. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 4 Dividend Equivalent Payments by a Qualified Derivatives Dealer (QDD) Check here if any payments were made by a QDD . . If box is checked, you must: (1) Attach Schedule Q (Form 1042). See instructions. (2) Enter the EIN (not the QI-EIN) of the QDD ▶ . . . . . . . . . . . . . . . . . . . . . . . . . Form 1042 (2019) D-59