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1 Taxpayer information Taxpayer must sign and date this form on line 6 Taxpayer name and address Taxpayer identification number(s) Daytime telephone number Plan number (if applicable) 2 Designee(s) If you wish to name more than two designees, attach a list to this form Check here if a list of additional designees is attached Name and

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For the year January 1–December 31, 2020, or other tax year beginning, 2020, and ending, 20 Your first name and initial Last name Your U S taxpayer identification number, if anyFill in your addresses only if you are filing this form by itself and not with your U S tax return Address in country of residence Address in the United States

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