해외금융계좌 신고서식(영문)

＊ 이 서식은 해외금융계좌 신고서식을 영문으로 번역한 것으로 법정서식이 아닌 참고용입니다.

2011. 3

국  세  청

[Form no. 21] (Since March 18, 2011)	(Page 1)
		Report of Foreign Financial Accounts	Filing type	□Regular	Type of filer	□Resident
Filing for calender year
□Amended
□Domestic Corporation
1. Filer information
①Name (Organization name)	(Korean)	②Resident registration no. (Business registration no.)
(English)	③Passport no.
④Address		⑤Telephone no.
2. Information on Foreign Financial Account(s) Owned
⑥Total number of owned accounts	Maximum value of the total accounts during the calendar year being reported
⑦As of (date)	⑧Maximum Value(KRW)
	. . .
3. Details of Each Account (Unit : Foreign currency, Korean Won)
Account Serial Number ( 1 )	⑨Related account owner(s)	□None, □Joint owners □The nominal owner of the account is different from the actual owner
⑩Name of Financial institution		⑪Type of account
⑫Account number		⑬Currency code
⑭Name of account owner		⑮Code no. of overseas branch/liaison office
⑯Balance on the reference date	(Foreign currency)	⑰Date of account opening	. . .
(Korean Won)	⑱Date of account closing	. . .
⑲Address of financial institution	Country	State	City	Number, Street, Suite No. etc.
I hereby declare that I report the information above in accordance with the Article 34 of the Adjustment of International Taxes Act and the information given above in this form is true. Filing date (yyyy/mm/dd): Filer's name and signature:
Agent	Name (Name of agency)		Business registration no. (Resident Registration no.)		Telephone no.

[Form no. 21]	(Page 2)
< Instructions > ※ Enter the calendar year being reported, and check the appropriate box describing the filing type and the type of filer. 1. ①∼⑤: Provide filer information as of the date of reporting. If the filer is an individual resident, enter the resident registration number. If he/she does not have a resident registration number, then provide an alternative number(The report number of the domestic place of residence for a Korean national residing abroad or the Foreign registration number for a foreigner). If the filer is a corporation, enter the business registration number. If it does not have a business registration number, then put any other taxpayer identification number. 2. ①∼③: If the filer is a resident, enter the full name of the filer both in English and Korean and the passport number which are shown in the passport. 3. ⑥Total number of owned accounts : Enter the total number of owned accounts and provide detailed information about each account in 「3. Details of Each Account」. If the number of accounts subject to reporting is 2 or more, use the Statement of Foreign Financial Accounts starting with the second account in Page 3. 4. ⑦∼⑧ : Provide the date on which a sum of balances of owned accounts reached the maximum value during the calendar year being reported. Enter the maximum value of date thereof. Convert foreign currency into Korean won by using the official exchange rate at the end of the attributable date. A sum is an aggregated amount of balances that appear on owned accounts on a day. If no financial interest is paid to the accounts, you do not have to add the interest amount. 5. ⑨Related account owner(s) : Check the appropriate box and provide more details in the Statement of Related Account Owner(s) (Page 4). If the account has both joint owner and actual owner, then check both boxes. 6. ⑩Name of Financial institution : Provide the name of the financial institution with which the account is held in full English name. If the English name is not available, provide a Korean name. 7. ⑪Type of account : Indicate the type of account such as savings, installment savings, stock accounts, etc, 8. ⑫Account number : Enter the account number which the financial institution uses to designate the account not including hyphens(“-”) 9. ⑬Currency code : Use a three-digit ISO currency code for ⑬Currency code. * i.e.) US Dollar(USD), Euro(EUR), Hong Kong Dollar(HKD), Japanese Yen(JPY), Chinese Yuan(CNY), UK Pound(GBP), Swiss Franc(CHF), Canadian Dollar(CAD), Australian Dollar(AUD), Singapore Dollar(SGD), Vietnam Dong(VND), Indonesia Rupiah(IDR), Malaysia Ringgit(MYR) 10. ⑭Name of account owner : Provide the name of nominal owner of the account in full English name. If the English name is not available, provide a Korean name. If the account owner is a foreign branch or liaison office, enter the name of the foreign branch or liaison office. 11. ⑮Code no. of overseas branch : Enter the Code no. of overseas branch which the competent tax office in Korea has given to identify the foreign branch/liaison office. 12. ⑯Balance on the reference date : Put the amount both in the foreign currency and Korean won shown on the date of ⑦. In case there are related owners who have a certain amount of shares for the account, enter the balance amount shown on the account, not the amount of the share. 13. ⑲Address of financial institution : Provide the complete mailing address of the financial institution in English. If providing the English address is not possible, provide it in Korean.

[Form no. 21]												(Page 3)
				Statement of Foreign Financial Accounts									Type of filer	□Resident
	Filing for calender year
														□Domestic Corporation
							Resident registration no. (Business registration no.)
(Unit : Foreign currency, Korean won)
Account Serial Number ( )		⑨Related account owner(s)			□None, □Joint owners, □The nominal owner of the account is different from the actual owner
		⑩Name of Financial institution							⑪Type of account
		⑫Account number							⑬Currency code
		⑭Name of account owner							⑮Code no. of overseas branch/liaison office
		⑯Balance on the reference date	(Foreign currency)						⑰Date of account opening				. . .
			(Korean Won)						⑱Date of account closing				. . .
		⑲Address of financial institution	Country			State		City		Number, Street, Suite No. etc.
Account Serial Number ( )		⑨Related account owner(s)			□None, □Joint owners, □The nominal owner of the account is different from the actual owner
		⑩Name of Financial institution							⑪Type of account
		⑫Account number							⑬Currency code
		⑭Name of account owner							⑮Code no. of overseas branch/liaison office
		⑯Balance on the reference date	(Foreign currency)						⑰Date of account opening				. . .
			(Korean Won)						⑱Date of account closing				. . .
		⑲Address of financial institution	Country			State		City		Number, Street, Suite No. etc.
Account Serial Number ( )		⑨Related account owner(s)			□None, □Joint owners, □The nominal owner of the account is different from the actual owner
		⑩Name of Financial institution							⑪Type of account
		⑫Account number							⑬Currency code
		⑭Name of account owner							⑮Code no. of overseas branch/liaison office
		⑯Balance on the reference date	(Foreign currency)						⑰Date of account opening				. . .
			(Korean Won)						⑱Date of account closing				. . .
		⑲Address of financial institution	Country			State		City		Number, Street, Suite No. etc.
Account Serial Number ( )		⑨Related account owner(s)			□None, □Joint owners, □The nominal owner of the account is different from the actual owner
		⑩Name of Financial institution							⑪Type of account
		⑫Account number							⑬Currency code
		⑭Name of account owner							⑮Code no. of overseas branch/liaison office
		⑯Balance on the reference date	(Foreign currency)						⑰Date of account opening				. . .
			(Korean Won)						⑱Date of account closing				. . .
		⑲Address of financial institution	Country			State		City		Number, Street, Suite No. etc.
Page ( of ) 1. This form is used only when the number of accounts subject to reporting is 2 or more, starting with the second account. 2. For each account, enter information for items ⑨ to ⑲.

[Form no. 21]									(Page 4)
				Statement of Related Account Owner(s)				Type of filer			□Resident
	Filing for calender year
											□Domestic Corporation
						Resident registration no. (Business registration no.)
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Owner serial number ( )		Account serial number				Account owner type	□Type1, □Type2, □Type3
		Owner information	Name (Organization name)			Resident registration no. (Business registration no.)
			Address				TEL NO
Page ( of ) 1. This form is used only when there are related account owners (when "Joint owners" or " The nominal owner of the account is different from the actual owner" for item ⑨ of page 1 and 3 is checked). 2. If the number of accounts which have related account owners is 2 or more, provide information on the related account owners, starting with the owner serial number 1. If the number of related account owners for an account is 2 or more, provide above information for each owner. 3. "Account serial number" is the same number in page 1 and 3. 4. "Account owner type" : Check the appropriate box describing the account owner type. Type 1-Joint owner; Type 2-The filer is the nominal owner and he/she reports information of the actual owner; Type 3-The filer is the actual owner and he/she reports information of the nominal owner.