Statement – Additional taxation on pension insurance

This statement should be submitted to the Swedish Tax Agency if a circumstance has occurred, that leads or may lead to additional taxation on a private or a corporate pension insurance policy (Chapter 58, Section 19 and 19a of the Income Tax Act (1999:1229)). Circumstances that leads or may lead to additional taxation can be found in the form.

Foreign tax identification number (TIN)
TIN (in country of residence) is to be completed on the form if the person insured has limited tax liability in Sweden, or has unlimited tax liability in Sweden and is domiciled in another state or jurisdiction.

Citizenship
Also state citizenship if the person insured has limited tax liability in Sweden.

Insurance value
Enter the value of the insurance, at the time when the circumstance occurred, on the form. If it is an insurance in a currency other than SEK, convert the value to SEK (use the daily exchange rate published by the Riksbank, http://www.riksbank.se/en/Interest-and-exchange-rates/).

Where do I send the form?

Send the form to the address stated on the form.