Name and Social Security Number
The header line for the person making the disclosure.
14452
Foreign Account or Asset Statement
Form 14452, Foreign Account or Asset Statement, is an IRS statement used in a voluntary disclosure. The form says to submit a separate Statement for each foreign account or asset included in the voluntary disclosure, and that at least one Statement must be submitted.
Each statement names the foreign financial institution and its country, says what kind of account or asset it is, and records dates, values and the name the account was held under. The Privacy Act notice on the form says the information is used to determine and collect the correct amount of tax under the terms of the offshore voluntary disclosure program, and that applying for that program is not required.
You can fill out Form 14452 free in your browser on this page and download it without an account.

The header line for the person making the disclosure.
Name of the foreign financial institution, the country where it is located and a contact person there.
Yes or No for a bank account holding cash, money market or CD, a custodial account holding securities, or another type of account or asset, and what type.
Source of funds, name on the account, entity type, dates opened and closed, and whether it includes Passive Foreign Investment Company (PFIC) or mutual funds.
Description and location, purchase price and date acquired, sales price and date of disposition if sold, and FMV at 12/31 if the asset is still owned.
A note that the highest value of the account or fair market value of the asset over the period of the voluntary disclosure goes on the Penalty Computation Worksheet.
Fill in the name and Social Security Number at the top of each statement.
Use a separate Form 14452 for each foreign account or asset included in the voluntary disclosure.
Enter the institution's name, its country and a contact person at the institution.
Check Yes or No for each account type, and describe the type on question 7 for another kind of account or asset.
For an account, answer questions 8 to 13. For real estate, artwork, bullion or another asset, answer questions 14 to 17.
The form says to respond to each applicable question in the space provided, and that attachments are appropriate when more space is needed.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
The statement goes with a voluntary disclosure. The form has no signature line and prints no filing address; the one address shown is for comments on the time estimate.
The form says the highest value of the account and/or fair market value of the asset over the period of the voluntary disclosure should be included on the Penalty Computation Worksheet.
The Privacy Act notice says applying for the offshore voluntary disclosure program is not required, but an applicant is required to provide all the information the statement requests.
The notice says failure to provide this information may delay or prevent processing the application, and providing false information may lead to penalties.
The notice reads: "The estimated average time is: 2 hour."
The form says to submit a Statement for each foreign account or asset included in the voluntary disclosure.
A separate Statement goes with each foreign account or asset, and at least one Statement is submitted in total, the form says.
Questions 8 to 13 cover accounts, including the name the account was held under and, if held by an entity, the type of entity.
Questions 14 to 17 cover other assets, with real estate, artwork and bullion as the form's examples.
The Privacy Act notice says the IRS uses the information for the offshore voluntary disclosure program.
The person making the voluntary disclosure fills it out and enters their name and Social Security Number at the top.
The agency’s own page for Form 14452.
The official blank form, to print or fill by hand.
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The form says to submit a separate Statement for each foreign account or asset included in the voluntary disclosure, with at least one Statement in total.
The form's examples are real estate, artwork and bullion, covered in questions 14 to 17.
The form says attachments are appropriate when more space is needed.
The form says the highest value of the account and/or fair market value of the asset over the period of the voluntary disclosure.
The Privacy Act notice on the form says participation is not required, but an applicant is required to provide all the information requested.
The form is dated June 2014, and its footer reads Form 14452 (Rev. 6-2014).