Form 3922

Transfer of Stock Acquired Through an ESPP (Section 423(c))

Transfer of stock acquired under an employee stock purchase plan.

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Issuer / payer

The business or person that paid and is filing this return. Enter either a business name or an individual name.

Foreign entityIssuer TIN *TIN type *Business name controlFirst 4 significant characters of the business name.Business nameBusiness name (line 2)Individual first nameIndividual middle nameIndividual last nameForeign addressCheck to enter a non-US address (country + province + postal code).Address line 1 *Address line 2City *State (US address)Required for a US address.ZIP code (US address)Province / region (foreign)Country code (foreign)Two-letter ISO country code for a foreign address.Postal code (foreign)Phone number

Recipient / payee

The person or business that received the payment. Enter either a business name or an individual name.

Recipient TINTIN typeBusiness name controlBusiness nameBusiness name (line 2)Individual first nameIndividual middle nameIndividual last nameAdditional recipientForeign addressCheck to enter a non-US address (country + province + postal code).Address line 1 *Address line 2City *State (US address)Required for a US address.ZIP code (US address)Province / region (foreign)Country code (foreign)Two-letter ISO country code for a foreign address.Postal code (foreign)Account numberDistinguishes this recipient if you file more than one of the same form for them.

Filing details

Tax year *VoidCorrected

Form 3922 details

1Date option granted *2Date option exercised *3Fair market value per share on grant date4Fair market value per share on exercise date5Exercise price per share6Number of shares transferred *7Date legal title transferred8Exercise price per share determined as if exercised on grant date

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