Formulaire

Withholding tax on dividends: certificate of residence outside France (Form 12816*06)

Cerfa 12816*06 (5001-EN)

This form allows the withholding tax on dividends to be paid.

    Fill out the form

    To whom shall I send this form ?

    • Non-resident personal income tax department

      By telephone

      +33 (0) 1 72 95 20 42

      Monday to Friday from 9am to 4pm

      By E-mail

      Via your secure messaging on your personal account

      By mail

      10 Center Street

      TSA 10010

      93465 Noisy-Le-Grand Cedex

    Contact the entity in charge of this form

    Settlement and repayment of the withholding tax on interest

    FACULTATIF -

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    Émetteur du formulaire administratif : Ministry of Finance

    Verified 07 March 2024 - Directorate for Legal and Administrative Information (Prime Minister)