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NONDISCLOSURE STATEMENT OF TAXPAYER'S AUTHORIZED REPRESENTATIVE

I hereby agree that neither I nor any member of my firm's office staff nor any other person who may assist me or the firm in the mutual agreement proceeding requested in the letter of   [date]   submitted by      [name of taxpayer]__   to the competent authorities of the United States and _  [name of treaty partner]   _  will disclose to any person (other than the taxpayer, another concerned person,1 its authorized representative or agent, or one of the competent authorities or its authorized representative2)  any information received during the course of the arbitration proceeding from either Contracting State or the arbitration board, other than the determination of such board.


__________________                    _________________________________________
Date                                                     Signature
    
                                                             __________________________________________
                                                             Printed Name

                                                             __________________________________________
                                                             Position

 

__________________________

1 As defined in the relevant treaty provisions, the term "concerned person" means the taxpayer requesting mutual agreement procedure assistance from a competent authority under the MAP article [e.g., Article 25] and any other person whose tax liability to either the United States or treaty partner may be directly affected by the mutual agreement arising from that request. 
2 The U.S. Competent Authority has authorized the International Centre for Dispute Resolution (ICDR), a division of the American Arbitration Association to act on its behalf with respect to certain designated matters concerning the arbitration proceeding

Page Last Reviewed or Updated: 06-Nov-2013