Sample Composite Statement Of 1099 Forms

THIS IS A SAMPLE FORM AND WILL NOT SUBMIT ANY INFORMATION

This is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction may be imposed on you if this income is taxable and the IRS determines that it has not been reported.
Payer's Name and Address:
Payer's Federal Identification Number:
Recipient's Taxpayer Identification Number:
Recipient's Account Number:
Recipient's Name and Address:
Line 1a. Realized Futures Profit/Loss:
Line 1b. Realized Futures Profit/Loss
Line 2a. Aggregate Futures Profit/Loss:
Line 2b. Aggregate Futures Profit/Loss
Line 3. Interest Income:
Line 4. Commissions Paid:

Amounts resulting from transactions denominated in currencies other than U.S. dollars (USD) have been converted to U.S. dollars at the relevant exchange rates prevailing on the transaction dates.

Interactive Brokers is providing the Form 1099 to you in an electronic format, available by logging in to the IB website at
http://www.interactivebrokers.com. You have consented to receive the Form 1099 and other financial and tax statements from IB in electronic form and IB will continue to provide this information electronically for each tax year unless you withdraw this consent. In order to receive financial and tax statements electronically from IB, you must have a personal computer with an Internet connection, a valid Internet email address, and software allowing you to view the IB website and to read, send and receive email. Please notify IB immediately in the event of a change in your email address by: (i) using those procedures to change a customer email address that may be available on the IB website at http://www.interactivebrokers.com or (ii) contacting IB Customer Service at help@interactivebrokers.com for further
instructions.