Form 5713 International Boycott Report

1
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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
Action
INSTRUCTIONS TO PRINTERS
FORM 5713, PAGE 1 of 4
O.K. to print
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 559mm (22") FOLDED TO 216mm (81⁄2 )" x 279mm (11")
Revised proofs
PERFORATE: ON FOLD
requested
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Date

Form

5713

International Boycott Report
For tax year beginning
and ending

(Rev. December 2004)
Department of the Treasury
Internal Revenue Service

䊳

Date

Signature

OMB No. 1545-0216

, 20
, 20

,
.

Attachment
Sequence No. 123
File in Duplicate
(See Instructions)

Controlled groups, see page 3 of instructions.

Name

Identifying number

Number, street, and room or suite no. (If a P.O. box, see page 2 of instructions.)

City or town, state, and ZIP code

Address of service center where your tax return is filed

Type of filer (check one):
Individual
1
2

Partnership

Corporation

Trust

Estate

Other

Individuals—Enter adjusted gross income from your tax return (see page 2 of instructions)
Partnerships and corporations:
a Partnerships—Enter each partner’s name and identifying number.
b Corporations—Enter the name and employer identification number of each member of the controlled group (as defined in
section 993(a)(3)). Do not list members included in the consolidated return; instead, attach a copy of Form 851. List all
other members of the controlled group not included in the consolidated return.
If you list any corporations below or if you attach Form 851, you must designate a common tax year. Enter on line
4b the name and employer identification number of the corporation whose tax year is designated.
Name

Identifying number

䊳

If more space is needed, attach additional sheets and check this box
Code

Description

c Enter principal business activity code and description (see instructions)
d IC-DISCs—Enter principal product or service code and description (see instructions)
3

Partnerships—Each partnership filing Form 5713 must give the following information:
a Partnership’s total assets (see instructions)
b Partnership’s ordinary income (see instructions)

4

Corporations—Each corporation filing Form 5713 must give the following information:
a Type of form filed (Form 1120, 1120-F, 1120-FSC, 1120-IC-DISC, 1120-L, 1120-PC, etc.)
b Common tax year election (see page 2 of instructions)
(1) Name of corporation 䊳
(2) Employer identification number
(3) Common tax year beginning
, 20
, and ending
c Corporations filing this form enter:
(1) Total assets (see instructions)
(2) Taxable income before net operating loss and special deductions (see instructions)

5

, 20

.

Estates or trusts—Enter total income (Form 1041, page 1)

6
a
b
c
d
e

Enter the total amount (before reduction for boycott participation or cooperation) of the following tax benefits (see instructions):
Foreign tax credit
Deferral of earnings of controlled foreign corporations
Deferral of IC-DISC income
FSC exempt foreign trade income
Foreign trade income qualifying for the extraterritorial income exclusion

Please
Sign
Here

Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct, and complete.

䊳

Signature

For Paperwork Reduction Act Notice, see page 4 of the separate instructions.

Date

䊳

Title

Cat. No. 12030E

Form

5713

(Rev. 12-2004)

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 5713, PAGE 2 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 559mm (22") FOLDED TO 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 5713 (Rev. 12-2004)

Page

7a Are you a U.S. shareholder (as defined in section 951(b)) of any foreign corporation (including a FSC that does not
use the administrative pricing rules) that had operations reportable under section 999(a)?

2

Yes No

b If the answer to question 7a is “Yes,” is any foreign corporation a controlled foreign corporation (as defined in
section 957(a))?
c Do you own any stock of an IC–DISC?
d Do you claim any foreign tax credit?
e Do you control (within the meaning of section 304(c)) any corporation (other than a corporation included in this
report) that has operations reportable under section 999(a)?
If “Yes,” did that corporation participate in or cooperate with an international boycott at any time during its tax
year that ends with or within your tax year?
f Are you controlled (within the meaning of section 304(c)) by any person (other than a person included in this
report) who has operations reportable under section 999(a)?

g
h
i
j

If “Yes,” did that person participate in or cooperate with an international boycott at any time during its tax year
that ends with or within your tax year?
Are you treated under section 671 as the owner of a trust that has reportable operations under section 999(a)?
Are you a partner in a partnership that has reportable operations under section 999(a)?
Are you a foreign sales corporation (FSC) (as defined in section 922(a), as in effect before its repeal)?
Are you excluding extraterritorial income (defined in section 114(e)) from gross income?

Part I

Operations in or Related to a Boycotting Country (See instructions beginning on page 3.)

Yes No
Boycott of Israel—Did you have any operations in or related to any country (or with the government, a company, or
a national of that country) associated in carrying out the boycott of Israel which is on the list maintained by the
Secretary of the Treasury under section 999(a)(3)? (See Boycotting Countries on page 2 of the instructions.)
If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check
䊳
this box

8

Name of country

(1)

Identifying number of
person having operations

(2)

Principal business activity
Code

Description

IC-DISCs
only—Enter
product code

(3)

(4)

(5)

a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
Form

5713

(Rev. 12-2004)

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 5713, PAGE 3 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 559mm (22") FOLDED TO 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 5713 (Rev. 12-2004)

Page

3

Nonlisted countries boycotting Israel—Did you have operations in any nonlisted country which you know or Yes No
have reason to know requires participation in or cooperation with an international boycott directed against Israel?
If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check
䊳
this box

9

Principal business activity

Name of country

Identifying number of
person having operations

Code

Description

IC-DISCs
only—Enter
product code

(1)

(2)

(3)

(4)

(5)

a
b
c
d
e
f
g
h
Boycotts other than the boycott of Israel—Did you have operations in any other country which you know or have Yes No
reason to know requires participation in or cooperation with an international boycott other than the boycott of Israel?
If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check
䊳
this box

10

Principal business activity

Name of country

Identifying number of
person having operations

Code

Description

IC-DISCs
only—Enter
product code

(1)

(2)

(3)

(4)

(5)

a
b
c
d
e
f
g
h
Yes No
11

Were you requested to participate in or cooperate with an international boycott?
If “Yes,” attach a copy (in English) of any and all such requests received during your tax year. If the request was in
a form other than a written request, attach a separate sheet explaining the nature and form of any and all such
requests. (See page 4 of instructions.)

12

Did you participate in or cooperate with an international boycott?
If “Yes,” attach a copy (in English) of any and all boycott clauses agreed to, and attach a general statement of the agreement.
If the agreement was in a form other than a written agreement, attach a separate sheet explaining the nature and form of
any and all such agreements. (See page 4 of instructions.)

Note: If the answer to either question 11 or 12 is “Yes,” you must complete the rest of Form 5713. If you answered “Yes” to question
12, you must complete Schedules A and C or B and C (Form 5713).
Form

5713

(Rev. 12-2004)

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 5713, PAGE 4 of 4
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO FOOT
PAPER: WHITE, WRITING, SUB. 20
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 559mm (22") FOLDED TO 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 5713 (Rev. 12-2004)

Part II

Page

Requests for and Acts of Participation in or Cooperation With an International
Boycott

Requests

4

Agreements

Yes No Yes No

13a Did you receive requests to enter into, or did you enter into, any agreement (see page 4 of instructions):
(1) As a condition of doing business directly or indirectly within a country or with the government, a
company, or a national of a country to—
(a) Refrain from doing business with or in a country which is the object of an international
boycott or with the government, companies, or nationals of that country?
(b) Refrain from doing business with any U.S. person engaged in trade in a country which is
the object of an international boycott or with the government, companies, or nationals of
that country?
(c) Refrain from doing business with any company whose ownership or management is made up, in
whole or in part, of individuals of a particular nationality, race, or religion, or to remove (or refrain
from selecting) corporate directors who are individuals of a particular nationality, race, or religion?
(d) Refrain from employing individuals of a particular nationality, race, or religion?
(2) As a condition of the sale of a product to the government, a company, or a national of a country,
to refrain from shipping or insuring products on a carrier owned, leased, or operated by a person
who does not participate in or cooperate with an international boycott?
b Requests and agreements—If the answer to any part of 13a is “Yes,” complete the following table. If more space
䊳
is needed, attach additional sheets using the exact format and check this box
Name of country

Identifying number of
person receiving the
request or having the
agreement

Code

Description

(1)

(2)

(3)

(4)

Principal business activity

IC-DISCs
only—
Enter
product
code
(5)

Type of cooperation or participation
Number of requests

Number of agreements

Total

Code

Total

Code

(6)

(7)

(8)

(9)

a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
Printed on recycled paper

Form

5713

(Rev. 12-2004)