Form 8858 Information Return of U.S. Persons With Respect to Forei

Form

8858

(Rev. December 2011)

Information Return of U.S. Persons With Respect To
Foreign Disregarded Entities
▶

OMB No. 1545-1910

See separate instructions.

Information furnished for the foreign disregarded entity’s annual accounting period (see
Department of the Treasury
, 20
, and ending
, 20
instructions) beginning
Internal Revenue Service
Name of person filing this return

Attachment
Sequence No.

140

Filer’s identifying number

Number, street, and room or suite no. (or P.O. box number if mail is not delivered to street address)
City or town, state, and ZIP code
Filer’s tax year beginning

, 20

, and ending

, 20

Important: Fill in all applicable lines and schedules. All information must be in English. All amounts must be stated in
U.S. dollars unless otherwise indicated.
1a Name and address of foreign disregarded entity

b(1) U.S. identifying number, if any
b(2) Reference ID number (see instructions)

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c Country(ies) under whose laws organized and entity type under local tax law

d Date(s) of organization

e Effective date as foreign
disregarded entity

f If benefits under a U.S. tax treaty were claimed with respect to
income of the foreign disregarded entity, enter the treaty and
article number

h Principal business
activity

i Functional currency

g Country in which principal business
activity is conducted

Provide the following information for the foreign disregarded entity’s accounting period stated above.
a Name, address, and identifying number of branch office or agent (if any) in
the United States

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b Name and address (including corporate department, if applicable) of person(s)
with custody of the books and records of the foreign disregarded entity, and
the location of such books and records, if different

For the tax owner of the foreign disregarded entity (if different from the filer) provide the following:
a Name and address

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b Annual accounting period covered by the
return (see instructions)

c U.S. identifying number, if any

d Country under whose laws organized

e Functional currency

For the direct owner of the foreign disregarded entity (if different from the tax owner) provide the following:
a Name and address

b Country under whose laws organized

c U.S. identifying number, if any
d Functional currency

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Attach an organizational chart that identifies the name, placement, percentage of ownership, tax classification, and country of organization of all entities in the chain of
ownership between the tax owner and the foreign disregarded entity, and the chain of ownership between the foreign disregarded entity and each entity in which the
foreign disregarded entity has a 10% or more direct or indirect interest. See instructions.

Schedule C
Income Statement (see instructions)
Important: Report all information in functional currency in accordance with U.S. GAAP. Also, report each amount in U.S.
dollars translated from functional currency (using GAAP translation rules or the average exchange rate determined under
section 989(b)). If the functional currency is the U.S. dollar, complete only the U.S. Dollars column. See instructions for
special rules for foreign disregarded entities that use DASTM.
If you are using the average exchange rate (determined under section 989(b)), check the following box . . . . . .
Functional Currency

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3
4
5
6
7
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Gross receipts or sales (net of returns and allowances).
Cost of goods sold . . . . . . . . . . . .
Gross profit (subtract line 2 from line 1) . . . . . .
Other income . . . . . . . . . . . . . .
Total income (add lines 3 and 4) . . . . . . . .
Total deductions . . . . . . . . . . . . .
Other adjustments. . . . . . . . . . . . .
Net income (loss) per books . . . . . . . . .

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For Paperwork Reduction Act Notice, see the separate instructions.

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U.S. Dollars

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Cat. No. 21457L

Form 8858 (Rev. 12-2011)

Page 2

Form 8858 (Rev. 12-2011)

Schedule C-1

Section 987 Gain or Loss Information
(a)
(b)
Amount stated in
Amount stated in
functional currency of functional currency of
foreign disregarded entity
recipient

1 Remittances from the foreign disregarded entity .
2 Section 987 gain (loss) of recipient . . . . .

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2
Yes

No

3 Were all remittances from the foreign disregarded entity treated as made to the direct owner? . . . . .
4 Did the tax owner change its method of accounting for section 987 gain or loss with respect to remittances
from the foreign disregarded entity during the tax year? . . . . . . . . . . . . . . . . . .

Schedule F
Balance Sheet
Important: Report all amounts in U.S. dollars computed in functional currency and translated into U.S. dollars in
accordance with U.S. GAAP. See instructions for an exception for foreign disregarded entities that use DASTM.
(a)
Beginning of annual
accounting period

Assets
1 Cash and other current assets .
2 Other assets . . . . . .
3 Total assets . . . . . . .

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(b)
End of annual
accounting period

Liabilities and Owner’s Equity
4 Liabilities . . . . . . . . .
5 Owner’s equity . . . . . . .
6 Total liabilities and owner’s equity

Schedule G

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Other Information
Yes

No

1 During the tax year, did the foreign disregarded entity own an interest in any trust? . . . . . . . . .
2 During the tax year, did the foreign disregarded entity own at least a 10% interest, directly or indirectly, in
any foreign partnership?. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Answer the following question only if the foreign disregarded entity made its election to be treated as
disregarded from its owner during the tax year: Did the tax owner claim a loss with respect to stock or debt
of the foreign disregarded entity as a result of the election? . . . . . . . . . . . . . . . . .
4 Answer the following question only if the foreign disregarded entity is owned directly or indirectly by a
domestic corporation and the foreign disregarded entity incurred a net operating loss for the tax year: Is the
foreign disregarded entity a separate unit as defined in Regulations section 1.1503(d)-1(b)(4)? (If “Yes,” see
the instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Answer the following question only if the tax owner of the foreign disregarded entity is a controlled foreign
corporation (CFC): Were there any intracompany transactions between the foreign disregarded entity and
the CFC or any other branch of the CFC during the tax year, in which the foreign disregarded entity acted as
a manufacturing, selling, or purchasing branch? . . . . . . . . . . . . . . . . . . . . .

Schedule H
Current Earnings and Profits or Taxable Income (see instructions)
Important: Enter the amounts on lines 1 through 6 in functional currency.
1
2
3
4
5
6
7

Current year net income or (loss) per foreign books of account . . . . . . . . . . . . . .
Total net additions . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Total net subtractions . . . . . . . . . . . . . . . . . . . . . . . . . . .
Current earnings and profits (or taxable income—see instructions) (line 1 plus line 2 minus line 3) . .
DASTM gain or loss (if applicable) . . . . . . . . . . . . . . . . . . . . . . .
Combine lines 4 and 5 . . . . . . . . . . . . . . . . . . . . . . . . . . .
Current earnings and profits (or taxable income) in U.S. dollars (line 6 translated at the average
exchange rate determined under section 989(b) and the related regulations (see instructions)) . . . .
Enter exchange rate used for line 7 ▶

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Form 8858 (Rev. 12-2011)