Schedule M (Form 5 Transactions Between Controllwd Foreign Corporation and

SCHEDULE M
(Form 5471)
(Rev. December 2012)

Transactions Between Controlled Foreign Corporation
and Shareholders or Other Related Persons

▶

Information about Schedule M (Form 5471) and its instructions is at www.irs.gov/form5471.
▶ Attach to Form 5471.

Department of the Treasury
Internal Revenue Service
Name of person filing Form 5471

OMB No. 1545-0704

Identifying number

Name of foreign corporation

EIN (if any)

Reference ID number (see instructions)

Important: Complete a separate Schedule M for each controlled foreign corporation. Enter the totals for each type of transaction that occurred during
the annual accounting period between the foreign corporation and the persons listed in columns (b) through (f). All amounts must be stated in U.S.
dollars translated from functional currency at the average exchange rate for the foreign corporation’s tax year. See instructions.
Enter the relevant functional currency and the exchange rate used throughout this schedule ▶
(a) Transactions
of
foreign corporation

(b) U.S. person
filing this return

1 Sales of stock in trade (inventory) .

.

(c) Any domestic
(d) Any other foreign (e) 10% or more U.S. (f) 10% or more U.S.
shareholder of
corporation or
corporation or
shareholder of any
controlled foreign
partnership controlled partnership controlled corporation
corporation
(other than
by U.S. person filing by U.S. person filing the U.S. person
controlling the
filing
this return
this return
foreign corporation
this return)

.

2 Sales of tangible property other than stock
in trade . . . . . . . . . .
of
property
rights
3 Sales
trademarks, etc.) . . . . .

.

(patents,
. .

4 Platform contribution transaction payments
received . . . . . . . . . .
sharing
transaction
5 Cost
received . . . . . . .

payments
. . .

6 Compensation received for technical,
managerial, engineering, construction, or
like services . . . . . . . . .
7 Commissions received . . . . . .
8 Rents, royalties, and license fees received
9 Dividends received (exclude deemed
distributions under subpart F and
distributions of previously taxed income)
10 Interest received .

.

11 Premiums received
reinsurance . . .

.

.

.

.

.

.

for insurance or
. . . . . .

12 Add lines 1 through 11 . . . . .
13 Purchases of stock in trade (inventory)

.
.

14 Purchases of tangible property other than
stock in trade . . . . . . . . .
15 Purchases of property rights (patents,
trademarks, etc.) . . . . . . . .
16 Platform contribution transaction payments
paid . . . . . . . . . . .
17 Cost sharing transaction payments paid .
paid
for
technical,
18 Compensation
managerial, engineering, construction, or
like services . . . . . . . . .
19
20
21
22
23
24

Commissions paid . . . . . . .
Rents, royalties, and license fees paid .
Dividends paid . . . . . . . .
Interest paid . . . . . . . . .
Premiums paid for insurance or reinsurance
Add lines 13 through 23 . . . . . .

25 Amounts borrowed (enter the maximum
loan balance during the year) — see
instructions . . . . . . . . .
26 Amounts loaned (enter the maximum loan
balance during the year) — see instructions
For Paperwork Reduction Act Notice, see the Instructions for Form 5471.

Cat. No. 49963O

Schedule M (Form 5471) (Rev. 12-2012)