5472 Information Return of a 25% Foreign-Owned US Corporation

Form

5472

Information Return of a 25% Foreign-Owned U.S. Corporation or a
Foreign Corporation Engaged in a U.S. Trade or Business
(Under Sections 6038A and 6038C of the Internal Revenue Code)

(Rev. December 2012)
▶

Department of the Treasury For tax year of the reporting corporation beginning
Internal Revenue Service
Note. Enter all information in

Part I

OMB No. 1545-0805

Information about Form 5472 and its separate instructions is at www.irs.gov/form5472.
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, and ending

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English and money items in U.S. dollars.

Reporting Corporation (see instructions). All reporting corporations must complete Part I.

1a Name of reporting corporation

1b Employer identification number
1c Total assets

Number, street, and room or suite no. (if a P.O. box, see instructions)
City or town, state, and ZIP code (if a foreign address, see instructions)

$
1d Principal business activity ▶
1f Total value of gross payments made or received
(see instructions) reported on this Form 5472
$
1i Check here if this is a 1j Country of
incorporation
consolidated filing of
Form 5472 ▶
2

1g Total number of Forms 5472
filed for the tax year

1e Principal business activity code ▶
1h Total value of gross payments made or received (see
instructions) reported on all Forms 5472

$
1k Country(ies) under whose laws the reporting
1l Principal country(ies) where
corporation files an income tax return as a resident
business is conducted

Check here if, at any time during the tax year, any foreign person owned, directly or indirectly, at least 50% of (a) the total voting power of all
classes of the stock of the reporting corporation entitled to vote, or (b) the total value of all classes of stock of the reporting corporation ▶

Part II

25% Foreign Shareholder (see instructions)

1a Name and address of direct 25% foreign shareholder

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

1c Principal country(ies) where
business is conducted

1d Country of citizenship,
organization, or incorporation

1e Country(ies) under whose laws the direct 25% foreign shareholder
files an income tax return as a resident

2a Name and address of direct 25% foreign shareholder

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

2c Principal country(ies) where
business is conducted

2d Country of citizenship,
organization, or incorporation

2e Country(ies) under whose laws the direct 25% foreign shareholder
files an income tax return as a resident

3a Name and address of ultimate indirect 25% foreign shareholder

3b(1) U.S. identifying number, if any
3b(2) Reference ID number (see
instructions)

3c Principal country(ies) where
business is conducted

3d Country of citizenship,
organization, or incorporation

3e Country(ies) under whose laws the ultimate indirect 25% foreign
shareholder files an income tax return as a resident

4a Name and address of ultimate indirect 25% foreign shareholder

4b(1) U.S. identifying number, if any
4b(2) Reference ID number (see
instructions)

4c Principal country(ies) where
business is conducted

4d Country of citizenship,
organization, or incorporation

For Paperwork Reduction Act Notice, see instructions.

4e Country(ies) under whose laws the ultimate indirect 25% foreign
shareholder files an income tax return as a resident

Cat. No. 49987Y

Form

5472

(Rev. 12-2012)

Form 5472 (Rev. 12-2012)

Part III

Page

2

Related Party (see instructions)
Check applicable box: Is the related party a
foreign person or
U.S. person?
All reporting corporations must complete this question and the rest of Part III.

1a Name and address of related party

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

1c Principal business activity ▶
1d Principal business activity code ▶
1e Relationship—Check boxes that apply:
Related to 25% foreign shareholder
25% foreign shareholder
Related to reporting corporation
1f Principal country(ies) where business is conducted
1g Country(ies) under whose laws the related party files an income tax return as a
resident

Part IV

Monetary Transactions Between Reporting Corporations and Foreign Related Party (see instructions)
Caution: Part IV must be completed if the “foreign person” box is checked in the heading for Part III.
If estimates are used, check here

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1

Sales of stock in trade (inventory)

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2
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Sales of tangible property other than stock in trade .
Platform contribution transaction payments received

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2
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4
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b

Cost sharing transaction payments received . . . . .
Rents received (for other than intangible property rights) .
Royalties received (for other than intangible property rights)

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5a
5b

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7
8

Sales, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas) .
Consideration received for technical, managerial, engineering, construction, scientific, or like services .
Commissions received . . . . . . . . . . . . . . . . . . . . . . . .

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6
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8

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9
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11

Amounts borrowed (see instructions)

Interest received . . . . . . . . . .
Premiums received for insurance or reinsurance .

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9b
10
11

12
13
14

Other amounts received (see instructions) . . .
Total. Combine amounts on lines 1 through 12 .
Purchases of stock in trade (inventory) . . . .

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12
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14

15
16

Purchases of tangible property other than stock in trade
Platform contribution transaction payments paid . . .

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15
16

17
18a
b
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Cost sharing transaction payments paid . . . . . . . . . . . . . . . . . . .
Rents paid (for other than intangible property rights) . . . . . . . . . . . . . . . .
Royalties paid (for other than intangible property rights) . . . . . . . . . . . . . . .
Purchases, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas)

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18a
18b
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20
21

Consideration paid for technical, managerial, engineering, construction, scientific, or like services
Commissions paid
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24

Amounts loaned (see instructions)

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22b
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25
26

Other amounts paid (see instructions) . . . .
Total. Combine amounts on lines 14 through 25

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25
26

a Beginning balance

a Beginning balance

Interest paid . . . . . . . . . .
Premiums paid for insurance or reinsurance .

Part V

Part VI
1
2a

b Ending balance or monthly average ▶

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b Ending balance or monthly average ▶

Nonmonetary and Less-Than-Full Consideration Transactions Between the Reporting Corporation and
the Foreign Related Party (see instructions)
Describe these transactions on an attached separate sheet and check here. ▶
Additional Information
All reporting corporations must complete Part VI.
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Yes
Yes

No
No

If the answers to questions 1 and 2a are “Yes,” were the documents used to support this treatment of the imported
goods in existence and available in the United States at the time of filing Form 5472? . . . . . . . . . .

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3

During the tax year, was the foreign parent corporation a participant in any cost sharing arrangement? .

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Yes
Yes

No
No

4

During the course of the tax year, did the foreign parent corporation become a participant in any cost sharing
arrangement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b
c

Does the reporting corporation import goods from a foreign related party? . . . . . . . . . . . . .
If “Yes,” is the basis or inventory cost of the goods valued at greater than the customs value of the imported goods?
If “No,” do not complete b and c below.
If “Yes,” attach a statement explaining the reason or reasons for such difference.

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Form

Yes

5472

No
(Rev. 12-2012)