965, Schedule A U.S. Shareholder's Section 965(a) Inclusion Amount

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SCHEDULE A
(Form 965)
(January 2019)

DRAFT AS OF
September 5, 2018
DO NOT FILE
U.S. Shareholder’s Section 965(a) Inclusion Amount
Attach to Form 965.
▶ Go to www.irs.gov/Form965 for instructions and the latest information.
▶

Department of the Treasury
Internal Revenue Service

Identifying number

Name of person filing this return

(a)
EIN or Reference ID
Number of the
Foreign Corporation
(see instructions)

Name of Deferred Foreign Income Corporation
(DFIC)

1
2

OMB No. 1545-0123

(b)
U.S. Tax Year End
(Year/Month) of DFIC
(see instructions)

(c)
Accumulated Post-1986
Deferred Foreign Income
in Functional Currency
(see instructions)

(d)
December 31, 2017 Spot Rate

(e)
Accumulated Post-1986
Deferred Foreign Income
in U.S. Dollars
(divide column (c) by column (d))

3
4
5
6
7
8
9
10
11
12
13
14
15
16

Total (lines 1–15)

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For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 71324V

Schedule A (Form 965) (1-2019)

DRAFT AS OF
September 5, 2018
DO NOT FILE

Schedule A (Form 965) (1-2019)

(f)
U.S. Shareholder’s Pro Rata
Share of Column (e)

1
2
3
4
5

(g)
Deficit Allocation Ratio
(column (f) amount divided
by column (f), line 16)

(h)
U.S. Shareholder’s Aggregate
Foreign E&P Deficit
(see instructions)

(i)
Section 965(a) Inclusion Amount
(column (f) less column (h))

(j)
Section 965(a) Inclusion Amount
Taken Into Account in the
2017 Tax Year

Page 2

(k)
Section 965(a) Inclusion Amount
Taken Into Account in the
2018 Tax Year

6
7
8
9
10
11
12
13
14
15
16
Add schedules as needed.
Schedule A (Form 965) (1-2019)