5471, Schedule I-1 Info for Global Intangible Low-Taxed Income

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SCHEDULE I-1
(Form 5471)

Information for Global Intangible Low-Taxed Income
OMB No. 1545-0704

(September 2018)
Department of the Treasury
Internal Revenue Service

Attach to Form 5471.
Go to www.irs.gov/Form5471 for instructions and the latest information.
▶

▶

Identifying number

Name of person filing Form 5471

DRAFT AS OF
September 27, 2018
DO NOT FILE
Name of foreign corporation

Separate Category (enter code—see instructions)

1
2

a
b
c
d
e
3
4
5
6
7
8
9

Functional
Currency

▶

Gross income . . . . . . . . . . . . . . . . .
Exclusions
2a
Effectively connected income . . . .
2b
Subpart F income . . . . . . . .
2c
High-tax exception income per section 954(b)(4)
2d
Related party dividends . . . . . .
2e
Foreign oil and gas extraction income .
Total exclusions (total of lines 2a–2e) . . . . . . . . . .
Gross income less total exclusions (line 1 minus line 3) . . . .
Deductions properly allocable to amount on line 4 . . . . .
Tested income (loss) (line 4 minus line 5) (see instructions for line 6)
Other Amounts (see instructions)
Tested foreign income taxes . . . . . . . . . . . .
Qualified business asset investment (QBAI) . . . . . . . .
Interest expense . . . . . . . . . . . . . . . .

For Paperwork Reduction Act Notice, see instructions.

Reference ID number (see instructions)

EIN (if any)

Conversion
Rate

U.S. Dollars

1

3
4
5
6

7
8
9

Cat. No. 71400M

Schedule I-1 (Form 5471) (9-2018)