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

SCHEDULE I-1
(Form 5471)

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

(Rev. December 2019)
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
Name of foreign corporation

Reference ID number (see instructions)

EIN (if any)

Separate Category (Enter code–see instructions.)

.

.

.

.

.

.

.

.

.

.

.

.

Functional
Currency

1
2

Gross income . . . . .
Exclusions
a Effectively connected income
b Subpart F income . . . .
c High-tax exception income
954(b)(4) . . . . . . .

.

.

.

.

.

. . . .
. . . .
per section
. . . .

.

.

.

. .
. .
minus
. .

.

.

.

1

.
.
.
.
.
.

.
.
.
.
.
.

.
.
.
.
.
.

.
.
.
.
.
.

3
4
5
6
7
8

9b and line
. . . .

9d

.
10a
.
10b
line 10b). If zero or less,
. . . . . . . . .

10c

For Paperwork Reduction Act Notice, see instructions.

.

.

.

.

▶

Conversion
Rate

U.S. Dollars

2a
2b

2c
d Related party dividends . . . . . .
2d
e Foreign oil and gas extraction income .
2e
3
Total exclusions (total of lines 2a–2e) . . . . . .
4
Gross income less total exclusions (line 1 minus line 3)
5
Deductions properly allocable to amount on line 4 .
6
Tested income (loss) (line 4 minus line 5) . . . .
7
Tested foreign income taxes . . . . . . . .
8
Qualified business asset investment (QBAI) . . . .
9a Interest expense included on line 5 . .
9a
b Qualified interest expense . . . . .
9b
c Tested loss QBAI amount . . . . .
9c
d Tested interest expense (line 9a minus the sum of line
9c). If zero or less, enter -0- . . . . . . . . .
10a Interest income included in line 4
b Qualified interest income . . .
c Tested interest income (line 10a
enter -0- . . . . . . . .

.

.

Cat. No. 71400M

Schedule I-1 (Form 5471) (Rev. 12-2019)