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

SCHEDULE A
(Form 965)

U.S. Shareholder’s Section 965(a) Inclusion Amount

(January 2019)

OMB No. 1545-0123

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)

(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))

1
2
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)

Page 2

Schedule A (Form 965) (1-2019)
(f)
U.S. Shareholder’s Pro Rata
Share of Column (e)

(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

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Add schedules as needed.
Schedule A (Form 965) (1-2019)