Form 4876-A
(Rev. September 2016)
Department of the Treasury
Internal Revenue Service
Election To Be Treated as an
Interest Charge DISC
Information about Form 1120-IC-DISC and its separate instructions is at www.irs.gov/form1120icdisc.
OMB No. 1545-0123
Part I
The corporation named below elects to be treated as an interest charge domestic international sales corporation
(IC-DISC) for income tax purposes. All of the corporation’s shareholders must consent to this election.
Name of corporation
Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address)
City or town, state, and ZIP code
A Employer identification number
B Principal business classification (see
instructions)
C Tax year of IC-DISC: Must use tax year of shareholder (or shareholder group) with the highest
percentage of voting power (see instructions). Enter ending month and day
D Name of person who may be called for
information: (optional)
Telephone number:
E Election is to take effect for the tax year beginning
(month, day, year)
F Date corporation began doing business
G Name and address (including ZIP code) of each shareholder (or expected
shareholder) at the beginning of the tax year the election takes effect and when
the election is filed.
Ha Number of
shares of stock
held on first day
of year of election
Hb Number of
shares of stock
held on date
consent is made
I Identifying number
(see instructions)
1
2
3
4
5
6
7
8
9
10
Total. Enter total shares for all shareholders (include shares of shareholders listed on
any attachments) . . . . . . . . . . . . . . . . . . . .
Under penalties of perjury, I declare that the corporation named above has authorized me to make this election for the corporation to be treated as an IC-DISC and that the
statements made are to the best of my knowledge and belief true, correct, and complete.
Signature and Title of Officer
Date
,
Part II
Shareholders’ Consent Statement. Part II may be used instead of attachments. For this election to be valid, each
shareholder must sign and date below or attach a separate consent to this form (see instructions).
We, the undersigned shareholders, consent to the election of the corporation named above to be treated as an IC-DISC. Our consent is irrevocable and is binding upon all
transferees of our shares in this corporation.
Signature of shareholder and date. (If consent involves transferred shares, attach a schedule showing the name and address of the holder of the shares at the beginning of
the tax year and the number of shares for which the consent is made.)
1
2
3
4
5
6
7
8
9
10
For Paperwork Reduction Act Notice, see page 2.
Cat. No. 62075X
Form 4876-A (Rev. 9-2016)
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Form 4876-A (Rev. 9-2016)
Page 2
Future Developments
For the latest information about developments
related to Forms 4876-A and 1120-IC-DISC, such as
legislation enacted after they were published, go to
www.irs.gov/form1120icdisc.
General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.
Purpose of Form
A corporation files Form 4876-A to elect to be
treated as an interest charge domestic international
sales corporation (IC-DISC).
Once the election is made, it remains in effect until
terminated or revoked. See Regulations section
1.992-2(e). The election applies to each shareholder
who owns stock in the corporation while the election
is in effect.
What Is an IC-DISC?
An IC-DISC is a domestic corporation that meets
certain conditions regarding its organization and
international sales and that elects to be treated as an
IC-DISC. The corporation must be organized under
the laws of a state or the District of Columbia and
meet the following tests.
• At least 95% of its gross receipts during the tax
year are qualified export receipts.
• At the end of the tax year, the adjusted basis of its
qualified export assets is at least 95% of the sum of
the adjusted basis of all its assets.
• It has only one class of stock, and its outstanding
stock has a par or stated value of at least $2,500 on
each day of the tax year (or, for a new corporation,
on the last day to elect IC-DISC status for the year
and on each later day).
• It keeps separate books and records.
• Its tax year must conform to the tax year of the
shareholder (or shareholder group) who has the
highest percentage of voting power. If two or more
shareholders (or shareholder groups) have the same
highest percentage of voting power, the IC-DISC’s
tax year may be the same as that of any such
shareholder (or group). See section 441(h) and its
regulations for more information.
• Its election to be treated as an IC-DISC is in effect
for the tax year.
See section 992 and its regulations for details.
Also see section 993 and its regulations for
definitions of qualified export receipts and qualified
export assets.
Ineligible organizations. S corporations, certain
financial institutions, and other corporations listed in
section 992(d) are not eligible for IC-DISC treatment.
When To File
If it is the corporation’s first tax year, complete and
file Form 4876-A within 90 days after the beginning
of the tax year. For any tax year that is not the
corporation’s first tax year, the election must be
made during the 90-day period immediately
preceding the first day of that tax year.
For the election to be valid, all of the corporation’s
shareholders, as of the first day of the tax year the
election is to take effect, must consent to it.
Where To File
File Form 4876-A with the IRS Service Center where
the corporation will file its annual return, Form
1120-IC-DISC.
Specific Instructions
Part I
Address. Include the suite, room, or other unit
number after the street address. If the post office
does not deliver mail to the street address and the
corporation has a P.O. box, show the box number
instead.
Item B—Principal business classification. Use the
list of Codes for Principal Business Activity in the
Instructions for Form 1120-IC-DISC to enter the
corporation’s business code number, principal
business activity, and principal product or service.
Item C—Tax year change. If a corporation electing
to be an IC-DISC has to change its tax year to meet
the tax year requirements of section 441(h), the
corporation generally does not need IRS consent to
make the change. A tax year change by a
shareholder requires IRS consent. A subsequent
change by the corporation to meet the tax year
requirements of section 441(h) may require IRS
consent. See section 442 and the regulations under
sections 441, 442, and 921 for more information.
Also see Rev. Proc. 2002-37, 2002-22 I.R.B. 1030,
and Rev. Proc. 2002-39, 2002-22 I.R.B. 1046, as
clarified and modified by Notice 2002-72, 2002-46
I.R.B. 843.
Columns Ha and Hb. Number of shares of stock.
Enter the number of shares of stock held on the first
day of the year of election and the number held on
the date of consent to make the election. Complete
both columns for each shareholder.
Column I—Identifying number. The identifying
number for an individual is the social security
number. For all others, it is the employer
identification number.
Signature. Form 4876-A must be signed by the
president, vice president, treasurer, assistant
treasurer, chief accounting officer, or other officer
(such as tax officer) authorized to sign for the
corporation.
Part II
Shareholders’ Consent Statement. An election for
IC-DISC treatment will be valid only if all
shareholders sign either the consent statement in
Part II or a separate statement as described below.
Several shareholders may combine their consents in
one statement.
If legally married spouses jointly own the stock or
the income from it, both must sign the consent. If
tenants in common, joint tenants, or tenants by the
entirety own the stock, each person must sign. The
legal guardian should sign for a minor; if none has
been appointed, the natural guardian should sign.
The executor or administrator should sign for an
estate, and the trustee should sign for a trust. If the
estate or trust has more than one executor,
administrator, or trustee, any of them who is
authorized to file the returns may sign the consent.
For a corporation or partnership, an officer or partner
who is authorized to sign the other returns may sign
the consent for the IC-DISC election.
A foreign person’s consent may be signed by any
individual who would be authorized to sign if the
person were a U.S. person.
Extension. Normally, the consents must be attached
to Form 4876-A. If you establish reasonable cause
for not filing a consent on time, you may file the
consent within an extended period granted by an
IRS Service Center. File the consents with the same
service center where you filed Form 4876-A.
Consent by transferee shareholder. If shares are
transferred before a consent is filed, the transferee
shareholder may consent to the IC-DISC election as
long as the transfer occurs and the consent is filed
within the first 90 days of the tax year. The service
center may grant an extension beyond that date. If
the transfer takes place more than 90 days after the
tax year began, an extension can be granted only if
the transferor was eligible for one.
Separate statement. Any shareholder who does
not sign the consent in Part II of Form 4876-A must
sign a separate consent statement for the election to
be valid. The statement must say: “I, (shareholder’s
name), a shareholder of (corporation’s name),
consent to the election of (corporation’s name) to be
treated as an IC-DISC. The consent so made by me
is irrevocable and is binding on all transferees of my
shares in (corporation’s name).”
In addition, the statement must show (a) the names,
addresses, and identification numbers of both the
corporation and the shareholder; (b) the number of
shares the shareholder owned (or expects to own) at
the beginning of the tax year the election takes effect;
and (c) the number of shares the shareholder owns
when making the consent.
For transferred stock, also show the name and
address of the person who held the shares at the
beginning of the tax year and the number of shares
to which this consent applies.
Supplemental Form 4876-A. If, between the date
the election is filed and the date it takes effect, the
corporation issues more shares of stock or the share
ownership changes, it must file a supplemental Form
4876-A, with “SUPPLEMENTAL” written across the
top of the form. The form must be filed within the
first 90 days of the tax year the election takes effect.
On the supplemental form, include all the
information from the earlier form except for the list of
owners contained in Parts I and II. Report only the
owners of the new or additional shares in Part I, and
in Part II obtain their consents only. Each new
shareholder or holder of additional shares must
consent to the IC-DISC election for the
Supplemental Form 4876-A to be valid.
Paperwork Reduction Act Notice. We ask for the
information on this form to carry out the Internal
Revenue laws of the United States. You are required
to give us the information. We need it to ensure that
you are complying with these laws and to allow us to
figure and collect the right amount of tax.
You are not required to provide the information
requested on a form that is subject to the Paperwork
Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form
or its instructions must be retained as long as their
contents may become material in the administration
of any Internal Revenue law. Generally, tax returns
and return information are confidential, as required
by section 6103.
The time needed to complete and file this form will
vary depending on individual circumstances. The
estimated average time is:
Recordkeeping . . . . . . 4 hr., 4 min.
Learning about the law
or the form . . . . . . . 1 hr., 5 min.
Preparing and sending
the form to the IRS . . . . . 1 hr., 12 min.
If you have comments concerning the accuracy of
these time estimates or suggestions for making this
form simpler, we would be happy to hear from you.
You can send us comments from
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and then on “Give us feedback.” Or you can write to
the Internal Revenue Service, Tax Forms and
Publications, 1111 Constitution Ave. NW, IR-6526,
Washington, DC 20224. Do not file your form at this
address. Instead, see Where To File, earlier.
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