Form 5472
(Rev. December 2018)
Department of the Treasury
Internal Revenue Service
Information Return of a 25% Foreign-Owned U.S. Corporation or a
Foreign Corporation Engaged in a U.S. Trade or Business
(Under Sections 6038A and 6038C of the Internal Revenue Code)
Go to www.irs.gov/Form5472 for instructions and the latest information.
For tax year of the reporting corporation beginning , , and ending ,
Note: Enter all information in English and money items in U.S. dollars.
OMB No. 1545-0123
Part I Reporting Corporation (see instructions). All reporting corporations must complete Part I.
1a Name of reporting corporation
Number, street, and room or suite no. (if a P.O. box, see instructions)
City or town, state, and ZIP code (if a foreign address, see instructions)
1b Employer identification number
1c Total assets
$
1d Principal business activity
1e Principal business activity code
1f Total value of gross payments made or received
reported on this Form 5472. See instructions.
$
1g Total number of Forms 5472
filed for the tax year
1h Total value of gross payments made or received
reported on all Forms 5472. See instructions.
$
1i Check here if this is a consolidated filing
of Form 5472 . . . . . .
1j Check here if this is the initial year for which the U.S.
reporting corporation is filing a Form 5472 . .
1k Country of incorporation
1l Country(ies) under whose laws the reporting
corporation files an income
tax return as a resident
1m Principal country(ies) where business is conducted
2 Check here if, at any time during the tax year, any foreign person owned, directly or indirectly, at least 50% of (a) the total voting power of all
classes of the stock of the reporting corporation entitled to vote, or (b) the total value of all classes of stock of the reporting corporation
3 Check here if the reporting corporation is a foreign-owned domestic disregarded entity (foreign-owned U.S. DE) treated as a corporation for
purposes of section 6038A. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . .
Part II 25% Foreign Shareholder (see instructions)
Check here if any direct (or ultimate indirect) 25% foreign shareholder listed in Part II is a surrogate foreign
corporation under section 7874(a)(2)(B).
1a Name and address of direct 25% foreign shareholder
1b(1) U.S. identifying number, if any 1b(2) Reference ID number (see instructions) 1b(3) Foreign taxpayer identification number (FTIN), if any (see
instructions)
1c Principal country(ies) where
business is conducted
1d Country of citizenship,
organization, or incorporation
1e Country(ies) under whose laws the direct 25% foreign shareholder
files an income tax return as a resident
2a Name and address of direct 25% foreign shareholder
2b(1) U.S. identifying number, if any 2b(2) Reference ID number (see instructions) 2b(3) FTIN, if any (see instructions)
2c Principal country(ies) where
business is conducted
2d Country of citizenship,
organization, or incorporation
2e Country(ies) under whose laws the direct 25% foreign shareholder
files an income tax return as a resident
3a Name and address of ultimate indirect 25% foreign shareholder
3b(1) U.S. identifying number, if any 3b(2) Reference ID number (see instructions) 3b(3) FTIN, if any (see instructions)
3c Principal country(ies) where
business is conducted
3d Country of citizenship,
organization, or incorporation
3e Country(ies) under whose laws the ultimate indirect 25% foreign
shareholder files an income tax return as a resident
4a Name and address of ultimate indirect 25% foreign shareholder
4b(1) U.S. identifying number, if any 4b(2) Reference ID number (see instructions) 4b(3) FTIN, if any (see instructions)
4c Principal country(ies) where
business is conducted
4d Country of citizenship,
organization, or incorporation
4e Country(ies) under whose laws the ultimate indirect 25% foreign
shareholder files an income tax return as a resident
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 49987Y
Form
5472 (Rev. 12-2018)
Form 5472 (Rev. 12-2018)
Page 2
Part III Related Party
(see instructions). All reporting corporations must complete this question and the rest of Part III.
Check applicable box: Is the related party a
foreign person or
U.S. person?
1a Name and address of related party
1b(1) U.S. identifying number, if any 1b(2) Reference ID number (see instructions) 1b(3) FTIN, if any (see instructions)
1c Principal business activity
1d Principal business activity code
1e Relationship—Check boxes that apply: Related to reporting corporation Related to 25% foreign shareholder 25% foreign shareholder
1f Principal country(ies) where business is conducted 1g Country(ies) under whose laws the related party files an income tax return as a
resident
Part IV
Monetary Transactions Between Reporting Corporations and Foreign Related Party (see instructions)
Caution: Part IV must be completed if the “foreign person” box is checked in the heading for Part III.
If estimates are used, check here.
1 Sales of stock in trade (inventory) . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Sales of tangible property other than stock in trade . . . . . . . . . . . . . . . . . . . 2
3 Platform contribution transaction payments received . . . . . . . . . . . . . . . . . . 3
4 Cost-sharing transaction payments received . . . . . . . . . . . . . . . . . . . . . 4
5a Rents received (for other than intangible property rights) . . . . . . . . . . . . . . . . . 5a
b Royalties received (for other than intangible property rights) . . . . . . . . . . . . . . . . 5b
6 Sales, leases, licenses, etc., of intangible property rights (for example, patents, trademarks, secret formulas) . . 6
7 Consideration received for technical, managerial, engineering, construction, scientific, or like services . . . . 7
8 Commissions received . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9
Amounts borrowed (see instructions)
a Beginning balance
b Ending balance or monthly average
9b
10 Interest received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Premiums received for insurance or reinsurance . . . . . . . . . . . . . . . . . . . . 11
12 Other amounts received (see instructions) . . . . . . . . . . . . . . . . . . . . . . 12
13 Total. Combine amounts on lines 1 through 12 . . . . . . . . . . . . . . . . . . . . 13
14 Purchases of stock in trade (inventory) . . . . . . . . . . . . . . . . . . . . . . . 14
15 Purchases of tangible property other than stock in trade . . . . . . . . . . . . . . . . . 15
16 Platform contribution transaction payments paid . . . . . . . . . . . . . . . . . . . . 16
17 Cost-sharing transaction payments paid . . . . . . . . . . . . . . . . . . . . . . 17
18 a Rents paid (for other than intangible property rights) . . . . . . . . . . . . . . . . . . . 18a
b Royalties paid (for other than intangible property rights) . . . . . . . . . . . . . . . . . . 18b
19 Purchases, leases, licenses, etc., of intangible property rights (for example, patents, trademarks, secret formulas) 19
20 Consideration paid for technical, managerial, engineering, construction, scientific, or like services . . . . . 20
21 Commissions paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
22
Amounts loaned (see instructions)
a Beginning balance
b Ending balance or monthly average
22b
23 Interest paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
24 Premiums paid for insurance or reinsurance . . . . . . . . . . . . . . . . . . . . . 24
25 Other amounts paid (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 25
26 Total. Combine amounts on lines 14 through 25 . . . . . . . . . . . . . . . . . . . 26
Part V
Reportable Transactions of a Reporting Corporation That is a Foreign-Owned U.S. DE (see instructions)
Describe on an attached separate sheet any other transaction as defined by Regulations section 1.482-1(i)(7),
such as amounts paid or received in connection with the formation, dissolution, acquisition, and disposition
of the entity, including contributions to and distributions from the entity, and check here.
Part VI
Nonmonetary and Less-Than-Full Consideration Transactions Between the Reporting Corporation and
the Foreign Related Party (see instructions)
Describe these transactions on an attached separate sheet and check here.
Form 5472 (Rev. 12-2018)
Form 5472 (Rev. 12-2018)
Page 3
Part VII Additional Information. All reporting corporations must complete Part VII.
1 Does the reporting corporation import goods from a foreign related party? . . . . . . . . . . . . . . Yes No
2 a If “Yes,” is the basis or inventory cost of the goods valued at greater than the customs value of the imported goods? .
Yes No
b If “Yes,” attach a statement explaining the reason or reasons for such difference.
c If the answers to questions 1 and 2a are “Yes,” were the documents used to support this treatment of the imported
goods in existence and available in the United States at the time of filing Form 5472? . . . . . . . . . . . Yes No
3 During the tax year, was the foreign parent corporation a participant in any cost-sharing arrangement? . . . . . .
Yes No
4
During the course of the tax year, did the foreign parent corporation become a participant in any cost-sharing arrangement? .
Yes No
5a
During the tax year, did the reporting corporation pay or accrue any interest or royalty, to the related party, for which the
deduction is not allowed under section 267A? See instructions . . . . . . . . . . . . . . . . . .
Yes No
b If “Yes,” enter the total amount of the disallowed deductions . . . . . . . . . . . . . . . . . $
6a Does the reporting corporation claim a foreign-derived intangible income (FDII) deduction (under section 250) with
respect to amounts listed in Part IV? . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
b If “Yes,” enter the amount of gross income derived from sales, leases, exchanges, or other dispositions (but not licenses)
of property to the foreign related party that the reporting corporation included in its computation of foreign-derived
deduction eligible income (FDDEI). See instructions . . . . . . . . . . . . . . . . . . . . $
c If “Yes,” enter the amount of gross income derived from a license of property to the foreign related party that the
reporting corporation included in its computation of FDDEI. See instructions. . . . . . . . . . . . . $
d If “Yes,” enter the amount of gross income derived from services provided to the foreign related party that the reporting
corporation included in its computation of FDDEI. See instructions . . . . . . . . . . . . . . . $
Part VIII Base Erosion
Payments and Base Erosion Tax Benefits Under Section 59A (see instructions)
1 Amounts defined as base erosion payments under section 59A(d) . . . . . . . . . . . . . . . . $
2 Amount of base erosion tax benefits under section 59A(c)(2) . . . . . . . . . . . . . . . . . $
3 Amount of total qualified derivative payments as described in section 59A(h) made by the reporting corporation . . $
4 Reserved for future use . . . . . . . . . . . . . . . . . . . . . . . . . . .
Form 5472 (Rev. 12-2018)
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