Department of the Treasury
Internal Revenue Service
Tax Jurisdiction and Constituent Entity Information
For reporting period beginning , 20 , and ending , 20
A separate Schedule A (Form 8975) is to be completed for each tax jurisdiction of the multinational enterprise group.
Information about Schedule A (Form 8975) and its separate instructions is at www.irs.gov/form8975.
OMB No. 1545-2272
Name of the reporting entity EIN
Tax Jurisdiction Information. All financial amounts must be stated in U.S. dollars. See instructions.
2. Profit (loss) before
3. Income tax paid
(on cash basis)
4. Income tax
5. Stated capital 6. Accumulated
7. Number of
8. Tangible assets
other than cash and
Part II Constituent Entity Information
1. Constituent entities resident in
the tax jurisdiction
3. Tax jurisdiction of
different from tax
4. Main business activities
If you entered the code for “Other,” describe the
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 69310N
Schedule A (Form 8975) (6-2017)