Form 5471 Questionnaire Template

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FORM 5471 QUESTIONNAIRE FOR _________________(list all tax years _________________
Client Name: __________________________
Date of Completion___________
Corporate Name
Corporate Address
Corporate Fiscal Year
Country of incorporation
Date of Incorporation
Your name or name of US shareholder
Date you acquired at least a 10% ownership in
Corporation
Dates you acquired additional ownership in
corporation and percentage of such additional
ownership.
Percentage Ownership of Corporation
Are you an officer of the Corporation?
Does your spouse or other family member co-own
your shares in the Corporation? Provide details
Are you a director of the Corporation?
Corporations US ID Number if any
Number of Shares you Own in Corporation
Type of shares or name of shares
Percentage of Ownership by US persons including
yourself.
Foreign Agent of Corporation including their name,
address and country of location
Custodian of corporate accounting records
including their name, address and country.
Business of Corporation
Foreign Currency Name and exchange rate used in
this questionnaire to convert
Other US owners of corporation including their
names, social security numbers, address, number of
shares owned, and percentage ownership.
Calendar Year Income and Expense statement for
Corporation (if not in US $ state currency and
exchange rate to convert to US $)
December 31 Balance Sheet for corporation in US
$ or foreign currency. Please state which
Salary Paid to You by Corporation by year
(amount)
Loans given to you for year by Corporation (total
amount)
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