Form 5471 Questionnaire Template Page 2

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FORM 5471 QUESTIONNAIRE FOR _________________(list all tax years _________________
Client Name: __________________________
Date of Completion__________
Loans from Corporation to you during year ( total
amount)
Have you received any dividend or other
distributions from the corporation during the year?
If so, please describe the distribution and amount.
Do you sign on corporate bank accounts or other
financial accounts?
Name of bank or financial institution, number of
.
account, maximum balance in account during the
year, and country of location [for each account]
If you no longer are an owner or reduced your
percentage of ownership, please explain, state date,
and details of transaction where you reduced
ownership percentage.
If the corporation has income from investments in
stocks, bonds, stock sales, dividends, interest or
land it might be a PASSIVE FOREIGN
INVESTMENT COMPANY and subject to special
rules. Please inform us if this might be the
situation. (More information is found below)
Please fill in all answers or information to the best
Acosta Tax & Advisory PA
of your ability. We will contact you with further
(954) 894-2003
questions based on your initial answers and a fee
julio@mycpa.net
quotation.
I verify all information contained in this questionnaire is true and correct and that I have not omitted
any important information.
Date:_______
______________________________________________
Shareholder/Beneficial Owner
ADDITIONAL INFORMATION ON PASSIVE FOREIGN INVESTMENT COMPANY (PFIC)
A company could be classified as a PFIC if it is not majority owned by US persons. A Company can be
considered a PFIC if 50% or more of its assets are passive (CASH IS ALWAYS CONSIDERED TO BE A
PASSIVE ASSET) OR 75% or more of its income is passive during any calendar quarter/year (i.e. investment
income). In addition, the test is like a “trip wire” in that once the 50% threshold is exceeded in any calendar
quarter, the company is always treated as a PFIC for as long as you hold the stock.
The negative consequences of being classified as a PFIC are most apparent on ultimate sale of company stock:
any gain is taxed at the highest rate in effect for the year of sale (i.e. 39.6%), plus an interest charge over the
time the stock is held. Please let us know if you have questions on this.
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