Exclusion of Income From the International
SCHEDULE S
OMB No. 1545-0123
(Form 1120-F)
Operation of Ships or Aircraft Under Section 883
2015
Attach to Form 1120-F.
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Department of the Treasury
Information about Schedule S (Form 1120-F) and its separate instructions is at
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Internal Revenue Service
Employer identification number
Name of corporation
Part I
Qualified Foreign Corporation
1a Enter the name of the qualified foreign country in which the foreign corporation was organized
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b Check one (and only one) of the following boxes to indicate the type of equivalent exemption granted by the foreign country
listed on line 1a above:
Domestic law
Exchange of notes
Income tax convention
c Enter the applicable authority (i.e., the specific provision) of the equivalent exemption type indicated on line 1b (see
instructions)
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2
Enter the gross income in each of the following categories of qualified income for which the exemption is being claimed:
Note. If an amount is not readily determinable, enter a reasonable estimate. If an estimate is used on any of the lines below,
check here
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a Income from the carriage of passengers and cargo .
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2a
b Time or voyage (full) charter income of a ship or wet lease income of an aircraft .
2b
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c Bareboat charter income of a ship or dry lease income of an aircraft
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2c
d Incidental bareboat charter income of a ship or incidental dry lease income of an aircraft .
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2d
e Incidental container-related income .
2e
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f
Income incidental to the international operation of ships or aircraft other than incidental income
included on lines 2d and 2e above .
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2f
g Capital gains derived by a qualified foreign corporation engaged in the international operation of ships
or aircraft from the sale, exchange or other disposition of a ship, aircraft, container or related
equipment or other moveable property used by that qualified foreign corporation in the international
operation of ships or aircraft .
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2g
h Income from participation in a pool, partnership, strategic alliance, joint operating agreement,
code-sharing arrangement, international operating agency, or other joint venture described in
Regulations section 1.883-1(e)(2) .
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2h
Stock ownership test of Regulations section 1.883-1(c)(2):
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Check one (and only one) of the following boxes to indicate the test under which the stock ownership test of Regulations
section 1.883-1(c)(2) was satisfied:
The publicly-traded test of Regulations section 1.883-2(a). Complete Part II.
The CFC stock ownership test of Regulations section 1.883-3(a). Complete Part III.
The qualified shareholder stock ownership test of Regulations section 1.883-4(a). Complete Part IV.
4
Check the box if any of the shares of the foreign corporation’s stock or the stock of any direct, indirect, or constructive
shareholder are issued in bearer form .
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5
If the box on line 4 is checked:
a Check the box on this line 5a if none of the bearer shares (other than bearer shares maintained in a dematerialized or
immobilized book-entry system) were relied on to satisfy any of the stock ownership tests described in Regulations section
1.883-1(c)(2) .
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b Check the box on this line 5b if any of the bearer shares were maintained in a dematerialized or immobilized book-entry system
and were relied on to satisfy any of the stock ownership tests described in Regulations section 1.883-1(c)(2) .
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Part II
Stock Ownership Test for Publicly-Traded Corporations
6
Enter the name of the country in which the stock is primarily traded
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7
Enter the name of the securities market(s) on which the stock is listed
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8
Enter a description of each class of stock relied on to meet the “regularly traded test” of Regulations section 1.883-2(d) (see
instructions for description requirements)
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9
Do
one
or
more
5%
shareholders
(see
instructions
for
definition)
own
in
the
aggregate
50%
or
more
of the vote and value of the outstanding shares of any class of stock for more than half the number of days during
the tax year? .
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. Yes
No
If “Yes,” complete line 10.
If “No,” skip line 10.
Schedule S (Form 1120-F) 2015
For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F.
Cat. No. 50766D