Schedule M-3(Form 1120-F) - Net Income (Loss) Reconciliation For Foreign Corporations - Department Of Treasury - 2013

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Net Income (Loss) Reconciliation for Foreign
SCHEDULE M-3
OMB No. 1545-0126
(Form 1120-F)
Corporations With Reportable Assets of $10 Million or More
2013
Attach to Form 1120-F.
Department of the Treasury
Information about Schedule M-3 (Form 1120-F) and its instructions is available at
Internal Revenue Service
Name of corporation
Employer identification number
Has the corporation reported taxable income on Form 1120-F, page 3, using a treaty provision to attribute
A
business profits to a U.S. permanent establishment under rules other than section 864(c)? .
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Yes
No
B
Did the corporation prepare a non-consolidated, worldwide, certified audited income statement for the
period (see instructions)?
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Yes
No
C
Did the corporation prepare a non-consolidated, worldwide income statement for the period (see instructions)?
Yes
No
D
Did the corporation prepare certified audited income statement(s) for the set(s) of books reported on
Form 1120-F, Schedule L? .
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Yes
No
Part I
Financial Information and Net Income (Loss) Reconciliation (see instructions)
1
Is the corporation a foreign bank as defined in Regulations section 1.882-5(c)(4)?
Yes. Complete the remainder of Part I as follows:
If D is “Yes,” use the income statement described in D to complete lines 2 through 5 and 7 through 11.
If D is “No,” use the income statement(s) for the set(s) of books reported on Form 1120-F, Schedule L
to complete lines 2 through 5 and 7 through 11.
No. Complete the remainder of Part I as follows:
If B is “Yes,” use the income statement described in B to complete lines 2 through 11.
If B is “No” and C is “Yes,” use the income statement described in C to complete lines 2 through 11.
If B and C are “No” and D is “Yes,” use the income statement described in D to complete lines 2 through 11.
If B, C, and D are “No,” use the income statement described in the instructions to complete lines 2 through 11.
2a Enter the income statement period: Beginning
Ending
b Has the corporation’s income statement been restated for the income statement period entered on line 2a?
Yes. Attach an explanation and the amount of each item restated.
No.
c Has the corporation’s income statement been restated for any of the 5 income statement periods preceding
the period on line 2a?
Yes. Attach an explanation and the amount of each item restated.
No.
3
Is any of the corporation’s stock publicly traded on any exchange, U.S. or foreign?
Yes. List exchange(s) and symbol
No.
4
Non-consolidated foreign corporation net income (loss) in U.S. dollars from the income statement
source identified in line 1 .
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4
5a Net income from includible disregarded foreign entities not included on line 4 (attach statement) .
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5a
5b (
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b Net loss from includible disregarded foreign entities not included on line 4 (attach statement) .
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c Net income from includible disregarded U.S. entities not included on line 4 (attach statement) .
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5c
5d (
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d Net loss from includible disregarded U.S. entities not included on line 4 (attach statement) .
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6
Net income (loss) from foreign locations not included on line 4 (attach statement) .
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7a (
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7a Net income of non-includible entities (attach statement)
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b Net loss of non-includible entities (attach statement)
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Adjustments to intercompany transactions (attach statement)
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9
Adjustments to reconcile income statement period to tax year (attach statement) .
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Other adjustments to reconcile to amount on line 11 (attach statement)
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11
Adjusted financial net income (loss) of non-consolidated foreign corporation. Combine lines 4
through 10
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For Paperwork Reduction Act Notice, see the Instructions
Cat. No. 39667H
Schedule M-3 (Form 1120-F) 2013
for Form 1120-F.

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