Form 5472 - Information Return Of A 25% Foreign-Owned U.s. Corporation Or A Foreign Corporation Engaged In A U.s. Trade Or Business Page 2

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2
Form 5472 (Rev. 12-2012)
Page
Part III
Related Party (see instructions)
Check applicable box: Is the related party a
foreign person or
U.S. person?
All reporting corporations must complete this question and the rest of Part III.
1a Name and address of related party
1b(1) U.S. identifying number, if any
1b(2) Reference ID number (see
instructions)
1c Principal business activity
1d Principal business activity code
▶
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1e Relationship—Check boxes that apply:
Related to reporting corporation
Related to 25% foreign shareholder
25% foreign shareholder
1f Principal country(ies) where business is conducted
1g Country(ies) under whose laws the related party files an income tax return as a
resident
Part IV
Monetary Transactions Between Reporting Corporations and Foreign Related Party
(see instructions)
Caution: Part IV must be completed if the “foreign person” box is checked in the heading for Part III.
If estimates are used, check here
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1
Sales of stock in trade (inventory) .
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1
2
2
Sales of tangible property other than stock in trade .
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3
Platform contribution transaction payments received
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3
4
Cost sharing transaction payments received .
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4
5a
Rents received (for other than intangible property rights)
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5a
b
5b
Royalties received (for other than intangible property rights)
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6
Sales, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas)
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6
7
Consideration received for technical, managerial, engineering, construction, scientific, or like services .
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7
8
8
Commissions received
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9
9b
Amounts borrowed (see instructions)
a Beginning balance
b Ending balance or monthly average
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10
Interest received .
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10
11
11
Premiums received for insurance or reinsurance .
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12
Other amounts received (see instructions) .
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12
13
Total. Combine amounts on lines 1 through 12 .
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13
14
Purchases of stock in trade (inventory) .
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14
15
15
Purchases of tangible property other than stock in trade
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16
Platform contribution transaction payments paid .
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16
17
Cost sharing transaction payments paid
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17
18 a
18a
Rents paid (for other than intangible property rights) .
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b
Royalties paid (for other than intangible property rights) .
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18b
19
Purchases, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas) .
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19
20
20
Consideration paid for technical, managerial, engineering, construction, scientific, or like services
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21
Commissions paid
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21
22
22b
Amounts loaned (see instructions)
a Beginning balance
b Ending balance or monthly average
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23
Interest paid
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23
24
24
Premiums paid for insurance or reinsurance .
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25
Other amounts paid (see instructions) .
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25
26
Total. Combine amounts on lines 14 through 25
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26
Part V
Nonmonetary and Less-Than-Full Consideration Transactions Between the Reporting Corporation and
the Foreign Related Party
(see instructions)
Describe these transactions on an attached separate sheet and check here.
▶
Part VI
Additional Information
All reporting corporations must complete Part VI.
1
Does the reporting corporation import goods from a foreign related party? .
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Yes
No
2 a
If “Yes,” is the basis or inventory cost of the goods valued at greater than the customs value of the imported goods?
Yes
No
If “No,” do not complete b and c below.
b
If “Yes,” attach a statement explaining the reason or reasons for such difference.
c
If the answers to questions 1 and 2a are “Yes,” were the documents used to support this treatment of the imported
goods in existence and available in the United States at the time of filing Form 5472? .
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Yes
No
3
During the tax year, was the foreign parent corporation a participant in any cost sharing arrangement? .
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Yes
No
4
During the course of the tax year, did the foreign parent corporation become a participant in any cost sharing
arrangement? .
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Yes
No
5472
Form
(Rev. 12-2012)

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