Form 5713 - International Boycott Report Page 3
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Form 5713 (Rev. 12-2010)
Page
Yes No
9
Nonlisted countries boycotting Israel— Did you have operations in any nonlisted country which you know or
have reason to know requires participation in or cooperation with an international boycott directed against Israel?
If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check
this box
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Principal business activity
IC-DISCs
Name of country
Identifying number of
only—Enter
person having operations
Code
Description
product code
(2)
(1)
(3)
(4)
(5)
a
b
c
d
e
f
g
h
Yes No
10
Boycotts other than the boycott of Israel—Did you have operations in any other country which you know or have
reason to know requires participation in or cooperation with an international boycott other than the boycott of Israel?
If “Yes,” complete the following table. If more space is needed, attach additional sheets using the exact format and check
this box
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▶
Principal business activity
IC-DISCs
Name of country
Identifying number of
only—Enter
person having operations
Description
Code
product code
(2)
(1)
(3)
(4)
(5)
a
b
c
d
e
f
g
h
Yes No
11
Were you requested to participate in or cooperate with an international boycott? .
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If “Yes,” attach a copy (in English) of any and all such requests received during your tax year. If the request was in
a form other than a written request, attach a separate sheet explaining the nature and form of any and all such
requests. (See instructions.)
12
Did you participate in or cooperate with an international boycott?
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If “Yes,” attach a copy (in English) of any and all boycott clauses agreed to, and attach a general statement of the agreement.
If the agreement was in a form other than a written agreement, attach a separate sheet explaining the nature and form of any
and all such agreements. (See instructions.)
Note: If the answer to either question 11 or 12 is “Yes,” you must complete the rest of Form 5713. If you answered “Yes” to question
12, you must complete Schedules A and C or B and C (Form 5713).
5713
Form
(Rev. 12-2010)
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