Form 8621 - Information Return By A Shareholder Of A Passive Foreign Investment Company Or Qualified Electing Fund Page 3

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Form 8621 (Rev. 12-2011)
3
Page
Part V
Status of Prior Year Section 1294 Elections and Termination of Section 1294 Elections
Complete a separate column for each outstanding election. Complete lines 9 and 10 only if there is a partial
termination of the section 1294 election.
(i)
(ii)
(iii)
(iv)
(v)
(vi)
1
Tax year of outstanding
election .
.
.
.
.
.
.
2
Undistributed earnings to
which the election relates
.
3
Deferred tax
.
.
.
.
.
4
Interest accrued on deferred
tax (line 3) as of the filing date
5
Event terminating election
.
6
Earnings distributed or
deemed distributed during
the tax year
.
.
.
.
.
7
Deferred tax due with this
return
.
.
.
.
.
.
.
8
Accrued interest due with this
return
.
.
.
.
.
.
.
9
Deferred tax outstanding after
partial termination of election .
10
Interest accrued after partial
termination of election
.
.
8621
Form
(Rev. 12-2011)

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