One-Time Dividends Received Deduction for Certain Cash

Dividends from Controlled Foreign Corporations

Form 8895

OMB No. 1545-1948 (August 2005)

Department of the Treasury

Internal Revenue Service

Cat. No. 37703U Form 8895 (8-2005)

 Attach to the corporation’s tax return.

For Paperwork Reduction Act Notice, see instructions.

Name of corporation Employer identification number

C

D Does the corporation have an applicable financial statement (as defined in section 965(c)(1)) that shows a specific

amount of earnings permanently reinvested outside the United States?

If “Yes,” enter that amount on line 2 below. However, if the corporation is a member of a controlled group

of corporations, see instructions.

If “No,” complete item E below.

E If item D is “No,” does the corporation have an applicable financial statement that shows a specific amount of

tax liability attributable to earnings permanently reinvested outside the United States?

If “Yes,” divide the tax liability by 0.35 and enter the result on line 2 below. However, if the corporation is a

member of a controlled group of corporations, see instructions.

If “No,” enter -0- on line 2 below.

A Enter the date(s) the corporation’s domestic reinvestment plan(s) (DRP) was approved by the corporation’s

president, CEO, or comparable official  , 20 .

Part I Qualifying Information

Dividends Received Deduction

3

4

5

6

7

8

13

9

10

1

1 Enter the “cash dividends” that the corporation received from all controlled foreign corporations

(CFCs) during the tax year. See instructions

Section 965(b)(1) limit. Enter the greater of line 2 or $500,000,000. However, if the corporation

is a member of a controlled group of corporations, see instructions

2 Earnings permanently reinvested outside the United States (see items D and E above)

4 Section 965(b)(2) base period amount. Enter amount from Part VI, line 51

6 Section 965(b)(4) limit. Amounts to be reinvested in the United States under a DRP

5 Section 965(b)(2) limit. Subtract line 4 from line 1. If zero or less, stop here (see instructions).

7 Enter the smallest of lines 3, 5, and 6

9 Enter the amount of CFC indebtedness to any related person as of the

close of October 3, 2004 (see instructions)

8 Enter the amount of CFC indebtedness to any related person as of the

close of the tax year (see instructions)

10 Section 965(b)(3) limit. Subtract line 9 from line 8. If zero or less, enter -0-

3

12 Enter all section 965(a)(2) amounts included on line 11 (see instructions)

13 Deductible portion of qualifying dividends. Multiply line 11 by 85%. Enter here and on Form

1120, Schedule C, line 12, column (c)

11 Qualifying dividends. Subtract line 10 from line 7. If zero or less, stop here (see instructions). If more

than zero, enter the result here and on Form 1120, Schedule C, line 12, column (a) 11

Part II

15 Nondeductible CFC dividends. Subtract line 13 from line 11. See instructions 15

B

2

Enter the date(s) the DRP was approved by the corporation’s board of directors, management committee,

executive committee, or similar body  , 20 .

The DRP states that the corporation anticipates completing all reinvestments in the tax year ending

14 Expenses disallowed under section 965(d)(2) with respect to line 13 amount

Regular Tax Liability for Computing Credit Limitations and Alternative Minimum Tax

Tax on nondeductible CFC dividends. Enter the smaller of line 18 or 35% of line 15

Foreign tax credit that reduces tax on line 19 (see instructions)

20

21

22

23

19

18

Part III

17

18 Enter the corporation’s regular tax liability (Form 1120, Schedule J, line 3)

19

20

21

22

Alternative minimum tax (see instructions)

23

25

Subtract line 21 from line 19

24

25

24

Foreign tax credit that reduces tax on line 20. Subtract line 21 from line 39

16 Enter the corporation’s taxable income (Form 1120, line 30) 16

14

Taxable income excluding nondeductible CFC dividends. Subtract line 15 from line 16 17

Tax on line 17 amount. Subtract line 19 from line 18

Subtract line 23 from line 20

12

, 20 . See Notice 2005-10 for required attachment.

F Is the corporation required to adjust the amount of its base period inclusions, APB 23 limitation, or related party

indebtedness pursuant to Notice 2005-38?

Yes No

Yes

Yes

No

No
Form 8895 (8-2005) Page 2

Foreign Tax Credit—Additional Limitation for Separate Categories With Nondeductible CFC

Dividends (see instructions)

Subtract line 27 from the amount on Form 1118, Schedule B, Part II, line 6

Subtract line 27 from the amount on Form 1118, Schedule B, Part II, line 7c

Divide line 28 by line 29

Subtract line 31 from the amount on Form 1118, Schedule B, Part II, line 9

Multiply line 30 by line 32

Enter foreign taxes paid or accrued with respect to line 27 amount

Add lines 33 and 34

Enter the credit computed for the separate category on Form 1118, Schedule B, Part III

Enter the smaller of line 35 or line 36

Part IV

26

28

29

30

32

33

34

35

36

37

Enter the name of the separate category 

29

33

30

32

31

34

35

36

37

Totals 

Schedule of Dividends (see instructions)

(a)

Name of CFC

(c)

“Cash dividends”

from CFCs

(d)

Check

box if a

section

965(a)(2)

amount

(1)

Functional

Currency

(2)

U.S.

Dollars

Part VI

Part V

(b)

Date Paid

(e)

Column (c)(2) line

amounts the corporation

specifically identifies 

as qualifying dividends 

(see instructions)

Section 965(b)(2) Base Period Amount (see instructions)

See instructions if the corporation has fewer than 5 tax years in its base period.

Most recent tax year

ending on or before

June 30, 2003

Tax year prior to line 41 year

Tax year prior to line 42 year

Tax year prior to line 43 year

Tax year prior to line 44 year

Add lines 41 through 45, column (d)

Add lines 47 and 48

Subtract line 49 from line 46

Divide line 50 by 3. (See instructions if the corporation has fewer than 5 tax years in its base

period.) Enter the result here and on page 1, line 4

Form 8895 (8-2005)

Tax Years in Base Period

(a)

Section 965(b)(2)(B)(i)

dividends

(c)

Section 965(b)(2)(B)(iii)

distributions

(d)

Total. Add columns (a)

through (c)

(b)

Section 965(b)(2)(B)(ii)

inclusions

41

42

43

44

45

46

49

50

51

47 Enter the largest of lines 41 through 45, column (d)

48 Enter the smallest of lines 41 through 45, column (d)

40

46

49

50

51

47

48

27 Enter the amount of nondeductible CFC dividends in the separate category

31 Enter 35% of line 27

38 Enter the smaller of line 31 or line 34

39 Enter the corporation’s revised foreign tax credit for all separate categories (see instructions)

38

39

28

27