Form 4876-A

(Rev. September 2016)

Department of the Treasury 

Internal Revenue Service 

Election To Be Treated as an 

Interest Charge DISC

▶ Information about Form 1120-IC-DISC and its separate instructions is at www.irs.gov/form1120icdisc.

OMB No. 1545-0123

Part I The corporation named below elects to be treated as an interest charge domestic international sales corporation 

(IC-DISC) for income tax purposes. All of the corporation’s shareholders must consent to this election.

Name of corporation

Number, street, and room or suite no. (or P.O. box if mail is not delivered to street address)

City or town, state, and ZIP code

A Employer identification number

B Principal business classification (see 

 instructions)

C Tax year of IC-DISC: Must use tax year of shareholder (or shareholder group) with the highest 

 percentage of voting power (see instructions). Enter ending month and day ▶

D Name of person who may be called for 

 information: (optional)

E Election is to take effect for the tax year beginning Telephone number:

 (month, day, year)

F Date corporation began doing business

G Name and address (including ZIP code) of each shareholder (or expected 

shareholder) at the beginning of the tax year the election takes effect and when 

the election is filed.

Ha Number of 

shares of stock 

held on first day 

of year of election

Hb Number of 

shares of stock 

held on date 

consent is made

I Identifying number 

(see instructions)

1

2

3

4

5

6

7

8

9

10

Total. Enter total shares for all shareholders (include shares of shareholders listed on

any attachments) . . . . . . . . . . . . . . . . . . . .

Under penalties of perjury, I declare that the corporation named above has authorized me to make this election for the corporation to be treated as an IC-DISC and that the 

statements made are to the best of my knowledge and belief true, correct, and complete.

Signature and Title of Officer ▶ Date ,

Part II Shareholders’ Consent Statement. Part II may be used instead of attachments. For this election to be valid, each 

shareholder must sign and date below or attach a separate consent to this form (see instructions).

We, the undersigned shareholders, consent to the election of the corporation named above to be treated as an IC-DISC. Our consent is irrevocable and is binding upon all 

transferees of our shares in this corporation.

Signature of shareholder and date. (If consent involves transferred shares, attach a schedule showing the name and address of the holder of the shares at the beginning of 

the tax year and the number of shares for which the consent is made.)

1

2

3

4

5

6

7

8

9

10

For Paperwork Reduction Act Notice, see page 2. Cat. No. 62075X Form 4876-A (Rev. 9-2016)
Form 4876-A (Rev. 9-2016) Page 2

Future Developments

For the latest information about developments 

related to Forms 4876-A and 1120-IC-DISC, such as 

legislation enacted after they were published, go to 

www.irs.gov/form1120icdisc.

General Instructions

Section references are to the Internal Revenue Code 

unless otherwise noted.

Purpose of Form

A corporation files Form 4876-A to elect to be 

treated as an interest charge domestic international 

sales corporation (IC-DISC).

Once the election is made, it remains in effect until 

terminated or revoked. See Regulations section 

1.992-2(e). The election applies to each shareholder 

who owns stock in the corporation while the election 

is in effect.

What Is an IC-DISC?

An IC-DISC is a domestic corporation that meets 

certain conditions regarding its organization and 

international sales and that elects to be treated as an 

IC-DISC. The corporation must be organized under 

the laws of a state or the District of Columbia and 

meet the following tests.

• At least 95% of its gross receipts during the tax 

year are qualified export receipts.

• At the end of the tax year, the adjusted basis of its 

qualified export assets is at least 95% of the sum of 

the adjusted basis of all its assets.

• It has only one class of stock, and its outstanding 

stock has a par or stated value of at least $2,500 on 

each day of the tax year (or, for a new corporation, 

on the last day to elect IC-DISC status for the year 

and on each later day).

• It keeps separate books and records.

• Its tax year must conform to the tax year of the 

shareholder (or shareholder group) who has the 

highest percentage of voting power. If two or more 

shareholders (or shareholder groups) have the same 

highest percentage of voting power, the IC-DISC’s 

tax year may be the same as that of any such 

shareholder (or group). See section 441(h) and its 

regulations for more information.

• Its election to be treated as an IC-DISC is in effect 

for the tax year.

See section 992 and its regulations for details. 

Also see section 993 and its regulations for 

definitions of qualified export receipts and qualified 

export assets.

Ineligible organizations. S corporations, certain

financial institutions, and other corporations listed in 

section 992(d) are not eligible for IC-DISC treatment.

When To File

If it is the corporation’s first tax year, complete and 

file Form 4876-A within 90 days after the beginning 

of the tax year. For any tax year that is not the 

corporation’s first tax year, the election must be 

made during the 90-day period immediately 

preceding the first day of that tax year.

For the election to be valid, all of the corporation’s 

shareholders, as of the first day of the tax year the 

election is to take effect, must consent to it.

Where To File

File Form 4876-A with the IRS Service Center where 

the corporation will file its annual return, Form 

1120-IC-DISC.

Specific Instructions

Part I

Address. Include the suite, room, or other unit

number after the street address. If the post office

does not deliver mail to the street address and the 

corporation has a P.O. box, show the box number 

instead.

Item B—Principal business classification. Use the 

list of Codes for Principal Business Activity in the 

Instructions for Form 1120-IC-DISC to enter the 

corporation’s business code number, principal 

business activity, and principal product or service.

Item C—Tax year change. If a corporation electing 

to be an IC-DISC has to change its tax year to meet 

the tax year requirements of section 441(h), the 

corporation generally does not need IRS consent to 

make the change. A tax year change by a 

shareholder requires IRS consent. A subsequent 

change by the corporation to meet the tax year 

requirements of section 441(h) may require IRS 

consent. See section 442 and the regulations under 

sections 441, 442, and 921 for more information. 

Also see Rev. Proc. 2002-37, 2002-22 I.R.B. 1030, 

and Rev. Proc. 2002-39, 2002-22 I.R.B. 1046, as

clarified and modified by Notice 2002-72, 2002-46 

I.R.B. 843.

Columns Ha and Hb. Number of shares of stock. 

Enter the number of shares of stock held on the first 

day of the year of election and the number held on 

the date of consent to make the election. Complete 

both columns for each shareholder.

Column I—Identifying number. The identifying

number for an individual is the social security

number. For all others, it is the employer

identification number.

Signature. Form 4876-A must be signed by the

president, vice president, treasurer, assistant

treasurer, chief accounting officer, or other officer 

(such as tax officer) authorized to sign for the 

corporation.

Part II

Shareholders’ Consent Statement. An election for 

IC-DISC treatment will be valid only if all

shareholders sign either the consent statement in 

Part II or a separate statement as described below. 

Several shareholders may combine their consents in 

one statement.

If legally married spouses jointly own the stock or 

the income from it, both must sign the consent. If 

tenants in common, joint tenants, or tenants by the 

entirety own the stock, each person must sign. The 

legal guardian should sign for a minor; if none has 

been appointed, the natural guardian should sign.

The executor or administrator should sign for an 

estate, and the trustee should sign for a trust. If the 

estate or trust has more than one executor, 

administrator, or trustee, any of them who is 

authorized to file the returns may sign the consent. 

For a corporation or partnership, an officer or partner 

who is authorized to sign the other returns may sign 

the consent for the IC-DISC election.

A foreign person’s consent may be signed by any 

individual who would be authorized to sign if the 

person were a U.S. person.

Extension. Normally, the consents must be attached 

to Form 4876-A. If you establish reasonable cause 

for not filing a consent on time, you may file the 

consent within an extended period granted by an 

IRS Service Center. File the consents with the same

service center where you filed Form 4876-A.

Consent by transferee shareholder. If shares are 

transferred before a consent is filed, the transferee 

shareholder may consent to the IC-DISC election as 

long as the transfer occurs and the consent is filed 

within the first 90 days of the tax year. The service 

center may grant an extension beyond that date. If 

the transfer takes place more than 90 days after the 

tax year began, an extension can be granted only if 

the transferor was eligible for one.

Separate statement. Any shareholder who does

not sign the consent in Part II of Form 4876-A must 

sign a separate consent statement for the election to 

be valid. The statement must say: “I, (shareholder’s 

name), a shareholder of (corporation’s name), 

consent to the election of (corporation’s name) to be 

treated as an IC-DISC. The consent so made by me 

is irrevocable and is binding on all transferees of my 

shares in (corporation’s name).”

In addition, the statement must show (a) the names, 

addresses, and identification numbers of both the 

corporation and the shareholder; (b) the number of 

shares the shareholder owned (or expects to own) at 

the beginning of the tax year the election takes effect; 

and (c) the number of shares the shareholder owns 

when making the consent.

For transferred stock, also show the name and 

address of the person who held the shares at the 

beginning of the tax year and the number of shares 

to which this consent applies.

Supplemental Form 4876-A. If, between the date 

the election is filed and the date it takes effect, the 

corporation issues more shares of stock or the share 

ownership changes, it must file a supplemental Form 

4876-A, with “SUPPLEMENTAL” written across the 

top of the form. The form must be filed within the 

first 90 days of the tax year the election takes effect.

On the supplemental form, include all the 

information from the earlier form except for the list of 

owners contained in Parts I and II. Report only the 

owners of the new or additional shares in Part I, and 

in Part II obtain their consents only. Each new 

shareholder or holder of additional shares must 

consent to the IC-DISC election for the 

Supplemental Form 4876-A to be valid.

Paperwork Reduction Act Notice. We ask for the 

information on this form to carry out the Internal 

Revenue laws of the United States. You are required 

to give us the information. We need it to ensure that 

you are complying with these laws and to allow us to 

figure and collect the right amount of tax.

You are not required to provide the information 

requested on a form that is subject to the Paperwork 

Reduction Act unless the form displays a valid OMB 

control number. Books or records relating to a form 

or its instructions must be retained as long as their 

contents may become material in the administration 

of any Internal Revenue law. Generally, tax returns 

and return information are confidential, as required 

by section 6103.

The time needed to complete and file this form will 

vary depending on individual circumstances. The 

estimated average time is:

Recordkeeping . . . . . . 4 hr., 4 min.

Learning about the law 

or the form . . . . . . . 1 hr., 5 min.

Preparing and sending 

the form to the IRS . . . . . 1 hr., 12 min.

If you have comments concerning the accuracy of 

these time estimates or suggestions for making this 

form simpler, we would be happy to hear from you. 

You can send us comments from 

www.irs.gov/formspubs. Click on “More Information” 

and then on “Give us feedback.” Or you can write to 

the Internal Revenue Service, Tax Forms and 

Publications, 1111 Constitution Ave. NW, IR-6526, 

Washington, DC 20224. Do not file your form at this 

address. Instead, see Where To File, earlier.