SCHEDULE S 

(Form 1120-F)

Department of the Treasury 

Internal Revenue Service

Exclusion of Income From the International 

Operation of Ships or Aircraft Under Section 883

▶ Attach to Form 1120-F.

OMB No. 1545-0126

2012

Name of corporation Employer identification number

Part I Qualified Foreign Corporation

1a Enter the name of the qualified foreign country in which the foreign corporation was organized ▶

b Check one (and only one) of the following boxes to indicate the type of equivalent exemption granted by the foreign country 

listed on line 1a above:

Domestic law

Exchange of notes

Income tax convention

c Enter the applicable authority (i.e., the specific provision) of the equivalent exemption type indicated on line 1b (see 

instructions) ▶

2 Enter the gross income in each of the following categories of qualified income for which the exemption is being claimed:

Note. If an amount is not readily determinable, enter a reasonable estimate. If an estimate is used on any of the lines below, 

check here ▶

a Income from the carriage of passengers and cargo . . . . . . . . . . . . . . . . . 2a

b Time or voyage (full) charter income of a ship or wet lease income of an aircraft . . . . . . . . 2b

c Bareboat charter income of a ship or dry lease income of an aircraft . . . . . . . . . . . 2c

d Incidental bareboat charter income of a ship or incidental dry lease income of an aircraft . . . . . 2d

e Incidental container-related income . . . . . . . . . . . . . . . . . . . . . . 2e

f Income incidental to the international operation of ships or aircraft other than incidental income

included on lines 2d and 2e above . . . . . . . . . . . . . . . . . . . . . . . 2f

g 

 

 

Capital gains derived by a qualified foreign corporation engaged in the international operation of ships 

or aircraft from the sale, exchange or other disposition of a ship, aircraft, container or related

equipment or other moveable property used by that qualified foreign corporation in the international

operation of ships or aircraft . . . . . . . . . . . . . . . . . . . . . . . . . 2g

h 

 

Income from participation in a pool, partnership, strategic alliance, joint operating agreement, 

code-sharing arrangement, international operating agency, or other joint venture described in

Regulations section 1.883-1(e)(2) . . . . . . . . . . . . . . . . . . . . . . . 2h

Stock ownership test of Regulations section 1.883-1(c)(2):

3 Check one (and only one) of the following boxes to indicate the test under which the stock ownership test of Regulations 

section 1.883-1(c)(2) was satisfied:

The publicly-traded test of Regulations section 1.883-2(a). Complete Part II.

The CFC stock ownership test of Regulations section 1.883-3(a). Complete Part III.

The qualified shareholder stock ownership test of Regulations section 1.883-4(a). Complete Part IV.

4 Check the box if any of the shares of the foreign corporation’s stock or the stock of any direct, indirect, or constructive 

shareholder are issued in bearer form. . . . . . . . . . . . . . . . . . . . . . . . . . . .

5 If the box on line 4 is checked:

a Check the box on this line 5a if none of the bearer shares (other than bearer shares maintained in a dematerialized or 

immobilized book-entry system) were relied on to satisfy any of the stock ownership tests described in Regulations section

1.883-1(c)(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Check the box on this line 5b if any of the bearer shares were maintained in a dematerialized or immobilized book-entry system

and were relied on to satisfy any of the stock ownership tests described in Regulations section 1.883-1(c)(2) . . . .

Part II Stock Ownership Test for Publicly-Traded Corporations

6 Enter the name of the country in which the stock is primarily traded ▶

7 Enter the name of the securities market(s) on which the stock is listed ▶

8 Enter a description of each class of stock relied on to meet the “regularly traded test” of Regulations section 1.883-2(d) (see 

instructions for description requirements) ▶

9 Do one or more 5% shareholders (see instructions for definition) own in the aggregate 50% or more 

of the vote and value of the outstanding shares of any class of stock for more than half the number of days during 

the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

If “Yes,” complete line 10.

If “No,” skip line 10.

For Paperwork Reduction Act Notice, see the Instructions for Form 1120-F. Cat. No. 50766D Schedule S (Form 1120-F) 2012

▶ Information about Schedule S (Form 1120-F) and its separate instructions is at www.irs.gov/form1120f.
Schedule S (Form 1120-F) 2012 Page 2 

10 For each class of stock relied on to meet the “regularly traded test” of Regulations section 1.883-2(d), indicate:

a (i) The days during the tax year of the corporation in which the class of stock was closely held, without regard to the 

exception in Regulations section 1.883-2(d)(3)(ii) ▶

(ii) The total percentage of the vote and value of the class of stock that is owned by 5% shareholders during 

such days ▶ %

b 

 

For all qualified shareholders on which the corporation intends to rely to satisfy the closely-held exception test of

Regulations section 1.883-2(d)(3)(ii), and who own stock in the closely-held block (directly, indirectly, or by applying the

attribution rules of Regulations section 1.883-4(c)), enter:

(i) The total number of qualified shareholders, as defined in Regulations section 1.883-4(b)(1) ▶

(ii) The total percentage of the value of the shares of the class of stock owned, directly or indirectly, by such qualified 

shareholders by country of residence (see instructions):

Country code (see instructions) Percentage

(iii) The days during the tax year of the corporation that such qualified shareholders owned, directly or indirectly, their shares in 

the closely-held block of stock ▶

Part III Stock Ownership Test for Controlled Foreign Corporations (CFC)

11 a Enter the percentage of the value of all outstanding shares of the CFC that is owned by all “qualified U.S. persons” identified in 

the qualified ownership statements required under Regulations section 1.883-3(c)(2), applying the attribution of ownership rules 

of Regulations section 1.883-3(b)(4) ▶ %

b Enter the percentage of the value of all outstanding shares of the CFC that is owned by the “qualified U.S. persons” referred to 

on line 11a above as bearer shares maintained in a dematerialized or immobilized book-entry system ▶ %

12 Enter the period during which such qualified U.S. persons held such stock (see instructions) ▶

13 Enter the period during which the foreign corporation was a CFC (see instructions) ▶

14 Is the CFC directly held by qualified U.S. persons? . . . . . . . . . . . . . . . . . . . Yes No

Part IV Qualified Shareholder Stock Ownership Test

15 Check the box if more than 50% of the value of the outstanding shares of the corporation is owned (or treated as owned by

reason of Regulations section 1.883-4(c)) by qualified shareholders for each category of income for which the exemption is 

claimed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16 With respect to all qualified shareholders relied on to satisfy the 50% ownership test of Regulations section 1.883-4(a):

a Enter the total number of such qualified shareholders as defined in Regulations section 1.883-4(b)(1) ▶

b Enter the total percentage of the value of the outstanding shares owned, applying the attribution rules of Regulations section 

1.883-4(c), by such qualified shareholders by country of residence or organization, whichever is applicable:

Country code (see instructions) Percentage

Total

c Enter the percentage of the value of the outstanding shares that is owned by the qualified shareholders as bearer shares 

maintained in a dematerialized or immobilized book-entry system ▶ %

d Enter the period during the tax year of the foreign corporation that such stock was held by qualified shareholders ▶

Schedule S (Form 1120-F) 2012