OMB No. 1545-0126 U.S. Income Tax Return of a Foreign Corporation

Name Employer identification number

Number, street, and room or suite no. (see page 7 of instructions) Check applicable boxes:

Initial return Name change

City or town, state and ZIP code, or country (see page 7 of instructions) Final return Address change

A Country of incorporation

Foreign country under whose laws the income reported on this return

is subject to tax

B

Yes No

C Date incorporated

Location of corporation’s primary books and records (city, province or

state, and country)

D

Did the corporation file a U.S. income tax return

for the preceding tax year?

H

If the corporation had an agent in the United States at any time during

the tax year, enter:

E

Kind of agent

At any time during the tax year, was the corporation

engaged in a trade or business in the United States?

I

Name

Address

At any time during the tax year, did the corporation

have a permanent establishment in the United

States for purposes of applying section 894(b) and

any applicable tax treaty between the United

States and a foreign country?

J

If “Yes,” enter the name of the foreign country:

Computation of Tax Due or Overpayment

1 Tax from Section I, line 11, page 2 1

2 Tax from Section II, Schedule J, line 10, page 4 2

3 Tax from Section III (add lines 6 and 10 on page 5) 3

4 Personal holding company tax (attach Schedule PH (Form 1120))—see page 7 of instructions 4

5 Total tax. Add lines 1 through 4 5

6 Payments:

a 2003 overpayment credited to 2004 6a

b 2004 estimated tax payments 6b

c Less 2004 refund applied for on Form 4466 6c ( ) Bal  6d

e Tax deposited with Form 7004 6e

Credit for tax paid on undistributed capital gains (attach Form 2439) 6f f

Credit for Federal tax on fuels (attach Form 4136). See instructions 6g g

U.S. income tax paid or withheld at source (add line 12, page 2, and amounts

from Forms 8288-A and 8805 (attach Forms 8288-A and 8805))

h

6h

Total payments. Add lines 6d through 6h 6i i

7 Estimated tax penalty (see page 8 of instructions). Check if Form 2220 is attached  7

8 Tax due. If line 6i is smaller than the total of lines 5 and 7, enter amount owed 8

9 Overpayment. If line 6i is larger than the total of lines 5 and 7, enter amount overpaid 9

10 Enter amount of line 9 you want: Credited to 2005 estimated tax  Refunded  10

Form 1120-F

For calendar year 2004, or tax year beginning , 2004, and ending , 20 Department of the Treasury

Internal Revenue Service  Instructions are separate.

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,

correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Sign

Here

Signature of officer Date Title

Date Preparer’s SSN or PTIN Preparer’s

signature

Check if

self-employed

Paid

Preparer’s

Use Only

Firm’s name (or

yours if self-employed),

address, and ZIP code

EIN

Phone no. ( )

Cat. No. 11470I Form 1120-F (2004)

F See page 22 of the instructions and enter the corporation’s principal:

(1) Business activity code number 

(2) Business activity 

(3) Product or service 

Check method of accounting: (1) Cash (2) Accrual

(3) Other (specify) 

G

Is the corporation a foreign personal holding

company? (See section 552 for definition.)

K

If “Yes,” has Form 5471 been filed? (Sec. 6035)

Did the corporation have any transactions with

related parties?

L

If “Yes,” Form 5472 may have to be filed (section 6038A

and section 6038C). (See page 4 of the instructions.)

Enter number of Forms 5472 attached  

Principal location of business

If the corporation maintains an office or place of business in the

United States, check here 

Amended return

Yes No

May the IRS discuss this return

with the preparer shown below  (see page 4 of instructions)?







For Privacy Act and Paperwork Reduction Act Notice, see page 21 of the instructions.

Use

IRS

label.

Otherwise,

print or

type.

Note: Additional information is required at the bottom of pages 2

and 5.

2004
Form 1120-F (2004) Page 2

SECTION I— Income From U.S. Sources Not Effectively Connected With the Conduct of a Trade or Business in

the United States (See page 8 of instructions.)

If you are required to complete Section II or are using Form 1120-F as a claim for refund of tax withheld at source, include below all income from

U.S. sources that is not effectively connected with the conduct of a trade or business in the United States. Otherwise, include only those items of

income on which the U.S. income tax was not fully paid at the source. The rate of tax on each item of gross income listed below is 30% (4% for

the gross transportation tax) or such lower rate specified by tax treaty. No deductions are allowed against these types of income. Fill in treaty rates

where applicable. If the corporation is claiming a lower treaty rate, also complete Item W on page 5.

Name of treaty country, if any 

(e)

Amount of U.S. income tax

paid or withheld at the source

(a)

Nature of income

(b)

Gross income

(c)

Rate of tax (%)

(d)

Amount of tax

1 Interest

2 Dividends

3 Rents

4 Royalties

5 Annuities

6 Gains from disposal of timber, coal, or

domestic iron ore with a retained

economic interest (attach supporting

schedule)

7 Gains from sale or exchange of

patents, copyrights, etc.

8 Fiduciary distributions (attach

supporting schedule)

Gross transportation income (see

page 8 of instructions)

9

4

Other fixed or determinable annual or

periodic gains, profits, and income

10

11 Total. Enter here and on line 1, page 1 

12 Total. Enter here and include on line 6h, page 1 

Enter the available NOL carryover from prior tax years.

(Do not reduce it by any deduction on line 30a,

page 3.)  $

S

At the end of the tax year, did any individual,

partnership, corporation, estate, or trust own, directly

or indirectly, 50% or more of the corporation’s voting

stock? (See section 267(c) for rules of attribution.)

T

At the end of the tax year, did the corporation own,

directly or indirectly, 50% or more of the voting stock

of a U.S. corporation? (See section 267(c) for rules of

attribution.)

Q

If “Yes,” attach a schedule showing (1) name and

employer identification number (EIN) of such U.S.

corporation; (2) percentage owned; and (3) taxable

income or (loss) before NOL and special deductions

of such U.S. corporation for the tax year ending with

or within your tax year.

Enter percentage owned 

If “Yes,” attach a schedule showing the name and

identifying number. (Do not include any information

already entered in item T above.)

Additional Information Required (continued from page 1)

Yes No Yes No

Enter tax-exempt interest received or accrued during

the tax year (see instructions)  $

P

Is the corporation a personal holding company? (See

section 542 for definition.)

M

Is the corporation a controlled foreign corporation?

(See section 957(a) for definition.)

N

O Is the corporation a personal service corporation? (See

page 8 of instructions for definition.) Is the corporation a subsidiary in a parent-subsidiary

controlled group?

If “Yes,” enter the name and EIN of the parent

corporation  

U

Form 1120-F (2004)

If the corporation has a net operating loss (NOL) for

the tax year and is electing to forego the carryback

period, check here 

R

Note: Additional information is required at the bottom of page 5.
SECTION II—Income Effectively Connected With the Conduct of a Trade or Business in the United States

(See page 9 of the instructions.)

Important: Fill in all applicable lines and schedules. If you need more space, see Assembling the Return on page 4 of instructions.

1a Gross receipts or sales b Less returns and allowances c Bal  1c

2 Cost of goods sold (Schedule A, line 8) 2

3 Gross profit (subtract line 2 from line 1c) 3

4 Dividends (Schedule C, line 14) 4

5 Interest 5

6 Gross rents 6

Income

7 Gross royalties 7

8 Capital gain net income (attach Schedule D (Form 1120)) 8

9 Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) 9

10 Other income (see page 10 of instructions—attach schedule) 10

11 Total income. Add lines 3 through 10  11

12 Compensation of officers (Schedule E, line 4). Deduct only amounts connected with a U.S. business 12

13 13

14 Repairs and maintenance 14

15 Bad debts 15

16 Rents 16

17 Taxes and licenses 17

18 Interest allowable under Regulations section 1.882-5 (see page 12 of instructions—attach schedule) 18

19 Charitable contributions (see page 13 of instructions for 10% limitation) 19

20 Depreciation (attach Form 4562) 20

21 Less depreciation claimed on Schedule A and elsewhere on return 21

22 Balance (subtract line 21 from line 20) 22

23 Depletion 23

24 Advertising 24

25 Pension, profit-sharing, etc., plans 25

26 Employee benefit programs 26

27 Other deductions (attach schedule) 27

28 Total deductions. Add lines 12 through 27  28

29 Taxable income before NOL deduction and special deductions (subtract line 28 from line 11) 29

30 Less: a Net operating loss deduction (see page 14 of instructions) 30a

Deductions (See instructions for limitations on deductions.)

b Special deductions (Schedule C, line 15) 30b 30c

31 Taxable income or (loss). Subtract line 30c from line 29 31

Cost of Goods Sold (See instructions on page 15.)

1 Inventory at beginning of year 1

2 Purchases 2

3 Cost of labor 3

4 Additional section 263A costs (attach schedule) 4

Other costs (attach schedule) 5

Add lines 1 through 5

5

6 6

Inventory at end of year 7

Cost of goods sold. Subtract line 7 from line 6. Enter here and on Section II, line 2 above

7

9a Check all methods used for valuing closing inventory:

Cost as described in Regulations section 1.471-3

Lower of cost or market as described in Regulations section 1.471-4

Other (Specify method used and attach explanation.) 

c Check if the LIFO inventory method was adopted this tax year for any goods 

If checked, attach Form 970.

d If the LIFO inventory method was used for this tax year, enter percentage (or amounts) of closing

inventory computed under LIFO 9d

e If property is produced or acquired for resale, do the rules of section 263A apply to the corporation? Yes No

f Was there any change in determining quantities, cost, or valuations between opening and closing inventory?

If “Yes,” attach explanation.

Form 1120-F (2004) Page 3

Yes No

Schedule A

8 8

Salaries and wages (less employment credits)

b Check if there was a writedown of subnormal goods as described in Regulations section 1.471-2(c) 

(1)

(2)

(3)

Form 1120-F (2004)
Dividends and Special Deductions (See page 15 of instructions.)

(a) Dividends

received

(c) Special deductions:

(a)  (b) (b) %

Dividends from less-than-20%-owned domestic corporations that are

subject to the 70% deduction (other than debt-financed stock)

1

70

Dividends from 20%-or-more-owned domestic corporations that are

subject to the 80% deduction (other than debt-financed stock)

2

80

see

3 Dividends on debt-financed stock of domestic and foreign corporations (section 246A) instructions

4 Dividends on certain preferred stock of less-than-20%-owned public utilities 42

5 Dividends on certain preferred stock of 20%-or-more-owned public utilities 48

Dividends from less-than-20%-owned foreign corporations that are

subject to the 70% deduction

6

70

Dividends from 20%-or-more-owned foreign corporations that are subject

to the 80% deduction

7

80

8 Total. Add lines 1 through 7. See page 16 of instructions for limitation

9 0ther dividends from foreign corporations not included on lines 3, 6, or 7

10 Foreign dividend gross-up (section 78)

11 IC-DISC and former DISC dividends not included on lines 1, 2, or 3 (section 246(d))

12 Other dividends

13 Deduction for dividends paid on certain preferred stock of public utilities

14 Total dividends. Add lines 1 through 12. Enter here and on line 4, page 3

15 Total special deductions. Add lines 8 and 13. Enter here and on line 30b, page 3 

Compensation of Officers (See instructions for line 12 on page 12 of instructions.)

Percent of corporation

stock owned (c) Percent of

time devoted

to business

(f) Amount of

compensation

(b) Social security

number (a) Name of officer

(d) Common (e) Preferred

1 % % %

% % %

% % %

% % %

% % %

2 Total compensation of officers

3 Compensation of officers claimed on Schedule A and elsewhere on this return

4 Subtract line 3 from line 2. Enter the result here and on line 12, page 3

Tax Computation (See page 16 of instructions.)

1 Check if the corporation is a member of a controlled group (see sections 1561 and 1563) 

If the box on line 1 is checked, enter the corporation’s share of the $50,000, $25,000, and

$9,925,000 taxable income bracket amounts (in that order):

2a

(1) $ (2)

b Enter the corporation’s share of:

3 3

6a Foreign tax credit (attach Form 1118) 6a

6b

b

6c

c General business credit. Check box(es) and indicate which forms

are attached: Form 3800 Form(s) (specify) 

d Credit for prior year minimum tax (attach Form 8827) 6d

7 Total credits. Add lines 6a through 6e 7

8 Subtract line 7 from line 5 8

9

9 Other taxes. Check if from:

4 Alternative minimum tax (attach Form 4626) 4

e Qualified zone academy bond credit (attach Form 8860) 6e

Form 1120-F (2004) Page 4

Schedule J

Schedule E

Schedule C

Income tax. Check if a qualified personal service corporation (see instructions) 

Nonconventional source fuel credit

QEV credit (attach Form 8834)

Check:

$ (3) $

(1)

(2)

Additional 5% tax (not more than $11,750)

Additional 3% tax (not more than $100,000)

$

$

Important: Members of a controlled group, see instructions.

5 Add lines 3 and 4 5

10 Total tax. Add lines 8 and 9. Enter here and on line 2, page 1 10

Form 1120-F (2004)

Form 4255 Form 8611 Form 8697

Form 8866 Other (attach schedule)

Note: Complete Schedule E only if total receipts (line 1a plus lines 4 through 10 of Section II) are

$500,000 or more.
SECTION III—Branch Profits Tax and Tax on Excess Interest

Part I—Branch Profits Tax (See page 19 of instructions.)

1 Enter the amount from Section II, line 29 1

2 Enter total adjustments to line 1 to get effectively connected earnings and profits. (Attach a

schedule showing the nature and amount of adjustments.) (See instructions.) 2

3 Effectively connected earnings and profits. Combine line 1 and line 2 3

4a Enter U.S. net equity at the end of the current tax year. (Attach schedule.) 4a

b Enter U.S. net equity at the end of the prior tax year. (Attach schedule.) 4b

Increase in U.S. net equity. If line 4a is greater than or equal to line 4b, subtract line 4b from

line 4a. Enter the result here and skip to line 4e

c

4c

d Decrease in U.S. net equity. If line 4b is greater than line 4a, subtract line 4a from line 4b 4d

e Non-previously taxed accumulated effectively connected earnings and profits. Enter excess,

if any, of effectively connected earnings and profits for preceding tax years beginning after

1986 over any dividend equivalent amounts for those tax years 4e

5 Dividend equivalent amount. Subtract line 4c from line 3. If zero or less, enter -0-. If no amount

is entered on line 4c, add the lesser of line 4d or line 4e to line 3 and enter the total here

Branch profits tax. Multiply line 5 by 30% (or lower treaty rate if the corporation is a qualified

resident or otherwise qualifies for treaty benefits). Enter here and include on line 3, page 1.

(See instructions.) Also complete Items W and X below

6

6

Part II—Tax on Excess Interest (See page 19 of instructions.)

7a Enter the interest from Section II, line 18

7c

Enter the branch interest (including capitalized and other nondeductible interest). (See

instructions for definition.) If the interest paid by the foreign corporation’s U.S. trade or business

was increased because 80% or more of the foreign corporation’s assets are U.S. assets, check

this box 

8

8

9a Excess interest. Subtract line 8 from line 7c. If zero or less, enter -0- 9a

b If the foreign corporation is a bank, enter the excess interest treated as interest on deposits.

Otherwise, enter -0-. (See instructions.) 9b

c Subtract line 9b from line 9a 9c

10 Tax on excess interest. Multiply line 9c by 30% or lower treaty rate (if the corporation is a

qualified resident or otherwise qualifies for treaty benefits). (See instructions.) Enter here and

include on line 3, page 1. Also complete Items W and X below 10

Additional Information Required (continued from page 2)

Is the corporation claiming a reduction in, or

exemption from, the branch profits tax due to:

V

Form 1120-F (2004) Page 5

5

If the corporation is claiming it is a qualified resident of its

country of residence for purposes of computing its branch

profits tax and excess interest tax (see page 20 of

instructions), check the basis for that claim:

X Yes No

Stock ownership and base erosion test

Publicly traded test

Active trade or business test

Private letter ruling

b Enter the interest apportioned to the effectively connected income of the foreign corporation

that is capitalized or otherwise nondeductible

7a

7b

c Add lines 7a and 7b

A complete termination of all U.S. trades or

businesses?

The tax-free liquidation or reorganization of

a foreign corporation?

The tax-free incorporation of a U.S. trade or

business?

(1)

(2)

(3)

If (1) applies or (2) applies and the transferee is

domestic, attach Form 8848. If (3) applies, attach

the statement required by Regulations section

1.884-2T(d)(5).

If “Yes,” complete and attach Form 8833.

Is the corporation taking a position on this return

that a U.S. tax treaty overrules or modifies an

Internal Revenue law of the United States

thereby causing a reduction of tax?

W

Note: Failure to disclose a treaty-based return

position may result in a $10,000 penalty (see

section 6712).

Form 1120-F (2004)

During the tax year, did the corporation own any

foreign entity that was disregarded as an entity

separate from its owner under Regulations

sections 301.7701-2 and 301.7701-3? If “Yes,”

attach a statement listing the name, country

under whose laws the entity was organized, and

EIN (if any) of each such entity

Y

Yes No

Z During the tax year, did the corporation own at

least a 10% interest, directly or indirectly, in any

foreign partnership? If “Yes,” see page 20 of

instructions for required attachment
Additional schedules to be completed for Section II or Section III (See page 20 of instructions.)

Balance Sheets per Books Beginning of tax year End of tax year

(a) (b) (c) (d) Assets

1 Cash

2a Trade notes and accounts receivable

( ) ) b Less allowance for bad debts

3 Inventories

4 U.S. government obligations

5 Tax-exempt securities (see instructions)

6 Other current assets (attach schedule)

7 Loans to shareholders

8 Mortgage and real estate loans

9 Other investments (attach schedule)

10a Buildings and other depreciable assets

( ) ( ) b Less accumulated depreciation

11a Depletable assets

( ) ( ) b Less accumulated depletion

12 Land (net of any amortization)

13a Intangible assets (amortizable only)

( ) ( ) b Less accumulated amortization

14 Other assets (attach schedule)

15 Total assets

Liabilities and Shareholders’ Equity

16 Accounts payable

17 Mtges., notes, bonds payable in less than 1 year

18 Other current liabilities (attach schedule)

19 Loans from shareholders

20 Mtges., notes, bonds payable in 1 year or more

21 Other liabilities (attach schedule)

22 Capital stock: a Preferred stock

b Common stock

23 Additional paid-in capital

24 Retained earnings—Appropriated (attach schedule)

25 Retained earnings—Unappropriated

( ) ( 27 Less cost of treasury stock

28 Total liabilities and shareholders’ equity

Reconciliation of Income (Loss) per Books With Income per Return

1 Net income (loss) per books Income recorded on books this year

not included on this return (itemize):

7

2 Federal income tax per books

3 Excess of capital losses over capital gains a Tax-exempt interest $

Income subject to tax not recorded on

books this year (itemize):

4

8 Deductions on this return not charged

against book income this year (itemize):

Expenses recorded on books this year

not deducted on this return (itemize):

5 a Depreciation

b

a

Charitable contributions

Depreciation

b Charitable contributions $

c Travel and entertainment $

9 Add lines 7 and 8

Income (line 29, page 3)—line 6 less 

line 9

10

6 Add lines 1 through 5

Analysis of Unappropriated Retained Earnings per Books (Schedule L, line 25)

1 Balance at beginning of year 5 Distributions: a Cash

2 Net income (loss) per books b Stock

3 Other increases (itemize): c Property

6 Other decreases (itemize):

7 Add lines 5a through 6

4 Add lines 1, 2, and 3 8 Balance at end of year (line 4 less line 7)

Form 1120-F (2004) Page 6

Schedule M-2

Schedule M-1

Schedule L

$

$

$

(

Note: The corporation is not required to complete Schedules M-1 and M-2 below if the total assets on Schedule L, line 15, column (d) are less than $25,000.

26 Adjustments to shareholders’ equity (attach schedule)

)

Form 1120-F (2004)