Form 5472

(Rev. December 2012) 

Department of the Treasury 

Internal Revenue Service 

Information Return of a 25% Foreign-Owned U.S. Corporation or a 

Foreign Corporation Engaged in a U.S. Trade or Business 

(Under Sections 6038A and 6038C of the Internal Revenue Code)

▶ Information about Form 5472 and its separate instructions is at www.irs.gov/form5472.

For tax year of the reporting corporation beginning , , and ending , 

Note. Enter all information in English and money items in U.S. dollars. 

OMB No. 1545-0805 

Part I Reporting Corporation (see instructions). All reporting corporations must complete Part I. 

1a Name of reporting corporation 1b Employer identification number 

Number, street, and room or suite no. (if a P.O. box, see instructions) 

City or town, state, and ZIP code (if a foreign address, see instructions) 

1c Total assets 

$ 

1d Principal business activity ▶ 1e Principal business activity code ▶

1f Total value of gross payments made or received 

(see instructions) reported on this Form 5472 

$ 

1g Total number of Forms 5472 

filed for the tax year 

1h Total value of gross payments made or received (see 

instructions) reported on all Forms 5472 

$ 

1i Check here if this is a 

consolidated filing of 

Form 5472 ▶

1j Country of 

incorporation 

1k Country(ies) under whose laws the reporting 

corporation files an income tax return as a resident 

1l Principal country(ies) where 

business is conducted 

2 Check here if, at any time during the tax year, any foreign person owned, directly or indirectly, at least 50% of (a) the total voting power of all 

classes of the stock of the reporting corporation entitled to vote, or (b) the total value of all classes of stock of the reporting corporation ▶

Part II 25% Foreign Shareholder (see instructions) 

1a Name and address of direct 25% foreign shareholder 1b(1) U.S. identifying number, if any 

1b(2) Reference ID number (see 

instructions)

1c Principal country(ies) where 

business is conducted 

1d Country of citizenship, 

organization, or incorporation 

1e Country(ies) under whose laws the direct 25% foreign shareholder 

files an income tax return as a resident 

2a Name and address of direct 25% foreign shareholder 2b(1) U.S. identifying number, if any 

2b(2) Reference ID number (see 

instructions)

2c Principal country(ies) where 

business is conducted 

2d Country of citizenship, 

organization, or incorporation 

2e Country(ies) under whose laws the direct 25% foreign shareholder 

files an income tax return as a resident 

3a Name and address of ultimate indirect 25% foreign shareholder 3b(1) U.S. identifying number, if any 

3b(2) Reference ID number (see 

instructions)

3c Principal country(ies) where 

business is conducted 

3d Country of citizenship, 

organization, or incorporation 

3e Country(ies) under whose laws the ultimate indirect 25% foreign 

shareholder files an income tax return as a resident 

4a Name and address of ultimate indirect 25% foreign shareholder 4b(1) U.S. identifying number, if any 

4b(2) Reference ID number (see 

instructions)

4c Principal country(ies) where 

business is conducted 

4d Country of citizenship, 

organization, or incorporation 

4e Country(ies) under whose laws the ultimate indirect 25% foreign 

shareholder files an income tax return as a resident 

For Paperwork Reduction Act Notice, see instructions. Cat. No. 49987Y Form 5472 (Rev. 12-2012) 
Form 5472 (Rev. 12-2012) Page 2 

Part III Related Party (see instructions) 

Check applicable box: Is the related party a foreign person or U.S. person?

All reporting corporations must complete this question and the rest of Part III. 

1a Name and address of related party 1b(1) U.S. identifying number, if any 

1b(2) Reference ID number (see 

instructions)

1c Principal business activity ▶ 1d Principal business activity code ▶

1e Relationship—Check boxes that apply: Related to reporting corporation Related to 25% foreign shareholder 25% foreign shareholder

1f Principal country(ies) where business is conducted 1g Country(ies) under whose laws the related party files an income tax return as a 

resident 

Part IV Monetary Transactions Between Reporting Corporations and Foreign Related Party (see instructions) 

Caution: Part IV must be completed if the “foreign person” box is checked in the heading for Part III. 

If estimates are used, check here ▶

1 Sales of stock in trade (inventory) . . . . . . . . . . . . . . . . . . . . . . . . 1 

2 Sales of tangible property other than stock in trade . . . . . . . . . . . . . . . . . . . 2 

3 Platform contribution transaction payments received . . . . . . . . . . . . . . . . . . 3

4 Cost sharing transaction payments received . . . . . . . . . . . . . . . . . . . . . 4

5a Rents received (for other than intangible property rights) . . . . . . . . . . . . . . . . . 5a 

b Royalties received (for other than intangible property rights) . . . . . . . . . . . . . . . . 5b 

6 Sales, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas) . . . . 6

7 Consideration received for technical, managerial, engineering, construction, scientific, or like services . . . . 7

8 Commissions received . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

9 Amounts borrowed (see instructions) a Beginning balance b Ending balance or monthly average ▶ 9b 

10 Interest received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Premiums received for insurance or reinsurance . . . . . . . . . . . . . . . . . . . . 11

12 Other amounts received (see instructions) . . . . . . . . . . . . . . . . . . . . . . 12 

13 Total. Combine amounts on lines 1 through 12 . . . . . . . . . . . . . . . . . . . . 13 

14 Purchases of stock in trade (inventory) . . . . . . . . . . . . . . . . . . . . . . . 14

15 Purchases of tangible property other than stock in trade . . . . . . . . . . . . . . . . . 15

16 Platform contribution transaction payments paid . . . . . . . . . . . . . . . . . . . . 16

17 Cost sharing transaction payments paid . . . . . . . . . . . . . . . . . . . . . . 17

18 a Rents paid (for other than intangible property rights) . . . . . . . . . . . . . . . . . . . 18a 

b Royalties paid (for other than intangible property rights) . . . . . . . . . . . . . . . . . . 18b 

19 Purchases, leases, licenses, etc., of intangible property rights (e.g., patents, trademarks, secret formulas) . . . 19

20 Consideration paid for technical, managerial, engineering, construction, scientific, or like services . . . . . 20

21 Commissions paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

22 Amounts loaned (see instructions) a Beginning balance b Ending balance or monthly average ▶ 22b 

23 Interest paid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

24 Premiums paid for insurance or reinsurance . . . . . . . . . . . . . . . . . . . . . 24

25 Other amounts paid (see instructions) . . . . . . . . . . . . . . . . . . . . . . . 25

26 Total. Combine amounts on lines 14 through 25 . . . . . . . . . . . . . . . . . . . 26 

Part V Nonmonetary and Less-Than-Full Consideration Transactions Between the Reporting Corporation and 

the Foreign Related Party (see instructions) 

Describe these transactions on an attached separate sheet and check here. ▶

Part VI Additional Information 

All reporting corporations must complete Part VI. 

1 Does the reporting corporation import goods from a foreign related party? . . . . . . . . . . . . . . Yes No

2 a If “Yes,” is the basis or inventory cost of the goods valued at greater than the customs value of the imported goods? Yes No

If “No,” do not complete b and c below. 

b If “Yes,” attach a statement explaining the reason or reasons for such difference. 

c If the answers to questions 1 and 2a are “Yes,” were the documents used to support this treatment of the imported 

goods in existence and available in the United States at the time of filing Form 5472? . . . . . . . . . . . Yes No

3 During the tax year, was the foreign parent corporation a participant in any cost sharing arrangement? . . . . . . Yes No

4 During the course of the tax year, did the foreign parent corporation become a participant in any cost sharing 

arrangement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

Form 5472 (Rev. 12-2012)