Information Return of a 25% Foreign-Owned U.S. Corporation or a Foreign Corporation Engaged in a U.S. Trade or Business

• Legal Form Number: 5472
• Year: 2023
• Issuer: Treasury Department
• Section: Treasury Department

Form 5472

(Rev. December 2023)

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)

Go to www.irs.gov/Form5472 for instructions and the latest information.

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. 1545-0123

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

1a Name of reporting corporation

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.)

1b Employer identification number

1c Total assets

$

1d Principal business activity 1e Principal business activity code

1f Total value of gross payments made or received

reported on this Form 5472. See instructions.

$

1g Total number of Forms 5472

filed for the tax year

1h Total value of gross payments made or received

reported on all Forms 5472. See instructions.

$

1i Check here if this is a

consolidated filing of

Form 5472 . .

1j Check here if this is the initial year for

which the U.S. reporting corporation

is filing a Form 5472 . . . .

1k Total number of Parts VIII

attached to Form 5472

1l Country of incorporation

1

m

Date of incorporation 1n Country(ies) under whose laws the reporting

corporation files an income tax return as a resident

1o 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 .

3 Check here if the reporting corporation is a foreign-owned domestic disregarded entity (foreign-owned U.S. DE) treated as a corporation for

purposes of section 6038A. See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part II 25% Foreign Shareholder (see instructions)

Check here if any direct (or ultimate indirect) 25% foreign shareholder listed in Part II is a surrogate foreign

corporation under section 7874(a)(2)(B).

4a Name and address of direct 25% foreign shareholder

4b(1) U.S. identifying number, if any 4b(2) Reference ID number (see instructions) 4b(3) Foreign taxpayer identification number (FTIN), if any

(see instructions)

4c Principal country(ies) where

business is conducted

4d Country of citizenship,

organization, or incorporation

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

shareholder files an income tax return as a resident

5a Name and address of direct 25% foreign shareholder

5b(1) U.S. identifying number, if any 5b(2)

Reference ID number (see instructions)

5b(3) FTIN, if any (see instructions)

5c Principal country(ies) where

business is conducted

5d Country of citizenship,

organization, or incorporation

5e Country(ies) under whose laws the direct 25% foreign

shareholder files an income tax return as a resident

6a Name and address of ultimate indirect 25% foreign shareholder

6b(1) U.S. identifying number, if any 6b(2)

Reference ID number (see instructions)

6b(3) FTIN, if any (see instructions)

6c Principal country(ies) where

business is conducted

6d Country of citizenship,

organization, or incorporation

6e Country(ies) under whose laws the ultimate indirect 25% foreign

shareholder files an income tax return as a resident

7a Name and address of ultimate indirect 25% foreign shareholder

7b(1) U.S. identifying number, if any 7b(2)

Reference ID number (see instructions)

7b(3) FTIN, if any (see instructions)

7c Principal country(ies) where

business is conducted

7d Country of citizenship,

organization, or incorporation

7e 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. 12-2023)