Form 5472 Example: A Completed Sample With the Pro Forma 1120

A completed Form 5472 for a foreign-owned single-member LLC is the three-page IRS form plus a Part V statement, attached to a pro forma Form 1120. Most boxes stay blank. The sample below uses an invented Wyoming LLC, Sample Widget Studio LLC, owned by an invented UK resident, Alex Sample.

Download the watermarked sample package (PDF): cover letter, pro forma Form 1120, Form 5472 and the Part V statement, produced by the same generator that builds customer packages and stamped SAMPLE – NOT FOR FILING on every page. Identifying numbers are placeholders such as XX-XXXXXXX.

The top of Form 5472 records the reporting corporation's tax year. A foreign-owned US disregarded entity uses its owner's US tax year or, if the owner has none, the calendar year, so the sample enters 1 January 2025 to 31 December 2025. The form's note requires English entries and US-dollar amounts.

Part I identifies the reporting corporation, which for a foreign-owned disregarded entity is the LLC itself, not its owner. Use the LLC's legal name, EIN and US address exactly as the IRS has them. The instructions tell domestic filers to take total assets from Form 1120, item D.

Line 1o must list the actual countries where business is conducted; the instructions say not to enter "worldwide". The sample enters the United States on line 1n, as our package generator does for a US-formed LLC, and on line 1o because the invented LLC conducts its business there. Codes for line 1e come from the principal business activity list in the Form 1120 instructions.

Line 1f totals the foreign related-party transactions on this form, and for a foreign-owned disregarded entity that total includes Part V. The sample's $10,000 contribution plus $4,000 distribution gives $14,000. Line 3 is the box that identifies the filer as a foreign-owned U.S. DE.

With one related party, one Form 5472 is filed, so lines 1f and 1h match. Line 1j stays unchecked because the invented LLC first filed for 2024. Line 2 is checked because a foreign person owns 100%. Line 1k is 0 because there is no cost sharing arrangement, so no Part VIII is attached.

Part II names the 25% foreign shareholder, and for a foreign-owned disregarded entity the instructions say to report the foreign owner there. A reference ID is required only when no US identifying number is entered, and a DE must enter the owner's FTIN, or "None" or "N/A" if there is none.

Reference IDs are self-assigned: alphanumeric, no spaces or special characters, at most 50 characters, and used consistently every year. The sample's SAMPLEOWNER01 follows those rules, and the FTIN is a placeholder. Lines 5a to 7e stay blank because there is one direct owner and no indirect owner.

All filers complete Part III, even when the related party is already listed in Part II. In the sample the related party is Alex Sample again, so line 8a repeats the owner's name and address, the foreign person box is checked, and line 8e marks the 25% foreign shareholder.

A separate Form 5472 is filed for each related party with which the LLC had a reportable transaction, and line 1g counts those forms. If the owner's other company had also paid the LLC, that company would need its own Form 5472.

Part IV lists monetary transactions by category, such as sales, rents, royalties, services, loans and interest, and must be completed when the related party is a foreign person. The sample owner sold nothing to the LLC, lent nothing and charged no fees, so lines 22 and 36 show zero.

If the owner had lent money to the LLC, the balance would go on line 17 (amounts borrowed) and any interest on line 32. A payment by the LLC for the owner's services would go on line 29. Amounts are stated in US dollars with a schedule of the exchange rates used, and an amount of $50,000 or less may be reported as "$50,000 or less".

Part V is the part written for foreign-owned DEs. Check its box and attach a statement describing other transactions under Treas. Reg. §1.482-1(i)(7), including amounts paid or received on formation, dissolution, acquisition and disposition, and contributions to and distributions from the entity.

The sample statement lists each transaction with its date, description and US-dollar amount, and its total ties to line 1f. A longer worked version with more transaction types is in the Part V statement example.

Part VII applies to every filer, so the sample answers its questions rather than skipping them. Parts VI, VIII and IX describe transactions the sample LLC did not have, so they stay blank, and the instructions tell a foreign-owned DE not to complete lines 43a and 43b.

Only the name and address of the foreign-owned DE and items B and E on page 1 are required, and "Foreign-owned U.S. DE" is written across the top. The income, deduction and tax lines stay blank because a foreign-owned DE has no income tax return filing requirement of its own.

Item E has four boxes: initial return, final return, name change and address change. None applies to the sample year. Items C and D are not on the required list; our generator mirrors them from Form 5472 lines 1m and 1c so the two forms agree. Signing the page 1 block is covered in how to sign the pro forma 1120.

The package is assembled in a fixed order and sent by fax or mail, because a foreign-owned U.S. DE cannot file Form 5472 electronically.

1. Put a short cover letter first that names the LLC, its EIN and the tax year (our packages include one; the IRS does not prescribe it).
2. Place the pro forma Form 1120 next, with "Foreign-owned U.S. DE" across the top.
3. Attach all three pages of Form 5472 behind the Form 1120.
4. Attach the Part V statement, plus an exchange-rate schedule if Part IV amounts were converted.
5. Fax at 300 DPI or higher to the IRS at 855-887-7737, or mail to Internal Revenue Service, 1973 Rulon White Blvd, M/S 6112, Attn: PIN Unit, Ogden, UT 84201.
6. Keep the complete package and the fax or mailing record together.

Yes. Form5472 Prep prepares the pro forma Form 1120, Form 5472 and Part V statement from your answers, then faxes the package to the IRS and sends you the transmission record. Every filing is reviewed by a qualified accountant before it is submitted. See the Form 5472 filing service.

For the line-by-line rules behind this sample, read the plain-English Form 5472 instructions.