SCHEDULE Q                             Borrower’s Certificate of Compliance 
(Form 1120-IC-DISC)
(Rev. September 2016)                  With the Rules for Producer’s Loans                                                        OMB No. 1545-0123
                                                               ▶
Department of the Treasury                                       Attach to Form 1120-IC-DISC.
Internal Revenue Service     ▶ Information about Form 1120-IC-DISC and its separate instructions is at www.irs.gov/form1120icdisc.

For tax year beginning                                                                     and ending
Name of IC-DISC                                                                                           Employer identification number

Name of borrower                                                                                          Employer identification number

Address of borrower (number and street)

City or town, state or province, and ZIP or foreign postal code

Note: An  IC-DISC  may  establish  that  the  borrower  has  met  the  limitation  and  increased  investment  requirements  of 
sections 993(d)(2) and (3) by attaching to its return either (a) Schedule Q (Form 1120-IC-DISC), or (b) a written statement 
of compliance of the borrower certified by a certified public accountant.

Under penalties of perjury, I certify that the loan                                 2.    The percentage which our receipts during the 3 tax 
received from the above-mentioned IC-DISC qualifies                                       years immediately preceding the tax year in which 
as a producer’s loan for the following reasons.                                           the loan was made from the sale, lease, or rental 
A. Limitation Rule. The amount of this loan, when added                                   outside the United States of property which would 
to the unpaid balance of all of our other qualified                                       be export property (determined without regard to 
producer’s loans outstanding at the time this loan was                                    section 993(c)(2)(C) or (D)) if held by an IC-DISC, is 
made, does not exceed:                                                                    of the gross receipts during such 3 tax years from 
                                                                                          the sale, lease, or rental of property held by us 
1a.  The amount of our adjusted basis (at the beginning                                   primarily for sale, lease, or rental to our customers 
   of our tax year in which the loan was made) in plant,                                  in the ordinary course of our trade or business.
   machinery, and equipment, and supporting 
   production facilities in the United States; plus                                 B. Increased Investment Requirement. The amount of 
                                                                                    this loan, when added to the unpaid balance of all of our 
1b.  The amount of property held primarily for sale, lease,                         producer’s loans made during our tax year, does not 
     or rental to our customers in the ordinary course of                           exceed:
     our trade or business at the beginning of our tax 
     year; plus                                                                     1.    The amount by which the sum of the adjusted basis 
                                                                                          of our assets described in 1a and 1b above on the 
1c.  The aggregate amount of our research and                                             last day of the tax year during which this loan was 
   experimental expenditures (within the meaning of                                       made exceeds the adjusted basis of those assets 
   section 174) in the United States during all                                           on the first day of such tax year; plus
   preceding tax years beginning after December 31, 
   1971; multiplied by                                                              2.    The aggregate amount of our research and 
                                                                                          experimental expenditures (within the meaning of 
                                                                                          section 174) in the United States during such tax 
                                                                                          year.

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     Date (MM/DD/YYYY)                                         Signature of officer                       Type or print name and title
For Paperwork Reduction Act Notice, see the                    www.irs.gov/form1120icdisc Cat. No. 11479D Schedule Q (Form 1120-IC-DISC) (Rev. 9-2016)
Instructions for Form 1120-IC-DISC.