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Page 2 of 2 Fileid: … ns/I965C/201912/A/XML/Cycle05/source 11:16 - 27-Jan-2020
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
identification number, and street address Line 5. Enter the date the next installment Transferor signature. This transfer
or post office box. payment is due by the transferee in the agreement (Form 965-C) must be signed
space provided. The transferee must by a person who is authorized to sign a
Part III – Acceleration make an annual installment payment for return on behalf of the eligible section
Event the section 965(h) net tax liability they 965(h) transferor listed in Part I. By signing
assume by the due date of their income Part VI, you declare, under penalties of
Line 1. Indicate the type of acceleration tax return. See Regulations section perjury, that you have examined the form,
event leading to this transfer agreement 1.965-7(b)(3)(iii)(D) for details. and to the best of your knowledge and
by checking box a, b, or c. belief, Parts I, III, and IV are true, correct,
Check box a if the acceleration event Part V – Eligible Section and complete. You also certify that you
leading to this transfer agreement is have the authority to execute this transfer
described in Regulations section 965(h) Transferee’s Ability agreement.
1.965-7(b)(3)(iii)(A)(1)(i) or (ii). If you To Pay Remaining Liability Transferee signature. This transfer
check box a, answer the three questions Line 6. Check the “Yes” box to confirm agreement (Form 965-C) must also be
below box a. that the eligible section 965(h) transferee signed by a person who is authorized to
Check box b if the acceleration event is able to make the remaining payments sign a return on behalf of the eligible
leading to this transfer agreement is required under section 965(h) with respect section 965(h) transferee listed in Part II.
described in Regulations section to the section 965(h) net tax liability being By signing Part VI, you declare, under
1.965-7(b)(3)(iii)(A)(1)(iii). assumed. If you check the “No” box, you penalties of perjury, that you have
Check box c and box c(1) if the do not meet the requirements to enter into examined the form, and to the best of your
acceleration event leading to this transfer a valid transfer agreement. knowledge and belief, Parts II, III, IV, and
V are true, correct, and complete. You
agreement is described in Regulations Line 7. Check the “Yes” box if the
also certify that you have the authority to
section 1.965-7(b)(3)(iii)(A)(1)(iv). Also leverage ratio of the eligible section 965(h)
execute this transfer agreement.
answer the question below box c(1). transferee exceeds three to one.
Check box c and box c(2) if the Otherwise, check the “No” box. The
acceleration event leading to this transfer leverage ratio means the ratio that the Paperwork Reduction Act
agreement is described in Regulations total indebtedness of the transferee bears
section 1.965-7(b)(3)(iii)(A)(1)(v). Also to the sum of its money and all other Notice
answer the question below box c(2). assets reduced, but not below zero, by the We ask for the information on this form to
Check box c and box c(3) if the total indebtedness. See Regulations carry out the Internal Revenue laws of the
acceleration event leading to this transfer section 1.965-7(b)(3)(iii)(B)(6) for more United States. You are required to give us
agreement is described in Regulations information. the information. We need it to ensure that
section 1.965-7(b)(3)(iii)(A)(1)(vi). Also you are complying with these laws and to
answer the question below box c(3). Note. The leverage ratio of the eligible allow us to figure and collect the right
section 965(h) transferee is a factor the amount of tax.
Covered acceleration event. A person Commissioner uses to determine whether
satisfies the requirement to have a the eligible section 965(h) transferee has You are not required to provide the
covered acceleration event if that person the ability to pay the outstanding section information requested on a form that is
is able to check box a, b, or c based on 965(h) net tax liability. A leverage ratio in subject to the Paperwork Reduction Act
the above instructions. excess of three to one does not by itself unless the form displays a valid OMB
Line 2. Enter the date of the covered determine whether or not a transfer control number. Books or records relating
acceleration event in the space provided. agreement is valid. to a form or its instructions must be
retained as long as their contents may
Line 3. Provide a detailed description of Line 8. Provide any other pertinent become material in the administration of
the covered acceleration event in the information regarding the eligible section any Internal Revenue law. Generally, tax
space provided. 965(h) transferee's ability to pay the returns and return information are
section 965(h) net tax liability being confidential, as required by section 6103.
assumed. This information may include,
Part IV – Report of Unpaid but is not limited to, the adequacy of the The time needed to complete and file
Section 965(h) Net Tax transferee's income, the value of the this form will vary depending on individual
Liability Being Assumed transferee's assets, and the transferee's circumstances. The estimated burden for
access to capital. individual taxpayers filing this form is
Line 4. Enter the dollar amount of the approved under OMB control number
1545-0123 and is included in the
transferor's section 965(h) net tax liability Part VI – Terms of estimates shown in the instructions for
remaining unpaid.
Agreement their business income tax return.
Note. The amount of the transferor's By signing this transfer agreement, the
section 965(h) net tax liability is subject to eligible section 965(h) transferor and the
adjustment by the Commissioner. See eligible section 965(h) transferee agree to
Regulations section 1.965-7(b)(3)(iii)(B)(4) the terms set forth in Part VI of Form
(iv). 965-C.
-2- Instructions for Form 965-C (12-2019)
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