SCHEDULE A 
(Form 8975)                                               Tax Jurisdiction and Constituent Entity Information
(Rev. December 2020)           For reporting period beginning                                        , 20         , and ending                                      , 20               OMB No. 1545-2272
Department of the Treasury                ▶ A separate Schedule A (Form 8975) is to be completed for each tax jurisdiction of the multinational enterprise group. 
Internal Revenue Service                                  ▶ Go to www.irs.gov/Form8975 for instructions and the latest information.
Name of the reporting entity                                                                                                                                                      EIN

Part I          Tax Jurisdiction Information. All financial amounts must be stated in U.S. dollars. See instructions.
Tax jurisdiction

                            1. Revenues                   2. Profit (loss) before 3. Income tax paid      4. Income tax     5. Stated capital     6. Accumulated         7. Number of         8. Tangible assets 
(a)                            (b)                  (c)      income     tax       (on cash     basis)   accrued—current                                earnings          employees     other than     cash and 
Unrelated party             Related party           Total                                                    year                                                                             cash equivalents

Part II         Constituent Entity Information 
                1. Constituent entities resident in       2. Entity               3. TIN             4. Tax jurisdiction of                            5. Main business activities
                         the tax jurisdiction                role                                       organization or 
                                                                                                        incorporation if         (a)                                              (b) 
                                                                                                     different    from tax       Activity     code        If you entered the code for “Other,” describe the 
                                                                                                        jurisdiction of                                                     business activity.
                                                                                                          residence

For Paperwork Reduction Act Notice, see separate instructions.                                            Cat. No. 69310N                                           Schedule A (Form 8975) (Rev. 12-2020)

Schedule A (Form 8975) (Rev. 12-2020)                                                                                                                                                    Page 2
Part II  Constituent Entity Information (continued)
         1. Constituent entities resident in 2. Entity 3. TIN                         4. Tax jurisdiction of                            5. Main business activities
            the tax jurisdiction             role                                        organization or                                                               
                                                                                         incorporation if         (a)                                              (b)
                                                                                      different    from tax       Activity     code        If you entered the code for “Other,” describe the 
                                                                                         jurisdiction of                                                  business activity.
                                                                                         residence

Part III Additional Information
Enter any additional information related to the information reported in Part I and II.

                                                                                                                                                  Schedule A (Form 8975) (Rev. 12-2020)