Form 5472 Example: A Filled-Out Sample (2026)

The IRS publishes Form 5472 and twelve pages of instructions but no example of a completed form. If you own a foreign-owned single-member LLC, that leaves you guessing what a normal filing actually looks like, with a $25,000 penalty waiting if you guess wrong.

This guide fixes that with a complete worked example. We invent a typical founder Amira, a freelance designer in Egypt with a Wyoming LLC and fill out her entire Form 5472 line by line: what she writes in each part, which parts stay blank, how her numbers reconcile, and how the pro forma 1120 header looks. By the end, you can put your own numbers into the same template.

The Example Scenario: Amira and Nile Digital LLC

Our example filer is a realistic composite of the most common Form 5472 situation: a non-resident freelancer with a US single-member LLC. Here is everything that happened in her 2026 tax year:

• Amira Hassan, a freelance designer living in Cairo, Egypt, is the sole owner of Nile Digital LLC, a Wyoming single-member LLC formed on February 10, 2026. The LLC has an EIN and has not elected corporate taxation, so it is a foreign-owned U.S. disregarded entity.
• In March, Amira wired $5,000of her own money into the LLC’s new US bank account to get it running (a capital contribution). The LLC paid its own state filing and registered agent fees out of that money.
• Over the year, the LLC billed about $28,000 to design clients in Europe and the US none of them related to Amira.
• Amira transferred $12,000from the LLC’s account to her personal account in Egypt during the year (distributions).
• The LLC also paid Amira $3,000 for design work she invoiced to it as an individual contractor (a payment for services to a related party).
• Amira has no SSN or ITIN. She has an Egyptian tax ID.

Because Nile Digital LLC is 25%+ foreign-owned and had reportable transactions with its foreign owner, it must file Form 5472 attached to a pro forma Form 1120. If you want the rules behind that conclusion, our complete Form 5472 guide covers who must file and why.

Which of Amira’s Transactions Are Reportable?

Only money moving between the LLC and a foreign related party goes on Form 5472. Client revenue even $28,000 of it is not reportable, because clients are not related parties. Here is the full sort:

Total reportable transactions: $5,000 + $12,000 + $3,000 = $20,000. Remember that figure it reappears on line 1f in Part I, and the IRS expects it to reconcile. For the full menu of what counts, see Form 5472 reportable transactions explained.

Step 0: The Pro Forma 1120 Header

Amira’s Form 5472 cannot be filed on its own it attaches to a pro forma Form 1120 that acts as a cover page. She completes only the header:

• Name: Nile Digital LLC
• Address:the LLC’s mailing address (a US registered agent address or her Cairo address both work)
• EIN and tax year: calendar year 2026, with the incorporation date February 10, 2026
• Written across the top of page 1: “Foreign-owned U.S. DE”

Every income and deduction line on the 1120 stays blank the $28,000 of client revenue does not go here either, because a disregarded entity files this 1120 only as a carrier for Form 5472. Our pro forma 1120 instructions walk through the header field by field.

Part I Reporting Corporation: What Amira Enters

Part I identifies the LLC itself. Amira’s entries, line by line:

• 1a: Nile Digital LLC, plus the mailing address exactly as on the Articles of Organization
• 1b:the LLC’s EIN from its CP 575 letter
• 1c Total assets:the LLC’s bank balance at year end say $14,500
• 1d/1e:“Graphic design services” and the matching business activity code (541430, from the Form 1120 code list)
• 1f Total value of gross payments: $20,000 the sum of everything reported in Parts IV and V of this form
• 1g:“1” she is filing one Form 5472, because there is one related party (her). 1h therefore also reads $20,000
• 1j: checked 2026 is the first year Nile Digital LLC files Form 5472
• 1l/1m: country of incorporation United States; date February 10, 2026
• 1n/1o:Egypt where the entity’s owner files as a tax resident and where the business is principally conducted

Then the two checkboxes that matter most. Question 2 (is the entity 50%+ foreign-owned?): Yes. Question 3, the foreign-owned U.S. DE box: checked. That checkbox is what activates Part V and tells the IRS this form rides on a pro forma 1120.

Part II 25% Foreign Shareholder: Identifying Amira

Part II identifies the foreign owner. Amira enters:

• 4a: Amira Hassan, with her residential address in Cairo, Egypt
• 4b(1) U.S. identifying number: none she has no SSN or ITIN, and she does not need to get one to file
• 4b(2) Reference ID number: AMIRAHASSAN001 a code she invents herself (letters and numbers, up to 50 characters). The one rule: she must reuse exactly this ID every year
• 4b(3) FTIN: her Egyptian tax identification number
• 4c–4e: Egypt, Egypt, Egypt where she principally does business, her citizenship, and where she files income tax as a resident

Lines 5a–5e (a second direct shareholder) and lines 6–7 (ultimate indirect shareholders) stay blankAmira owns the LLC directly and alone.

Part III Related Party: Amira Again

Part III names the related party the LLC transacted with. For Amira as for most single-member LLCs that is the same person as Part II, so this section largely repeats itself:

• Checkbox: the related party is a foreign person
• 8a/8b: Amira Hassan, Cairo address, reference ID AMIRAHASSAN001 identical to Part II, plus her FTIN
• 8c/8d:principal business activity “freelance design services” with the matching code
• 8e: relationship checkbox the related party is the 25% foreign shareholder
• 8f/8g: Egypt and Egypt

If Amira’s LLC had also transacted with, say, a company she owns in Egypt, that would be a second related party and a second Form 5472. One form per related party.

Part IV Monetary Transactions: The $3,000 Design Fee

Part IV is the grid of dollar amounts for ordinary business transactions with the related party sales, rents, royalties, service fees, loans, interest. Amira has exactly one entry here: the LLC paid her $3,000 for design services she invoiced as an individual.

• On the “amounts paid” side, she enters $3,000 on the line for fees for services paid (technical, managerial, professional, or similar services).
• Every other Part IV line stays blank no rents, no royalties, no loans, no interest moved between Amira and the LLC.

The classic mistake here: putting the $5,000 contribution or the $12,000 in distributions into Part IV. For a foreign-owned disregarded entity, contributions and distributions belong in Part V, not Part IV. If Amira had paid herself nothing for services, her Part IV would be entirely blank and that would be correct.

Part V Amira’s Contribution and Distributions

Part V exists only for foreign-owned U.S. disregarded entities the box Amira checked in Part I, question 3. Mechanically it is one checkbox plus an attached statement. Amira checks the box and attaches a short statement like this:

• “Capital contribution from sole member to entity: $5,000(March 2026).”
• “Distributions from entity to sole member: $12,000(aggregate, 2026).”

No special format is required a plain page with the LLC’s name, EIN, and each transaction described with its dollar amount. Together with Part IV, the statement accounts for the full $20,000on line 1f: $3,000 (Part IV) + $17,000 (Part V). If your own year was quieter than Amira’s just formation costs and an opening deposit Part V may be the only place on the form with dollar amounts at all.

Parts VI–IX What Amira Leaves Blank

The rest of the form targets multinational groups, and Amira touches it only lightly. Part VI (nonmonetary and less-than-full-value transactions): nothing to report, left blank. Part VII (additional information): she answers every yes/no question “No”no hybrid payments, no FDII deduction, no section 385 instruments. Part VIII (cost sharing arrangements) and Part IX (base erosion payments under BEAT, which targets corporations with hundreds of millions in receipts): not applicable, left blank.

One warning: blank and unanswered are different things. Skipping the Part VII questions can make the form “substantially incomplete,” which the IRS penalizes exactly like not filing. Answer the questions even when every answer is “No.”

The Whole Form at a Glance: Part-by-Part Summary

Here is Amira’s complete Form 5472 in one table a template you can adapt directly:

Cross-check before filing: line 1f ($20,000) must equal Part IV ($3,000) plus the Part V statement ($17,000). Totals that don’t reconcile are one of the most common triggers for IRS follow-up. You can download the blank form at irs.gov/pub/irs-pdf/f5472.pdf and the official instructions at irs.gov/instructions/i5472 to follow along line by line.

How Amira Files the Finished Package

A completed form still has to reach the IRS the right way and for a foreign-owned disregarded entity, e-filing is not an option. Amira staples her Form 5472 and Part V statement behind the pro forma 1120 and sends the package by one of two routes:

1. Fax (fastest, and it works from abroad): (855) 887-7737
2. Mail: Internal Revenue Service, 1973 Rulon White Blvd., M/S 6112, Attn: PIN Unit, Ogden, UT 84201

The deadline is April 15 following the tax year. Not ready? A Form 7004 extension faxed or mailed by April 15 pushes the deadline to October 15. Missing both means an automatic $25,000 penaltyunder IRC §6038A plus another $25,000 per 30-day period if the failure continues 90 days after an IRS notice. Run your own numbers through our penalty calculator if you are already late.

Adapting the Example to Your Own LLC

Your filing will differ from Amira’s only in the details, not the structure. Three common variations:

• Zero-activity year: no revenue, no service fees just formation costs and maybe an opening deposit. Part IV goes blank, and everything lives in the Part V statement.
• Owner paid LLC costs personally: if you covered the state fee or registered agent from your personal card, add those amounts to the Part V statement (and to line 1f).
• More related parties: if the LLC also transacted with your foreign company or a relative, each related party gets its own Form 5472, and line 1g counts them.

For deeper line-level detail on any single part, pair this example with our part-by-part Form 5472 instructions, which covers every line of the current revision.

Key Takeaways

• The IRS provides no filled-out Form 5472 sample but a typical single-member LLC filing uses only Parts I, II, III, V, and the Part VII questions.
• Only owner–LLC (related-party) transactions are reportable; client revenue never appears on Form 5472.
• In our example, $5,000 contributed + $12,000 distributed + $3,000 in service fees = $20,000 on line 1f.
• Contributions and distributions go in a Part V attached statement; payments for services go in Part IV.
• An owner with no SSN/ITIN uses a self-created reference ID (same one every year) plus their home-country tax ID.
• The form attaches to a pro forma 1120 with “Foreign-owned U.S. DE” written across the top and income lines left blank.
• Part VII questions must be answered(usually all “No”) unanswered questions can make the form substantially incomplete.
• Line 1f must reconcile with the sum of Parts IV and V mismatched totals invite scrutiny.
• File by fax at (855) 887-7737 or mail to Ogden, UT by April 15 (October 15 with Form 7004); e-filing is not available for foreign-owned DEs.
• The penalty for not filing or filing substantially wrong is $25,000 per form, per year.