BE-15 Claim BE-15 Claim for Exemption

FORM

BE-15 Claim for Exemption

FORM CODE X

(REV. 10/2011)

OMB No. 0608-0034: Approval Expires 08/31/2014

BE-15 Identification Number

MANDATORY — CONFIDENTIAL
2011 ANNUAL SURVEY OF FOREIGN DIRECT INVESTMENT IN THE UNITED STATES
CLAIM FOR EXEMPTION FROM FILING FORM BE-15A, BE-15B, OR BE-15(EZ)
A. Name and address of U.S. business enterprise

DUE DATE: MAY 31, 2012

1002 Name of U.S. affiliate
0

ELECTRONIC FILING:
1010 c/o (care of)
0

www.bea.gov/efile
MAIL REPORTS TO:

1003 Street or P.O. Box
0

U.S. Department of Commerce
Bureau of Economic Analysis BE-49(A)
Washington, DC 20230

1004 City
0

0998 State
0

DELIVER REPORTS TO:
1005 ZIP Code
0

U.S. Department of Commerce
Bureau of Economic Analysis, BE-49(A)
Shipping and Receiving Section, M100
1441 L Street, NW
Washington, DC 20005

Foreign Postal Code

OR

0

FOR INFORMATION OR ASSISTANCE:
Email:
Telephone:
Copies of blank forms:

FAX REPORTS TO:

be12/15@bea.gov
(202) 606-5577
www.bea.gov/fdi

(202) 606-1905*
Please include your BE-15 Identification Number with all requests.
B. Enter Employer Identification Number(s) used by the U.S. business enterprise to file income and payroll taxes.
Primary
1006 1

Other
2

–

–

RESPONSE REQUIRED
Section 806.4 of 15 CFR, Chapter VIII, requires that all persons subject to the reporting requirements of the BE-15 Survey respond, whether or not they are contacted
by BEA. It also requires that persons who are contacted by BEA about reporting in this survey, must respond in writing. They may respond by:
• filing the properly completed Form BE-15A, BE-15B, or BE-15(EZ) by May 31, 2012, as required;
• completing and returning the Form BE-15 Claim for Exemption From Filing Form BE-15A, BE-15B, or BE-15(EZ), by May 31, 2012;
• certifying in writing, by May 31, 2012 to the fact that the person had no direct investment within the purview of the reporting requirements of the BE-15 survey.
MANDATORY
CONFIDENTIALITY
PENALTIES

➔

This survey is being conducted under the International Investment and Trade in Services Survey Act (P.L. 94-472, 90 Stat. 2059, 22
U.S.C. 3101-3108, as amended). The filing of reports is mandatory and the Act provides that your report to this Bureau is confidential.
Whoever fails to report may be subject to penalties. See page 4 for more details.

PERSON TO CONSULT CONCERNING QUESTIONS
ABOUT THIS REPORT — Enter name and address
1000 Name
0
1029 Address
0
1030 0

CERTIFICATION — The undersigned official certifies that this report has been
prepared in accordance with the applicable instructions, is complete, and is
substantially accurate except that estimates may have been provided where data are
not available from customary accounting records or precise data could not be obtained
without undue burden.
Authorized official’s signature

1031 0
1001 Telephone number

Area code

Number

Extension

0

Date

0990 Print or type name
0

0991 Print or type title
0

0992 Telephone number
0

0993

FAX number
0

May FAX and/or email be used in correspondence between your enterprise and BEA, including FAX’ed reports, and/or to discuss questions relating to this
survey that may contain confidential information about your company?
* NOTE: The internet and telephone systems are not secure means of transmitting confidential information unless it is encrypted. If you choose to communicate with
BEA via FAX or electronic mail, BEA cannot guarantee the security of the information during transmission, but will treat information we receive as confidential in
accordance with Section 5(c) of the International Investment and Trade in Services Survey Act.
1027

1032

Email:

FAX:

1

1
1
2

1
1

1
2

Yes (If yes, please print your email address.)
No
Yes (If yes, please print your fax number.)
No

Email address (Please print)
0
1028

Fax number
1
0999

WHICH SECTIONS TO COMPLETE?
Complete items A and B on page 1, and the Person to Consult Concerning Questions About This Report and the Certification at the bottom of page 1. Also,
please review the questions below to determine the additional information required.
I Were at least 10 percent of the voting rights in your business directly or indirectly owned by a foreign person or entity at the end of your fiscal year that ended in
calendar year 2011?
Yes – Continue with question II below. Note: Your
business is hereinafter referred to as a "U.S. affiliate."

No – Complete item 2(a) or (b) or (c) or (e) on page 3. If your business has
been liquidated or dissolved, complete (a) or (b). Do not complete questions
II, III or IV below.

II Were more than 50 percent of the voting rights in this U.S. affiliate owned by another U.S. affiliate, or was this U.S. affiliate merged into another U.S. affiliate at the
end of this U.S. affiliate’s fiscal year that ended in calendar year 2011?
Yes – Yes continue with question III below.

No – Skip to question IV below.

III Will the data for this U.S. affiliate be consolidated into the 2011 BE-15 report filed for the U.S. affiliate that owns it more than 50 percent, or be included on the 2011
BE-15 report filed for the U.S. affiliate into which it was merged?
Yes – Complete item 2d(1) or 2d(2) on page 3.

No – Contact BEA for guidance.

IV Did any one of the items – Total assets, Sales or gross operating revenues, or Net income (loss) – for the U.S. affiliate (not just the foreign parent’s share) exceed
$40 million at the end of, or for, its fiscal year that ended in calendar year 2011?
Yes – You are not eligible to file Form BE-15 Claim for Exemption
and must file either a Form BE-15A, BE-15B, or BE-15(EZ).
Copies of blank forms can be found at: www.bea.gov/fdi

No – Complete items 1a through 1h below. Do NOT complete
page 3.

BASIS OF CLAIM FOR EXEMPTION
Select one type of exemption -- either based on Value (#1 below) or based on one of the reasons listed under Other Exemptions (#2 on page 3).
Please check box corresponding to the type of exemption you are claiming.
1. Exemption based on Value (check box below)
0100

1

1

If item 1 is applicable, complete ALL items (1.a. through 1.h.) below.
The U.S. business enterprise was a U.S. affiliate of a foreign person at the end of its fiscal year that ended in calendar year 2011, but is exempt from filing
Form BE-15A, BE-15B, or BE-15(EZ) because, on a fully consolidated, or in the case of real estate investments, an aggregated basis, none of the following
three items for the U.S. affiliate (not just the foreign parent’s share) exceeded $40 million (positive or negative) at the end of, or for, its fiscal year that
ended in calendar year 2011:
• Total assets (do not net out liabilities);
• Sales or gross operating revenues, excluding sales taxes; and
• Net income (loss) for FY 2011, after provision for U.S. Federal, state, and local income taxes.
Rounding – Report currency amounts in U.S. dollars rounded to
thousands (omitting 000). Do not enter amounts in the
shaded portions of each line.
Example – If amount is $1,334,891.00 report as:

Bil.

b. Sales or gross operating revenues for the fiscal year that ended in calendar year 2011,
excluding sales taxes – Do not give gross margin.
c. Net income (loss) for the fiscal year that ended in calendar year 2011, after provision
for U.S. Federal, state, and local income taxes.

Thous. Dols.
000

Bil.
a. Total assets at the close of the fiscal year that ended
in calendar year 2011 – Do not net out liabilities.

Mil.

Amount
Mil.
Thous. Dols.

1
2109

$

000

1

000

2149
1

000

2159
1

Please check box
1 3
if total liabilities
d. Total liabilities at the close of the fiscal year that ended in
$
are zero.
calendar year 2011.
000
2114
e. Major product(s) or service(s) of the fully consolidated domestic U.S. affiliate – Briefly describe the major product(s) and/or service(s) of
the U.S. affiliate. If a product, also state what is done to it, i.e., whether it is mined, manufactured, sold at wholesale, transported, packaged,
etc. (For example, "manufacture widgets.")
0
1163

ISI Code
f. Industry code of the fully consolidated domestic U.S. affiliate – Enter the 4-digit International Surveys Industry (ISI)
code of the industry with the largest sales or gross operating revenues. For a full explanation of each code, see the Guide
1
to Industry Classifications for International Surveys, 2007. A copy of this guide can be found on our web site at:
www.bea.gov/naics2007
1164
g. Please enter the country of the foreign parent in the box below. The foreign parent is the FIRST person or entity outside the U.S. in a chain of
ownership that has a 10 percent or more voting interest in this U.S. affiliate. See diagram on page 4 for an illustration of foreign parent.
Country of foreign parent

BEA USE ONLY
1
3016

h. Please enter the country of the ultimate beneficial owner (UBO) in the box below. The UBO is that person or entity, proceeding up
the ownership chain beginning with and including the foreign parent, that is not more than 50 percent owned or controlled by another
person or entity. See diagram on page 4 for an illustration of UBO.
Country of UBO

Page 2

BEA USE ONLY
1
3022
FORM BE-15 Claim For Exemption (REV. 10/2011)

Select one type of exemption either based on one of the reasons listed under Other Exemptions (#2 below) or based on
Value (#1 on page 2). Please check box corresponding to the type of exemption you are claiming.
This U.S. business enterprise is exempt from filing a Form BE-15A, BE-15B, or BE-15(EZ) because:

2. Other Exemptions (check box below)
(a)

0170

1

This U.S. business enterprise was a U.S. affiliate of a foreign person or entity at some time during calendar year 2011 but ceased to
be a U.S. affiliate before the end of the fiscal year that ended in calendar year 2011.
Give date foreign ownership ceased or went below 10 percent, or when the business was liquidated or dissolved.

1

7012

Month

Day
mm/dd/yyyy

Year

1

(b)

0110

1

This U.S. business enterprise was not a U.S. affiliate of a foreign person or entity at any time during calendar year 2011 but had
been a U.S. affiliate of a foreign person at some time before January 1, 2011.

1

Give date foreign ownership ceased or went below 10 percent, or when the business was liquidated or dissolved.
7010

Month

mm/dd/yyyy
Day

Year

1

(c)

0180

1

This U.S. business enterprise is a U.S. affiliate of a foreign person or entity, but became a U.S. affiliate after the end of its fiscal year
that ended in calendar year 2011, or if a newly formed company, its first fiscal year did not or will not end until after the end of
calendar year 2011. Complete items (1) and (2) below.

1

(1) Give date when the U.S. business enterprise became a U.S. affiliate of a foreign person.
7013

Month

Day
mm/dd/yyyy

Year

1

(2) Give the ending date of the U.S. business enterprise’s fiscal year that ended in calendar year 2011. If a newly formed company
give the ending date of the U.S. business enterprise’s first fiscal year. NOTE: For a newly formed company this must be a date
in calendar year 2012.
7014

Month

Day
mm/dd/yyyy

Year

1

(d) This U.S. business enterprise was a U.S. affiliate of a foreign person or entity during the fiscal year that ended in calendar year 2011
but was (please check appropriate box (1) or (2)):
(1)

0112

1

Fully consolidated into the 2011 BE-15
report filed for another U.S. affiliate;

1

OR

(2)

0112

2

1

Merged into another U.S. affiliate and its
operations are included on the 2011 BE-15 report
filed for the other U.S. affiliate.

On the lines below give the name, address, and BEA Identification Number of the U.S. affiliate into which this U.S. affiliate is fully
consolidated or merged.
Name
0120 0

Street or P.O. Box
0130 0

State

City
0140 0

0141 0

ZIP Code
0150 0

BE-15 Identification Number of the U.S. affiliate into which this U.S. affiliate is fully consolidated or merged.
7011

(e)

0190

1

1

0

Other – Specify and include reference to section of regulations or
instructions on which claim is based.
7015 0

Remarks

FORM BE-15 Claim For Exemption (REV. 10/2011)

Page 3

Authority – This survey is being conducted under the International Investment and Trade in Services Survey Act
(P.L. 94-472, 90 Stat. 2059, 22 U.S.C. 3101-3108, as amended), and the filing of reports is MANDATORY pursuant
to Section 5(b)(2) of the Act (22 U.S.C. 3104). The implementing regulations are contained in Title 15, CFR, Part
806.
Penalties – Whoever fails to report may be subject to a civil penalty of not less than $2,500, and not more than
$25,000, and to injunctive relief commanding such person to comply, or both. The civil penalties are subject to
inflationary adjustments. Those adjustments are found in 15 CFR 6.4. Whoever willfully fails to report shall be fined
not more than $10,000 and, if an individual, may be imprisoned for not more than one year, or both. Any officer,
director, employee, or agent of any corporation who knowingly participates in such violation, upon conviction, may
be punished by a like fine, imprisonment, or both. (22 U.S.C. 3105)
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject
to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork
Reduction Act, unless that collection of information displays a currently valid OMB Control Number. The control
number for this survey is at the top of page 1 of this form.
Respondent Burden – Public reporting burden for this form is estimated to vary from 20 to 75 minutes per
response with an average of 1 hour per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: Director, Bureau of Economic Analysis (BE-1), U.S. Department
of Commerce, Washington, DC 20230; and to the Office of Management and Budget, Paperwork Reduction Project
0608-0034, Washington, DC 20503.
Confidentiality – The Act provides that your report to this Bureau is CONFIDENTIAL and may be used only for
analytical or statistical purposes. Without your prior written permission, the information filed in your report CANNOT
be presented in a manner that allows it to be individually identified. Your report CANNOT be used for purposes of
taxation, investigation, or regulation. Copies retained in your files are immune from legal process.

ILLUSTRATION OF FOREIGN PARENT AND ULTIMATE BENEFICIAL OWNER (UBO)
Foreign Company X
(UBO)
>50 Percent
Foreign Company Y
(Foreign Parent)

Foreign
United States

Foreign Company Y is the
foreign parent but it is not the
UBO because it is more than 50
percent owned or controlled by
Foreign Company X. Foreign
Company X is the UBO.

10 to 100 Percent
U.S. affiliate A

Foreign Company Y directly owns
10 percent or more of the voting
rights of U.S. affiliate A.

U.S. affiliate B
U.S. affiliate B is indirectly owned
by Foreign Company Y through
U.S. affiliate A.

NOTE: Arrows connecting boxes represent direction of ownership. In the illustration above, if
Foreign Company Y does not have at least a 10 percent indirect voting interest in U.S. affiliate
B, then U.S. affiliate B is exempt from filing Form BE-15. In addition, if U.S. affiliate A owns more
than 50 percent of U.S. affiliate B, then the data for U.S. affiliate B should be consolidated on
the BE-15 report filed for U.S. affiliate A.

DEFINITIONS OF KEY TERMS
Affiliate means a business enterprise located in one country that is directly or indirectly owned or controlled by a
person or entity of another country to the extent of 10 percent or more of its voting stock for an incorporated
business or an equivalent interest for an unincorporated business, including a branch.
Direct investment means the ownership or control, directly or indirectly, by one person or entity of 10 percent or
more of the voting securities of an incorporated business enterprise or an equivalent interest in an unincorporated
business enterprise.
U.S. affiliate means an affiliate located in the United States in which a foreign person or entity has a direct
investment.
Page 4

FORM BE-15 Claim For Exemption (REV. 10/2011)