SECTION 2. REQUESTS FOR DISCRETIONARY LOB RELIEF

.01 In General. In addition to the requirements of section 1 of this appendix, a request for discretionary LOB relief must also include the following information.

Part 4 . Additional Information for Requests for Discretionary LOB Relief

4.1 Information necessary for identification and request review:

a. Statement about the type(s) of benefits requested (e.g., dividends, interest, royalties, branch profits, etc.) and the

relevant treaty provision(s) and amount of income at issue; b. Date on which the applicant requests that the determination become effective; and c. Statement as to whether the applicant made a previous request and the ultimate disposition of that request

4.2 Applicant organization information:

a. Narrative description of the business activities of the applicant’s U.S., foreign, and group holdings that describes the

ownership structure and any recent restructurings in ownership and the purposes therefor relevant to the applicant and its ultimate owner(s), including the tax reasons for the use of any hybrid entities in the structure; b. In the case of a country that applies a territorial or exemption system for relieving double taxation on income or gain

attributable to an office or branch in a third country, whether the applicant conducts business in the United States through such an office or permanent establishment, and if so, the name of the country in which the office or branch is located, the type of income or gain derived by the office or branch, and the applicable rate of tax applied to that income in that third jurisdiction; c. Name, address, and U.S. taxpayer identification number of U.S. entities related to the applicant from whom income

covered by the request was or will be received; d. A chart with the name and country of tax residence or organization of every entity, along with its ownership interest

in any intermediate entity, including its entity classification under U.S. and foreign law, between the applicant and ultimate owners of the applicant, (e.g., publicly traded corporations, pensions or other tax-exempt entities, governments, or individuals); e. Description of the control and business relationships between the applicant and relevant persons for the years in issue,

including any changes in such relationships prior to the date of the request; and f. Description of the relevant transactions, activities, or other circumstances involved in the matter covered by the request

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4.3 Applicant financial statement information:

a. Financial statements, if available, for the years in issue of the applicant and any U.S. branch or related entity

that paid or will pay income to the applicant during the period covered by the request; and b. Annual reports of any publicly traded shareholder that directly or indirectly owns stock in the applicant for the

years in issue, and an English translation of any similar filings with securities regulators reflecting the structure or transaction that is the subject of the request for the years in issue, if applicable

4.4 Additional applicant information:

a. Analysis of why the applicant does not meet each of the objective tests listed in the treaty LOB article (e.g., if

the company fails the base erosion test because it pays more than half of its gross income in the form of deductible expenses to persons not authorized by the treaty, including an explanation as to the reasons for making payments to such persons, or if a company is engaged in the active conduct of a trade or business in its country of residence, an explanation of what specifically prevents the company from meeting the active trade or business test in the treaty, or if the applicant’s parent was recently delisted from a recognized stock exchange and why, or if the applicant’s parent is publicly traded on a stock exchange not recognized under the treaty); b. Explanation of the non-tax business reasons why the applicant was formed or maintained in the particular treaty

country (e.g., that the country is the source of raw materials, the customer base is located in the country, substantial functions of the company’s business are located in the country, a substantial amount of services are performed in the country, or rents or royalties are derived from such country), and an explanation for any recent changes in these activities; c. Detailed description of the facts and circumstances that demonstrate that the applicant has a sufficient relation ship or nexus to the treaty country; d. Analysis of any relevant factor for determining whether to grant a request for discretionary LOB relief, as indi cated, for example, by the applicable U.S. tax treaty and Treasury Department Technical Explanation to the U.S. tax treaty; e. Statement from the applicant as to whether any entity in the ownership chain between the applicant and the

publicly held entity (including the publicly held entity) is a nominee, agent, or otherwise a conduit, and if so, why it is arranged in that manner; f. English translations of all tax rulings or tax concessions issued to the applicant by the country in which it is

organized, or a statement of whether the applicant otherwise benefits from a special tax regime in that country, and a description of the benefits; g. If the applicant has requested a certification from its country of residence regarding entitlement to the benefits

of the treaty, where applicable, a copy of all correspondence from the treaty country; h. Statement from the applicant whether an examination by any tax authority has been or is currently in process

that is related to the relief request; i. Whether a request for an APA has been or is anticipated to be made with respect to the income that is covered

by the request; j. Statement whether each entity between the applicant and the ultimate shareholders meets the base erosion test of

the treaty; k. If the requested treaty benefits relate to dividends, a description of the capital structure of the applicant and of

the U.S. entity paying the dividends, including details about each class of shares and associated rights (e.g., voting, conversion, dividend rate, etc.), the period during which the structure was in effect, and any reorganizations in the United States or of the applicant abroad, including change of residence; l. If the requested treaty benefits relate to interest, a general description of the terms of indebtedness, the method

used to calculate interest, and the existence of embedded options or other derivative structures; whether the debt is registered or in bearer form; whether it is publicly traded and, if so, on which exchange; whether it is held by a hedge fund or other type of investment vehicle; and whether the ultimate owners are known to the applicant; m. If the requested treaty benefits relate to royalties, a description of the intangible property generating the royalty

payments, when the applicant gained the rights to this property, and the terms of the royalty agreement; n. In the case of an applicant that is a hybrid entity, or that owns an interest in a hybrid entity through which it

derives income, profit, or gain with respect to which it seeks treaty benefits, a detailed explanation of why the applicant derives the income in accordance with the relevant treaty provisions; and o. Statement of understanding that if the request for discretionary LOB relief is accepted by the U.S. competent

authority the applicant is required to remit the user fee as provided by section 16 of the revenue procedure

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.02 Pre-filing Memorandum. The applicant must submit a pre-filing memorandum indicating whether a pre-filing conference is requested in accordance with section 3.02(3)(f) of the revenue procedure.

SECTION 3. “GENERALLY CORRESPONDS” PENSION DETERMINATIONS

In addition to the requirements of section 1 of this appendix, a request seeking a determination that a foreign pension plan generally corresponds to a pension plan recognized for tax purposes in the United States must also include the following information:

Part 5 . Additional Information for Requests for “Generally Corresponds” Pension Determinations

5.1 Copies of the Plan Documents (translated into English). For this purpose, the Plan Documents include the plan itself, the trust agreement, the summary plan description or similar document provided to participants, and any other document that will assist the U.S. competent authority in making its determination.

5.2 If the plan at issue relates to another plan of the employer, copies of the Plan Documents (as defined above) for that other plan (translated into English)

5.3 Copies of all applicable statutory provisions that govern the foreign pension plan (translated into English)

5.4 An explanation of why the foreign pension plan should be deemed to “generally correspond” to a pension plan recognized for tax purposes in the United States.