American Funds®

Foreign Qualified Dividend Income Worksheet

Worksheet Instructions

For each fund owned, refer to Box 1b of Form 1099-DIV. Enter the amount in Box 1b next to the fund’s name below.

Note: You must subtract from the amount shown in Box 1b any dividends received on shares for which you did not meet the 61-day holding period requirement.

What You Will Need

  • Your total foreign qualified dividend income (Box 1b) of Form 1099-DIV for each fund owned
  • IRS Form 1116 — call (800) 829-3676 to order, or download from the Forms & Publications section at

Investors should carefully consider investment objectives, risks, charges and expenses. This and other important information is contained in the fund prospectuses and summary prospectuses, which can be obtained from a financial professional and should be read carefully before investing.

Investments are not FDIC-insured, nor are they deposits of or guaranteed by a bank or any other entity, so they may lose value.

To determine your individual tax situation, please consult your tax advisor.