Foreign Qualified Dividend Income Worksheet

Foreign Qualified Dividend Income Worksheet

2017 Worksheet Instructions

For each fund and share class owned, enter the Total Ordinary Dividends reported in Box 1a of Form 1099-DIV next to the fund’s name in the worksheet.

Note: You must subtract from the amount shown in Box 1a any dividends you received on shares for which you did not meet the 61-day holding period requirement for Qualified Dividend Income. Learn more about qualified dividends and the 61-day holding period requirement.

What You Will Need

  • Your Total Ordinary Dividends (Box 1a) on Form 1099-DIV
  • IRS Form 1116 — call (800) 829-3676 to order or download from the Forms & Publications section at

*These funds of funds within the American Funds Portfolio SeriesSM have been renamed, effective 1/1/18:

  • American Funds Balanced PortfolioSM to American Funds Moderate Growth and Income PortfolioSM
  • American Funds Tax-Advantaged Income PortfolioSM to American Funds Tax-Advantaged Growth and Income Portfolio SM

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.