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This is a Official Federal Forms form that can be used for Financial Statements within Federal Reserve System.
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FR Y-7 OMB Number 7100-0297 Approval expires September 30, 2018 Page 1 of 4 Board of Governors of the Federal Reserve System Annual Report of Foreign Banking Organizations--FR Y-7 Report at the close of business as of the end of fiscal year This report form is authorized by law: Sections 8(a) and 13(a) of the International Banking Act (12 U.S.C. §§ 3106(a) and 3108(a)); sections 113, 165, 312, 618, 809 of the Dodd-Frank Act (12 U.S.C. §§ 5361, 5365, 5412, 1850a(c)(1), and 5468(b)(1)). Return to the appropriate Federal Reserve Bank the original and number of copies of the completed report required by the Federal Reserve Bank. The Federal Reserve may not conduct or sponsor, and an organization (or a person) is not required to respond to, an information collection unless it displays a currently valid OMB control number. Date of Report (foreign banking organization's fiscal year-end): Month / Day / Year NOTE: The Annual Report of Foreign Banking Organizations must be signed by an authorized official of the foreign banking organization. I, Name of Foreign Banking Organization Authorized Official Reporter's Legal Entity Identifier (LEI) (20-Character LEI Code) Reporter's Name, Street, and Mailing Address Legal Name of Foreign Banking Organization (Top-tier if filing as a tiered organization) Street Address of the Foreign Banking Organization City Country Title of Foreign Banking Organization Authorized Official attest that the Annual Report of Foreign Banking Organizations (including the supporting attachments) for this report date have been prepared in conformance with the instructions issued by the Federal Reserve System and are true and correct to the best of my knowledge and belief. With respect to information regarding individuals contained in this report, the Reporter certifies that it has the authority to provide this information to the Federal Reserve. The Reporter also certifies that it has the authority, on behalf of each individual, to consent or object to public release of information regarding that individual. The Federal Reserve may assume, in the absence of a request for confidential treatment submitted in accordance with the Board's "Rules Regarding Availability of Information," 12 C.F.R. Part 261, that the Reporter and individual consent to public release of all details in the report concerning that individual. Mailing Address of the Principal Office (If different from street address) City Country Person in the United States to whom questions about this report should be directed: Name Street City Area Code / Phone Number E-mail Address Address (URL) for the Foreign Banking Organization's web page State Zip Code Title Area Code / FAX Number Signature of Foreign Banking Organization Authorized Official Date of Signature Indicate status of Annual Report to Shareholders: is included with the FR Y-7 report will be sent under separate cover is not prepared Is confidential treatment requested for any portion 0=No of this report submission?.............................. 1=Yes In accordance with the General Instructions for this report (check only one), 1. a letter justifying this request is being provided along with the report ...................................................... 2. a letter justifying this request has been provided separately............................................................ NOTE: Information for which confidential treatment is being requested must be provided separately and labeled as "confidential." For Federal Reserve Bank Use Only RSSD ID C.I. Public reporting burden for the information collection in the FR Y-7 is estimated to average 4 hours per response, including time to gather and maintain data in the required form and to review instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551, and to the Office of Management 12/2016 and Budget, Paperwork Reduction Project (7100-0297), Washington, DC 20503. American LegalNet, Inc. www.FormsWorkFlow.com FR Y-7 Page 2 of 4 Checklist The checklist below is provided to assist the reporting foreign banking organization in filing all the necessary responses to the various report items. Each report item should be checked and the appropriate blanks filled in. The completed checklist should be returned with the report. Check the Yes, No, or N/A checkbox below, as appropriate, to indicate if the report item is included with the initial filing. Report Item 1: Financial Information Regarding the Foreign Banking Organization (FBO) Yes Yes No 1(a) Response provided in Attachment(s) # 1(b) Response provided in Attachment(s) # Report Item 2: Organization Information for the FBO Yes Yes N/A 2(a) Response provided in Attachment(s) # 2(b) Response provided in Attachment(s) # Report Item 3: Shares and Shareholders Yes Yes Yes No No 3(a) Response provided on Report Page # 3(b) Response provided on Report Page # 3(c) Response provided on Report Page # or in Attachment(s) # or in Attachment(s) # or in Attachment(s) # Report Item 4: Eligibility as a Qualified Foreign Banking Organization (QFBO) Yes Yes Yes No N/A N/A Items 4(e) and 4(f) have been completed and provided on Report Page # or in Attachment(s) # Items 4(j) and 4(k) have been completed and provided on Report Page # or in Attachment(s) # Items 4(l) and 4(m) have been completed and provided on Report Page # or in Attachment(s) # American LegalNet, Inc. www.FormsWorkFlow.com 12/2011 FR Y-7 Page 3 of 4 For Use by Tiered Foreign Banking Organizations Tiered foreign banking organizations must list the legal name, mailing address, and physical location of subsidiary foreign banking organizations below. Refer to Who Must Report in the general instructions for filing by tiered foreign banking organizations. A. For the fiscal year ending on Month / Day / Year Legal name of subsidiary foreign banking organization: Mailing address of head office: Street City Country Physical location of principal office: (not mailing address) Street City Country Name and address of authorized official in the United States: Name Street City State ZIP Code Area Code / Phone Number Area Code / FAX Number E-mail Address I, Name Title an authorized official of the company named above, certify that this Annual Report of Foreign Banking Organiz