Type of Filer
Individual
b
Partnership
c
Corporation
d
Consolidated
e
Fiduciary or Other—Enter type
5 Individual’s Date of Birth
MM/DD/YYYY
U.S. Taxpayer Identification Number 4 Foreign identification (Complete only if item 3 is not applicable.) a Type:
Passport
Other
c Country of Issue 7 First Name
If filer has no U.S. Identification Number complete Item 4.
6
Last Name or Organization Name
b Number
8 Middle Initial
9 Address (Number, Street, and Apt. or Suite No.)
10 City 11 State 12 Zip/Postal Code 13 Country
14 Does the filer have a financial interest in 25 or more financial accounts?
Yes
If “Yes” enter total number of accounts
(If “Yes” is checked, do not complete Part II or Part III, but retain records of this information)
No
Part II Information on Financial Account(s) Owned Separately 15 17 18 20 Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known 22 Zip/Postal Code, if known 23 Country 16 Type of account a Bank b Securities c Other—Enter type below Signature 44 Filer Signature 45 Filer Title, if not reporting a personal account 46 Date (MM/DD/YYYY) File this form with: U.S. Department of the Treasury, P.O. Box 32621, Detroit, MI 48232-0621
This form should be used to report a financial interest in, signature authority, or other authority over one or more financial accounts in foreign
countries, as required by the Department of the Treasury Regulations 31 CFR 1010.350 (formerly 31 CFR 103.24). No report is required if the aggregate value of the accounts did not exceed $10,000. See Instructions For Definitions.
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
Pursuant to the requirements of Public Law 93-579 (Privacy Act of 1974), notice is hereby given that the authority to collect information on TD F 90-22.1 in accordance with 5 USC 552a (e) is Public Law 91-508; 31 USC 5314; 5 USC 301; 31 CFR 1010.350 (formerly 31 CFR 103.24).
The principal purpose for collecting the information is to assure maintenance of reports where such reports or records have a high degree of
usefulness in criminal, tax, or regulatory investigations or proceedings. The information collected may be provided to those officers and employees of any constituent unit of the Department of the Treasury who have a need for the records in the performance of their duties. The records may be referred to any other department or agency of the United States upon the request of the head of such department or agency for use in a criminal, tax, or regulatory investigation or proceeding. The information collected may also be provided to appropriate state, local, and foreign law enforcement and regulatory personnel in the performance of their official duties. Disclosure of this information is mandatory. Civil and criminal penalties, including in certain circumstances a fine of not more than $500,000 and imprisonment of not more than five years, are provided for failure to file a report, supply information, and for filing a false or fraudulent report. Disclosure of the Social Security number is mandatory. The authority to collect is 31 CFR 1010.350 (formerly 31 CFR 103.24) . The Social Security number will be used as a means to identify the individual who files the report.
The estimated average burden associated with this collection of information is 20 minutes per respondent or record keeper, depending on individual circumstances. Comments regarding the accuracy of this burden estimate, and suggestions for reducing the burden should be directed to the Internal Revenue Service, Bank Secrecy Act Policy, 5000 Ellin Road C-3-242, Lanham MD 20706.
Cat. No. 12996D
Form TD F 90-22.1 (Rev. 3-2011)
Part II Continued—Information on Financial Account(s) Owned Separately Complete a Separate Block for Each Account Owned Separately This side can be copied as many times as necessary in order to provide information on all accounts. 1 Filing for calendar year 3–4 Check appropriate Identification Number Taxpayer Identification Number Foreign Identification Number Enter identification number here: 6 Last Name or Organization Name Form TD F 90-22.1 Page Number of 15 17 18 20 15 17 18 20 15 17 18 20 15 17 18 20 15 17 18 20 15 17 18 20
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
16 Type of account a Bank b Securities c Other—Enter type below 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known 16 Type of account a
23 Country b
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known 16 Type of account a
23 Country b
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known 16 Type of account a
23 Country b
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known 16 Type of account a
23 Country b
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known 16 Type of account a
23 Country b
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country
Form TD F 90-22.1 (Rev. 3-2011)
Part III Information on Financial Account(s) Owned JointlyComplete a Separate Block for Each Account Owned JointlyThis side can be copied as many times as necessary in order to provide information on all accounts. 1 Filing for calendar year 3–4 Check appropriate Identification Number Taxpayer Identification Number Foreign Identification Number Enter identification number here: 6 Last Name or Organization Name Form TD F 90-22.1 Page Number of 15 17 18 20 2426293015 17 18 20 2426293015 17 18 20 24262930
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Number of joint owners for this account16 Type of account a Bank b Securities c Other—Enter type below 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known 25
22 Zip/Postal Code, if known
23 Country
Taxpayer Identification Number of principal joint owner, if known. See instructions.
27
First Name of principal joint owner, if known
28
Middle initial, if knownLast Name or Organization Name of principal joint owner
Address (Number, Street, Suite or Apartment) of principal joint owner, if knownCity, if known
31
State, if known
32
Zip/Postal Code, if known
33
Country, if known
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Number of joint owners for this account16 Type of account a Bank b
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known 25
22 Zip/Postal Code, if known
23 Country
Taxpayer Identification Number of principal joint owner, if known. See instructions.
27
First Name of principal joint owner, if known
28
Middle initial, if knownLast Name or Organization Name of principal joint owner
Address (Number, Street, Suite or Apartment) of principal joint owner, if knownCity, if known
31
State, if known
32
Zip/Postal Code, if known
33b
Country, if known
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Number of joint owners for this account16 Type of account a Bank
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known 25
22 Zip/Postal Code, if known
23 Country
Taxpayer Identification Number of principal joint owner, if known. See instructions.
27
First Name of principal joint owner, if known
28
Middle initial, if knownLast Name or Organization Name of principal joint owner
Address (Number, Street, Suite or Apartment) of principal joint owner, if knownCity, if known
31
State, if known
32
Zip/Postal Code, if known
33
Country, if known
Form TD F 90-22.1 (Rev. 3-2011)
Part IVInformation on Financial Account(s) Where Filer has Signature Authority but No Financial Interest in the Account(s)Complete a Separate Block for Each AccountThis side can be copied as many times as necessary in order to provide information on all accounts. 1 Filing for calendar year 3–4 Check appropriate Identification Number Taxpayer Identification Number Foreign Identification Number Enter identification number here: 6 Last Name or Organization Name Form TD F 90-22.1 Page Number of 15 17 18 20 3436394315 17 18 20 3436394315 17 18 20 34363943
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
16 Type of account a Bank b Securities c Other—Enter type below 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
37
40
State
Middle initial
3841
Taxpayer Identification Number of Account OwnerLast Name or Organization Name of Account OwnerFirst NameCity
Filer's Title with this Owner
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
16 Type of account a
Address (Number, Street, and Apt. or Suite No.)Zip/Postal Code
42
Country
Bank b Securities c Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
37
40
State
Middle initial
3841
Taxpayer Identification Number of Account OwnerLast Name or Organization Name of Account OwnerFirst NameCity
Filer's Title with this Owner
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
16 Type of account a
Address (Number, Street, and Apt. or Suite No.)Zip/Postal Code
42
Country
Bank b Securities c Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
37
40
State
Middle initial
3841
Taxpayer Identification Number of Account OwnerLast Name or Organization Name of Account OwnerFirst NameCity
Filer's Title with this Owner
Address (Number, Street, and Apt. or Suite No.)Zip/Postal Code
42
Country
Form TD F 90-22.1 (Rev. 3-2011)
Information on Financial Account(s) Where the Filer is Filing a Consolidated ReportComplete a Separate Block for Each AccountPart VThis side can be copied as many times as necessary in order to provide information on all accounts. 1 Filing for calendar year 3–4 Check appropriate Identification Number Taxpayer Identification Number Foreign Identification Number Enter identification number here: 6 Last Name or Organization Name Form TD F 90-22.1 Page Number of 15 17 18 20 34383915 17 18 20 34383915 17 18 20 343839
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Corporate Name of Account OwnerAddress (Number, Street, and Apt. or Suite No.)City
40
State
16 Type of account a Bank b Securities c Other—Enter type below 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
Taxpayer Identification Number of Account Owner41Zip/Postal Code42Bank
b
Country
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Corporate Name of Account OwnerAddress (Number, Street, and Apt. or Suite No.)City
40
State
16 Type of account a
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
Taxpayer Identification Number of Account Owner41Zip/Postal Code42Bank
b
Country
Securities c
Other—Enter type below
Maximum value of account during calendar year reported Name of Financial Institution in which account is held Account number or other designation City
Corporate Name of Account OwnerAddress (Number, Street, and Apt. or Suite No.)City
40
State
16 Type of account a
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 21 State, if known
22 Zip/Postal Code, if known
23 Country 35
Taxpayer Identification Number of Account Owner41Zip/Postal Code42Country
Form TD F 90-22.1 (Rev. 3-2011)
Form TD F 90-22.1 (Rev. 3-2011)
General Instructions
Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts (the “FBAR”), is used to report a financial interest in or signature authority over a foreign financial account. The FBAR must be received by the Department of the Treasury on or before June 30th of the year
immediately following the calendar year being reported. The June 30th filing date may not be extended.
Who Must File an FBAR. interest in or signature authority over foreign financial accounts must file A United States person that has a financial an FBAR if the aggregate value of the foreign financial accounts exceeds $10,000 at any time during the calendar year. See General Definitions, to determine who is a United States person.
General Definitions
Financial Account. securities, brokerage, savings, demand, checking, deposit, time deposit, A financial account includes, but is not limited to, a or other account maintained with a financial institution (or other person performing the services of a financial institution). A financial account also includes a commodity futures or options account, an insurance policy with a cash value (such as a whole life insurance policy), an
annuity policy with a cash value, and shares in a mutual fund or similar pooled fund (i.e., a fund that is available to the general public with a regular net asset value determination and regular redemptions).
Foreign Financial Account. account located outside of the United States. For example, an account A foreign financial account is a financial maintained with a branch of a United States bank that is physically located outside of the United States is a foreign financial account. An account maintained with a branch of a foreign bank that is physically located in the United States is not a foreign financial account.
Financial Interest. foreign financial account for which:
A United States person has a financial interest in a title, regardless of whether the account is maintained for the benefit of (1) the United States person is the owner of record or holder of legal the United States person or for the benefit of another person; or
(2) the owner of record or holder of legal title is one of the following:(a)capacity on behalf of the United States person with respect to the An agent, nominee, attorney, or a person acting in some other account;
(b)indirectly: A corporation in which the United States person owns directly or (i) more than 50 percent of the total value of shares of stock or (ii) more than 50 percent of the voting power of all shares of stock;
(c)indirectly: A partnership in which the United States person owns directly or (i) an interest in more than 50 percent of the partnership's profits (e.g., distributive share of partnership income taking into account any special allocation agreement) or (ii) an interest in more than 50 percent of the partnership capital;
(d)and A trust of which the United States person: (ii) has an ownership interest in the trust for United States
(i) is the trust grantor federal tax purposes. See 26 U.S.C. sections 671-679 to determine if a grantor has an ownership interest in a trust;
(e)percent present beneficial interest in the assets or income of the A trust in which the United States person has a greater than 50 trust for the calendar year; or
(f)or indirectly more than 50 percent of the voting power, total value of Any other entity in which the United States person owns directly equity interest or assets, or interest in profits.
Person. not limited to, a limited liability company, corporation, partnership, trust, A person means an individual and legal entities including, but and estate.
Signature Authority. (alone or in conjunction with another individual) to control the disposition Signature authority is the authority of an individual of assets held in a foreign financial account by direct communication (whether in writing or otherwise) to the bank or other financial institution that maintains the financial account. See Exceptions, Signature Authority.
Page 6
United States.States, the District of Columbia, all United States territories and
For FBAR purposes, the United States includes the possessions (e.g., American Samoa, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico, Guam, and the United States Virgin Islands), and the Indian lands as defined in the Indian Gaming Regulatory Act. References to the laws of the United States include the laws of the United States federal government and the laws of all places listed in this definition.
United States Person.citizens; United States residents; entities, including but not limited to, United States person means United States corporations, partnerships, or limited liability companies created or organized in the United States or under the laws of the United States; and trusts or estates formed under the laws of the United States.
Note.the entity has an FBAR filing requirement. For example, an entity that is The federal tax treatment of an entity does not determine whether disregarded for purposes of Title 26 of the United States Code must file an FBAR, if otherwise required to do so. Similarly, a trust for which the trust income, deductions, or credits are taken into account by another person for purposes of Title 26 of the United States Code must file an FBAR, if otherwise required to do so.
United States Resident.the United States. To determine if the filer is a resident of the United A United States resident is an alien residing in States apply the residency tests in 26 U.S.C. section 7701(b). When applying the residency tests, use the definition of United States in these instructions.
Exceptions
Certain Accounts Jointly Owned by Spouses.individual who files an FBAR is not required to file a separate FBAR if The spouse of an the following conditions are met: (1) all the financial accounts that the non-filing spouse is required to report are jointly owned with the filing spouse; (2) the filing spouse reports the jointly owned accounts on a timely filed FBAR; and (3) both spouses sign the FBAR in Item 44. See Explanations for Specific Items, Part III, Items 25-33. Otherwise, both spouses are required to file separate FBARs, and each spouse must report the entire value of the jointly owned accounts.
Consolidated FBAR.named in a consolidated FBAR filed by a greater than 50 percent owner, If a United States person that is an entity is
such entity is not required to file a separate FBAR. See Explanations for Specific Items, Part V.
Correspondent/Nostro Account.(which are maintained by banks and used solely for bank-to-bank Correspondent or nostro accounts settlements) are not required to be reported.
Governmental Entity.entity of the United States (as defined above) is not required to be
A foreign financial account of any governmental reported by any person. For purposes of this form, governmental entity includes a college or university that is an agency of, an instrumentality of, owned by, or operated by a governmental entity. For purposes of this form, governmental entity also includes an employee retirement or welfare benefit plan of a governmental entity.
International Financial Institution.international financial institution (if the United States government is a A foreign financial account of any member) is not required to be reported by any person.
IRA Owners and Beneficiariesnot required to report a foreign financial account held in the IRA.
. An owner or beneficiary of an IRA is Participants in and Beneficiaries of Tax-Qualified Retirement Plans.A participant in or beneficiary of a retirement plan described in Internal Revenue Code section 401(a), 403(a), or 403(b) is not required to report a foreign financial account held by or on behalf of the retirement plan.Signature Authority.no financial interest in, a foreign financial account are not required to Individuals who have signature authority over, but report the account in the following situations:
the Comptroller of the Currency, the Board of Governors of the Federal (1) An officer or employee of a bank that is examined by the Office of Reserve System, the Federal Deposit Insurance Corporation, the Office of Thrift Supervision, or the National Credit Union Administration is not required to report signature authority over a foreign financial account owned or maintained by the bank.
with and examined by the Securities and Exchange Commission or (2) An officer or employee of a financial institution that is registered Commodity Futures Trading Commission is not required to report
signature authority over a foreign financial account owned or maintained by the financial institution.
Form TD F 90-22.1 (Rev. 3-2011)
required to report signature authority over a foreign financial account (3) An officer or employee of an Authorized Service Provider is not that is owned or maintained by an investment company that is
registered with the Securities and Exchange Commission. Authorized Service Provider means an entity that is registered with and examined by the Securities and Exchange Commission and provides services to an investment company registered under the Investment Company Act of 1940.
securities listed (or American depository receipts listed) on any United (4) An officer or employee of an entity that has a class of equity States national securities exchange is not required to report signature authority over a foreign financial account of such entity.
to report signature authority over a foreign financial account of the (5) An officer or employee of a United States subsidiary is not required subsidiary if its United States parent has a class of equity securities listed on any United States national securities exchange and the subsidiary is included in a consolidated FBAR report of the United States parent.
securities registered (or American depository receipts in respect of (6) An officer or employee of an entity that has a class of equity equity securities registered) under section 12(g) of the Securities
Exchange Act is not required to report signature authority over a foreign financial account of such entity.
Trust Beneficiaries.described in section (2)(e) of the financial interest definition is not A trust beneficiary with a financial interest required to report the trust's foreign financial accounts on an FBAR if the trust, trustee of the trust, or agent of the trust: (1) is a United States person and (2) files an FBAR disclosing the trust's foreign financial accounts.
United States Military Banking Facility.with a financial institution located on a United States military installation A financial account maintained is not required to be reported, even if that military installation is outside of the United States.
Filing Information
When and Where to File. receivedThe FBAR is an annual report and must be the year following the calendar year being reported by the Department of the Treasury on or before June 30th . Do Not file with of federal income tax return.File by mailing to:
Department of the Treasury Post Office Box 32621 Detroit, MI 48232-0621
If an express delivery service is used, file by mailing to:
IRS Enterprise Computing Center ATTN: CTR Operations Mailroom, 4th Floor 985 Michigan Avenue Detroit, MI 48226
The FBAR may be hand delivered to any local office of the Internal Revenue Service for forwarding to the Department of the Treasury, Detroit, MI. The FBAR may also be delivered to the Internal Revenue Service's tax attaches located in United States embassies and
consulates for forwarding to the Department of the Treasury, Detroit, MI. The FBAR is not considered filed until it is received by the Department of the Treasury in Detroit, MI.
No Extension of Time to File. for filing an FBAR. Extensions of time to fileThere is no extension of time available federal tax returns do NOT extend the time for filing an FBAR. If a delinquent FBAR is filed, attach a statement explaining the reason for the late filing.
Amending a Previously Filed FBAR.“Amended” box in the upper right hand corner of the first page of the To amend a filed FBAR, check the FBAR, make the needed additions or corrections, attach a statement explaining the additions or corrections, and staple a copy of the original FBAR to the amendment. An amendment should not be made until at least 90 calendar days after the original FBAR is filed. Follow the instructions in “When and Where to File” to file an amendment.
Record Keeping Requirements. retain records that contain the name in which each account is
Persons required to file an FBAR must maintained, the number or other designation of the account, the name and address of the foreign financial institution that maintains the
account, the type of account, and the maximum account value of each account during the reporting period. The records must be retained for a
Page 7
period of 5 years from June 30th of the year following the calendar year reported and must be available for inspection as provided by law. Retaining a copy of the filed FBAR can help to satisfy the record keeping requirements.
An officer or employee who files an FBAR to report signature authority over an employer's foreign financial account is not required to personally retain records regarding these accounts.
Questions.Computing Center Hotline at 1-800-800-2877, option 2.
For questions regarding the FBAR, contact the Detroit Explanations for Specific Items
Part I — Filer Information
Item 1. reported. If amending a previously filed FBAR, check the “Amended” The FBAR is an annual report. Enter the calendar year being box.
Item 2. Individuals reporting only signature authority, check box “a”. If filing a Check the box that describes the filer. Check only one box. consolidated FBAR, check box “d”. To determine if a consolidated
FBAR can be filed, see Part V. If the type of filer is not listed in boxes “a” through “c”, check box “e”, and enter the type of filer. Persons that should check box “e” include, but are not limited to, trusts, estates, limited liability companies, and tax-exempt entities (even if the entity is organized as a corporation). A disregarded entity must check box “e”, and enter the type of entity followed by “(D.E.)”. For example, a limited liability company that is disregarded for United States federal tax purposes would enter “limited liability company (D.E.)”.
Item 3. Generally, this is the filer's United States social security number (SSN), Provide the filer's United States taxpayer identification number. United States individual taxpayer identification number (ITIN), or
employer identification number (EIN). Throughout the FBAR, numbers should be entered with no spaces, dashes, or other punctuation. If the filer does NOT have a United States taxpayer identification number, complete Item 4.
Item 4. taxpayer identification number. Item 4 requires the filer to provide
Complete Item 4 only if the filer does NOT have a United States information from an official foreign government document to verify the filer's nationality or residence. Enter the document number followed by the country of issuance, check the appropriate type of document, and if “other” is checked, provide the type of document.
Item 5. month, day, and year convention.
If the filer is an individual, enter the filer's date of birth, using the Items 9, 10, 11, 12, and 13. residing in the United States must enter the street address of the
Enter the filer's address. An individual individual's United States residence, not a post office box. An individual residing outside the United States must enter the individual's United States mailing address. If the individual does not have a United States mailing address, the individual must enter a foreign residence address. An entity must enter its United States mailing address. If the entity does not have a United States mailing address, the entity must enter its foreign mailing address.
Item 14. accounts, check “Yes” and enter the number of accounts. Do not If the filer has a financial interest in 25 or more foreign financial complete Part II or Part III of the FBAR. If filing a consolidated FBAR, only complete Part V, Items 34-42, for each United States entity included in the consolidated FBAR.
Note.accounts, only complete Part IV, Items 34-43, for each person for which If the filer has signature authority over 25 or more foreign financial the filer has signature authority, and check “No” in Part I, Item 14.
Filers must comply with applicable recording keeping requirements. See Record Keeping Requirements.
Part II — Information on Financial Account(s) Owned Separately
Enter information in the applicable parts of the form only. Number the pages used, and mail only those pages. If there is not enough space to provide all account information, copy and complete additional pages of the required Part as necessary. Do not use any attachments unless otherwise specified in the instructions.
Form TD F 90-22.1 (Rev. 3-2011)
Item 15. Determining Maximum Account Value.
Step 1.of that account) during the calendar year being reported. The maximum Determine the maximum value of each account (in the currency value of an account is a reasonable approximation of the greatest value of currency or nonmonetary assets in the account during the calendar year. Periodic account statements may be relied on to determine the maximum value of the account, provided that the statements fairly reflect the maximum account value during the calendar year. For Item 15, if the filer had a financial interest in more than one account, each account must be valued separately.
Step 2.maximum account value for each account into United States dollars. In the case of non-United States currency, convert the
Convert foreign currency by using the Treasury's Financial Management Service rate (this rate may be found at www.fms.treas.gov) from the last day of the calendar year. If no Treasury Financial Management Service rate is available, use another verifiable exchange rate and provide the source of that rate. In valuing currency of a country that uses multiple exchange rates, use the rate that would apply if the currency in the
account were converted into United States dollars on the last day of the calendar year.
If the aggregate of the maximum account values exceeds $10,000, an FBAR must be filed. An FBAR is not required to be filed if the person did not have $10,000 of aggregate value in foreign financial accounts at any time during the calendar year.
For United States persons with a financial interest in or signature
authority over fewer than 25 accounts that are unable to determine if the aggregate maximum account values of the accounts exceeded $10,000 at any time during the calendar year, complete Part II, III, IV, or V, as appropriate, for each of these accounts and enter “value unknown” in Item 15.
Item 16. selected, describe the account.
Indicate the type of account. Check only one box. If “Other” is Item 17. account is held.
Provide the name of the financial institution with which the Item 18. to designate the account.
Provide the account number that the financial institution uses Items 19-23. institution where the account is located. If the foreign address does not Provide the complete mailing address of the financial include a state (e.g., province) or postal code, leave the box(es) blank.
Part III — Information on Financial Account(s) Owned Jointly
Enter information in the applicable parts of the form only. Number the pages used, and mail only those pages. If there is not enough space to provide all account information, copy and complete additional pages of the required Part as necessary. Do not use any attachments unless otherwise specified in the instructions.
For Items 15-23, see Part II. value of the account as determined under Item 15.
Each joint owner must report the entire Item 24. number is not known, provide an estimate. Do not count the filer when Enter the number of joint owners for the account. If the exact determining the number of joint owners.
Items 25-33. (excluding the filer) to complete Items 25-33. Leave blank items for
Use the identifying information of the principal joint owner which no information is available. If the filer's spouse has an interest in a jointly owned account, the filer's spouse is the principal joint owner. Enter “(spouse)” on line 26 after the last name of the joint spousal
owner. See Exceptions, Certain Accounts Jointly Owned by Spouses, to determine if the filer's spouse is required to independently report the jointly owned accounts.
Part IV — Information on Financial Account(s) Where Filer has Signature Authority but No Financial Interest in the Account(s)
Enter information in the applicable parts of the form only. Number the pages used, and mail only those pages. If there is not enough space to provide all account information, copy and complete additional pages of the required Part as necessary. Do not use any attachments unless otherwise specified in the instructions.
25 or More Foreign Financial Accounts.over 25 or more foreign financial accounts must complete only Items Filers with signature authority 34-43 for each person on whose behalf the filer has signature authority.
Page 8
Modified Reporting for United States Persons Residing and
Employed Outside of the United States.(1) an employer who is physically located outside of the United States, and resides outside of the United States, (2) A United States person who is an officer or employee of (3)or maintained by the individual's employer should only complete Part I has signature authority over a foreign financial account that is owned and Part IV, Items 34-43 of the FBAR. Part IV, Items 34-43 should only be completed one time with information about the individual's employer.For Items 15-23, see Part II.
Items 34-42.owner of the foreign financial account for which the individual has
Provide the name, address, and identifying number of the signature authority over but no financial interest in the account. If there is more than one owner of the account for which the individual has signature authority, provide the information in Items 34-42 for the principal joint owner (excluding the filer). If account information is completed for more than one account of the same owner, identify the owner only once and write “Same Owner” in Item 34 for the succeeding accounts with the same owner.
Item 43. authority (e.g., treasurer).
Enter filer's title for the position that provides signature Part V — Information on Financial Account(s) Where Corporate Filer Is Filing a Consolidated Report
Enter information in the applicable parts of the form only. Number the pages used, and mail only those pages. If there is not enough space to provide all account information, copy and complete additional pages of the required Part as necessary. Do not use any attachments unless otherwise specified in the instructions.
Who Can File a Consolidated FBAR.person that owns directly or indirectly a greater than 50 percent interest An entity that is a United States in another entity that is required to file an FBAR is permitted to file a consolidated FBAR on behalf of itself and such other entity. Check box “d” in Part I, Item 2 and complete Part V. If filing a consolidated FBAR and reporting 25 or more foreign financial accounts, complete only Items 34-42 for each entity included in the consolidated FBAR.For Items 15-23, see Part II.
Items 34-42. number, and address of the owner of the foreign financial account as Provide the name, United States taxpayer identification shown on the books of the financial institution. If account information is completed for more than one account of the same owner, identify the owner only once and write “Same Owner” in Item 34 for the succeeding accounts of the same owner.
Signatures
Items 44-46. the FBAR is being filed on behalf of a partnership, corporation, limited The FBAR must be signed by the filer named in Part I. If liability company, trust, estate, or other entity, it must be signed by an authorized individual. Enter the authorized individual's title in Item 45.An individual must leave “Filer's Title” blank, unless the individual is filing an FBAR due to the individual's signature authority. If an individual is filing because the individual has signature authority over a foreign financial account, the individual should enter the title upon which his or her authority is based in Item 45.
A spouse included as a joint owner, who does not file a separate FBAR in accordance with the instructions in Part III, must also sign the FBAR (in Item 44) for the jointly owned accounts. See the instructions for Part III.
Penalties
A person who is required to file an FBAR and fails to properly file may be subject to a civil penalty not to exceed $10,000. If there is reasonable cause for the failure and the balance in the account is properly reported, no penalty will be imposed. A person who willfully fails to report an account or account identifying information may be subject to a civil monetary penalty equal to the greater of $100,000 or 50 percent of the balance in the account at the time of the violation. See 31 U.S.C. section 5321(a)(5). Willful violations may also be subject to criminal penalties under 31 U.S.C. section 5322(a), 31 U.S.C. section 5322(b), or 18 U.S.C. section 1001.
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