Account Owner ? John Client (use your own name on the form)

1. Checking account #111222333 held at US Bank, 100 Main Street, Big City, OH 45000. Balance - $8,225 on 6/30/16; $5,129 on 12/31/16
2. Investment account #FNY309 held at London Investments, 100 Broad Street, London 1ZZ UK Value ? 32,789 euro on 6/30/16; 37,578 euro on 12/31/16

Account Owner ? ABC Corp

1. Checking account #333444555 held at US Bank, 100 Main Street, Big City, OH 45000. Balance - $25,895 on 6/30/16; $24,433 on 12/31/16
2. Savings account #42A000 held at Deutsche Bank, 500 Vine Street, Big City, OH 45000. Balance - $5,602 on 6/30/16; $12,985 on 12/31/16
3. Checking account #DM998400 held at Bank of Hamburg, 12 Mainstrasse, Hamburg, Germany 9900.
4. Balance ? 41,675 euro on 6/30/16; 40,768 euro on 12/31/16
5. Checking account #P10333AB held at US Bank, 250 Broad Street, London ZZ99 1AB United
6. Kingdom
7. Balance - $102,699 on 6/30/16; $137,547 on 12/31/16

Account Owner ? XYZ Corp

1. Checking account #555666777 held at US Bank, 100 Main Street, Big City, OH 45000. Balance - $59,632 on 6/30/16; $8,420 on 12/31/16
2. Checking account #DM665300 held at Bank of Hamburg, 12 Mainstrasse, Hamburg, Germany 9900
3. Balance ? 60,341 euro on 6/30/16; 78,364 euro on 12/31/16

TREASURY REPORTING RATES OF EXCHANGE AS OF DECEMBER 31, 2016 COUNTRY-CURRENCY AFGHANISTAN - AFGHANI ALBANIA - LEK ALGERIA - DINAR ANGOLA - KWANZA ANTIGUA - BARBUDA - E. CARIBBEAN DOLLAR ARGENTINA-PESO ARMENIA - DRAM AUSTRALIA - DOLLAR AUSTRIA - EURO AZERBAIJAN - NEW MANAT BAHAMAS - DOLLAR BAHRAIN - DINAR BANGLADESH - TAKA BARBADOS - DOLLAR BELARUS - NEW RUBLE BELARUS - RUBLE BELGIUM-EURO BELIZE - DOLLAR BENIN - CFA FRANC BERMUDA - DOLLAR BOLIVIA - BOLIVIANO BOSNIA-HERCEGOVINA MARKA BOTSWANA - PULA BRAZIL - REAL BRUNEI - DOLLAR BULGARIA - LEV BURKINA FASO - CFA FRANC BURMA-MYANMAR-KYAT BURUNDI - FRANC CAMBODIA (KHMER) - RIEL CAMEROON - CFA FRANC CANADA - DOLLAR CAPE VERDE - ESCUDO CAYMAN ISLANDS - DOLLAR CENTRAL AFRICAN REPUBLIC - CFA FRANC CHAD - CFA FRANC CHILE - PESO CHINA - RENMINBI COLOMBIA - PESO F.C. TO $1.00 66.5000 128.2500 110.0180 170.0000 2.7000 15.9030 480.0000 1.3850 0.9490 1.8400 1.0000 0.3770 79.0000 2.0200 1.9590 19585.0000 0.9490 2.0000 625.1400 1.0000 6.8700 1.8560 10.6720 3.2530 1.4450 1.8560 625.1400 1365.0000 1650.0000 4103.0000 621.7300 1.3460 104.7280 0.8200 621.7300 621.7300 668.8000 6.9420 3001.5000 COMOROS - FRANC CONGO - CFA FRANC CONGO, DEM. REP - CONGOLESE FRANC COSTA RICA - COLON COTE D'IVOIRE - CFA FRANC CROATIA - KUNA CUBA-PESO CYPRUS-EURO CZECH - KORUNA DENMARK - KRONE DJIBOUTI - FRANC DOMINICAN REPUBLIC - PESO ECUADOR-DOLARES EGYPT - POUND EL SALVADOR-DOLARES EQUATORIAL GUINEA - CFA FRANC ERITREA - NAKFA ESTONIA-EURO ETHIOPIA - BIRR EURO ZONE - EURO FIJI - DOLLAR FINLAND-EURO FRANCE-EURO GABON - CFA FRANC GAMBIA - DALASI GEORGIA-LARI GERMANY FRG-EURO GHANA - CEDI GREECE-EURO GRENADA - EAST CARIBBEAN DOLLAR GUATEMALA - QUETZAL GUINEA - FRANC GUINEA BISSAU - CFA FRANC GUYANA - DOLLAR HAITI - GOURDE HONDURAS - LEMPIRA HONG KONG - DOLLAR HUNGARY - FORINT ICELAND - KRONA INDIA - RUPEE INDONESIA - RUPIAH IRAN - RIAL IRAQ - DINAR 462.6500 621.7300 1210.0000 546.0000 625.1400 7.0500 1.0000 0.9490 25.0450 7.0540 177.0000 46.5900 1.0000 18.0000 1.0000 621.7300 15.0000 0.9490 22.4000 0.9490 2.0730 0.9490 0.9490 621.7300 44.0000 2.6600 0.9490 4.2200 0.9490 2.7000 7.5220 9225.0000 625.1400 205.0000 66.4600 23.4000 7.7560 293.7500 112.8700 67.8000 13380.0000 32376.0000 1166.0000 IRELAND-EURO ISRAEL-SHEKEL ITALY-EURO JAMAICA - DOLLAR JAPAN - YEN JERUSALEM-SHEKEL JORDAN - DINAR KAZAKHSTAN - TENGE KENYA - SHILLING KOREA - WON KUWAIT - DINAR KYRGYZSTAN - SOM LAOS - KIP LATVIA - EURO LEBANON - POUND LESOTHO - SOUTH AFRICAN RAND LIBERIA - U.S. DOLLAR LIBYA-DINAR LITHUANIA - EURO LUXEMBOURG-EURO MACAO - MOP MACEDONIA FYROM - DENAR MADAGASCAR-ARIA MALAWI - KWACHA MALAYSIA - RINGGIT MALI - CFA FRANC MALTA-EURO MARSHALLS ISLANDS - DOLLAR MARTINIQUE-EURO MAURITANIA - OUGUIYA MAURITIUS - RUPEE MEXICO - NEW PESO MICRONESIA - DOLLAR MOLDOVA - LEU MONGOLIA - TUGRIK MONTENEGRO-EURO MOROCCO - DIRHAM MOZAMBIQUE - METICAL NAMIBIA-DOLLAR NEPAL - RUPEE NETHERLANDS-EURO NETHERLANDS ANTILLES - GUILDER NEW ZEALAND - DOLLAR 0.9490 3.8410 0.9490 128.0000 117.0300 3.8410 0.7080 333.3000 102.4500 1203.2100 0.3050 69.3000 8170.0000 0.9490 1500.0000 13.7070 91.0000 1.4380 0.9490 0.9490 8.0000 58.1200 3350.5400 747.0000 4.4850 625.1400 0.9490 1.0000 0.9490 355.0000 35.8700 20.6520 1.0000 19.9000 2489.5300 0.9490 10.1540 70.8000 13.7070 108.7000 0.9490 1.7800 1.4370 NICARAGUA - CORDOBA NIGER - CFA FRANC NIGERIA - NAIRA NORWAY - KRONE OMAN - RIAL PAKISTAN - RUPEE PALAU-DOLLAR PANAMA - BALBOA PAPUA NEW GUINEA - KINA PARAGUAY - GUARANI PERU - NUEVO SOL PHILIPPINES - PESO POLAND - ZLOTY PORTUGAL-EURO QATAR - RIYAL ROMANIA - LEU RUSSIA - RUBLE RWANDA - FRANC SAO TOME & PRINCIPE - DOBRAS SAUDI ARABIA - RIYAL SENEGAL - CFA FRANC SERBIA-DINAR SEYCHELLES - RUPEE SIERRA LEONE - LEONE SINGAPORE - DOLLAR SLOVAK REPUBLIC - EURO SLOVENIA - EURO SOLOMON ISLANDS - DOLLAR SOUTH AFRICA - RAND SOUTH SUDANESE - POUND SPAIN - EURO SRI LANKA - RUPEE ST LUCIA - EC DOLLAR SUDAN - SUDANESE POUND SURINAME - GUILDER SWAZILAND - LILANGENI SWEDEN - KRONA SWITZERLAND - FRANC SYRIA - POUND TAIWAN - DOLLAR TAJIKISTAN - SOMONI TANZANIA - SHILLING THAILAND - BAHT 29.0500 625.1400 304.2000 8.6210 0.3850 104.3500 1.0000 1.0000 3.1010 5755.0000 3.3570 49.5910 4.1850 0.9490 3.6410 4.3050 61.0220 815.0000 23556.0240 3.7500 625.1400 117.1400 13.2190 7451.0000 1.4450 0.9490 0.9490 7.9370 13.7070 80.0000 0.9490 149.6000 2.7000 7.1000 7.4850 13.7070 9.0630 1.0190 515.0000 32.4010 7.8000 2178.0000 35.7700 TIMOR - LESTE DILI TOGO - CFA FRANC TONGA - PA'ANGA TRINIDAD & TOBAGO - DOLLAR TUNISIA - DINAR TURKEY - LIRA TURKMENISTAN - MANAT UGANDA - SHILLING UKRAINE - HRYVNIA UNITED ARAB EMIRATES - DIRHAM UNITED KINGDOM - POUND STERLING URUGUAY - PESO UZBEKISTAN - SOM VANUATU - VATU VENEZUELA - BOLIVAR VIETNAM - DONG WESTERN SAMOA - TALA YEMEN - RIAL ZAMBIA - NEW KWACHA ZAMBIA - KWACHA ZIMBABWE - DOLLAR 1.0000 625.1400 2.1530 6.6900 2.3010 3.5220 3.4910 3607.0000 27.0000 3.6720 0.8120 29.0700 3286.0000 111.8000 673.8300 22770.0000 2.4960 250.5000 9.9150 5455.0000 1.0000 DEPARTMENT OF THE TREASURY BUREAU OF FISCAL SERVICE FUNDS MANAGEMENT DIVISION [202] 874-7994 https://www.fiscal.treasury.gov/fsreports/rpt/treasRptRateExch/treasRptRateExch_home.htm Financial Crimes Enforcement Network BSA Electronic Filing Requirements For Report of Foreign Bank and Financial Accounts (FinCEN Form 114) Release Date January 2017 (v1.4) Effective January 2017 for the 2017 or earlier filing requirement. 1 Revision History Version Number Date Reason for Change 1.0 09/30/2013 Initial Version 1.1 3/14/2014 Conversion Rate - Incorrect Link: Updated Page 9, Second Paragraph starting with Step 2, Second Sentence, previous text: Convert foreign currency by using the Treasury's Financial Management Service rate (select Exchange Rates under Reference & Guidance at www.fms.treas.gov) for the last day of the calendar year. New text: Convert foreign currency by using the Treasury's Financial Management Service rate (http://www.fms.treas.gov/intn.html) for the last day of the calendar year. Amendment Instructions Clarification: Updated Page 7, Second Paragraph from Bottom of Page, entitled Amended Reports, previous text: Amended reports: An amended report must be filed whenever errors are discovered in a previously-filed FBAR. Please refer to the BSA Electronic Filing Requirements Attachment B - Error Correction Instructions for information regarding filing amended FBARs. New Text: Amended reports: If you filed your FBAR through the BSA E-Filing website and you need to amend your FBAR to correct any information, please fill out a new FBAR completely and check the Amend box in Item 1. You will need to provide your Prior Report BSA Identifier after selecting the Amend box. Your Prior Report BSA Identifier was provided to you either through email or via the BSA E-Filing System's secure messaging feature. If your Prior Report BSA Identifier is not known, please enter 00000000000000 in the Prior Report BSA Identifier field. If your FBAR was filed using batch mode, an amended report must be filed whenever errors are discovered in a previously-filed FBAR. Please refer to the BSA Electronic Filing Requirements Attachment B - Error Correction Instructions (http://bsaefiling.fincen.treas.gov/docs/FinCENFBARElectronicFilingRequirements .pdf) for information regarding filing amended FBARs. 2 1.2 3/28/2014 Telephone Numbers - Additional Instruction - Page 9 Added the following sentence to the end of the description: Telephone numbers that are part of the North American Numbering Plan should not be preceded with a \"1\". Monetary Amounts - Additional Instruction - Page 10 Added the following sentence to the end of the description: Note: After determining the value of the account, as described below, if the value results in a negative (minus) value, enter zero (0) in Item 15, Maximum Account Value. 1.3 6/11/2014 Filing requirement for minors clarified on Page 6. Added the following additional text: Responsibility for Child's FBAR Generally, a child is responsible for filing his or her own FBAR report. If a child cannot file his or her own FBAR for any reason, such as age, the child's parent, guardian, or other legally responsible person must file it for the child. Signing the child's FBAR. If the child cannot sign his or her FBAR, a parent or guardian must electronically sign the child's FBAR. In item 45 Filer Title enter \"Parent/Guardian filing for child.\" 1.4 1/1/2017 As mandated by the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015, Public Law 114-41 (the Act), the annual due date for filing FBARs is April 15th. The Act also mandated a maximum six-month extension of the filing deadline. FinCEN will grant filers failing to meet the FBAR annual due date of April 15th an automatic extension to October 15th each year. 3 FBAR - Electronic Filing Instructions The following instructions apply only to the electronic filing of the Report of Foreign Bank and Financial Accounts (FBAR), FinCEN Form 114, through the Financial Crimes Enforcement Network's (FinCEN's) BSA E-Filing System. Unless specifically mentioned in the text, these instructions do not apply to any other current or prior Bank Secrecy Act (BSA) reports. Also, the instructions or requirements for any prior or current BSA reports, including paper versions of the FBAR, do not apply to FBARs filed electronically under these filing requirements and instructions. General Instructions Purpose. FinCEN Form 114, Report of Foreign Bank and Financial Accounts, 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 April 15th of the year immediately following the calendar year being reported. FinCEN will grant filers failing to meet the FBAR annual due date of April 15th an automatic extension to October 15th each year. Accordingly, specific requests for this extension are not required. Who Must File an FBAR. A United States person that has a financial interest in or signature authority over foreign financial accounts must file 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. A financial account includes, but is not limited to, a securities, brokerage, savings, demand, checking, deposit, time deposit, 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). Joint Account. A financial account type listed above owned jointly by two or more persons. Foreign Financial Account. A foreign financial account is a financial account located outside of the United States. For example, an account 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. 4 Financial Interest. A United States person has a financial interest in a foreign financial account for which: 1. the United States person is the owner of record or holder of legal title, regardless of whether the account is maintained for the benefit of 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. An agent, nominee, attorney, or a person acting in some other capacity on behalf of the United States person with respect to the account; b. A corporation in which the United States person owns directly or indirectly: (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. A partnership in which the United States person owns directly or indirectly: (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. A trust of which the United States person: (i) is the trust grantor and (ii) has an ownership interest in the trust for United States federal tax purposes. See 26 U.S.C. sections 671-679 to determine if a grantor has an ownership interest in a trust; e. A trust in which the United States person has a greater than 50 percent present beneficial interest in the assets or income of the trust for the calendar year; or f. Any other entity in which the United States person owns directly or indirectly more than 50 percent of the voting power, total value of equity interest or assets, or interest in profits. Person. A person means an individual (including a minor child) and legal entities including, but not limited to, a limited liability company, corporation, partnership, trust, and estate. Signature Authority. Signature authority is the authority of an individual (alone or in conjunction with another individual) to control the disposition 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. United States. For FBAR purposes, the United States includes the States, the District of Columbia, all United States territories and 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. United States person means United States citizens (including minor children); United States residents; entities, including but not limited to, corporations, partnerships, or limited liability 5 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 federal tax treatment of an entity does not determine whether the entity has an FBAR filing requirement. For example, an entity that is 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. Responsibility for Child's FBAR Generally, a child is responsible for filing his or her own FBAR report. If a child cannot file his or her own FBAR for any reason, such as age, the child's parent, guardian, or other legally responsible person must file it for the child. Signing the child's FBAR. If the child cannot sign his or her FBAR, a parent or guardian must electronically sign the child's FBAR. In item 45 Filer Title enter \"Parent/Guardian filing for child.\" United States Resident. A United States resident is an alien residing in the United States. To determine if the filer is a resident of the United 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. The spouse of an individual who files an FBAR is not required to file a separate FBAR if 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 electronically signed; and (3) the filers have completed and signed Form 114a, \"Record of Authorization to Electronically File FBAR's\" (maintained with the filers' records). Otherwise, both spouses are required to file separate FBARs, and each spouse must report the entire value of the jointly owned accounts. See instructions for specific items, Part III, Items 25-33. Consolidated FBAR. If a United States person that is an entity is named in a consolidated FBAR filed by a greater than 50 percent owner, such entity is not required to file a separate FBAR. See Explanations for Specific Items, Part V. Correspondent/Nostro Account. Correspondent or nostro accounts (which are maintained by banks and used solely for bank-to-bank settlements) are not required to be reported. Governmental Entity. A foreign financial account of any governmental entity of the United States (as defined above) is not required to be reported by any person. For purposes of this form, governmental entity includes a college or university that is an agency of, an 6 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. A foreign financial account of any international financial institution (if the United States government is a member) is not required to be reported by any person. IRA Owners and Beneficiaries. An owner or beneficiary of an IRA is not required to report a foreign financial account held in the IRA. 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. Individuals who have signature authority over, but no financial interest in, a foreign financial account are not required to report the account in the following situations: 1. An officer or employee of a bank that is examined by the Office of the Comptroller of the Currency, the Board of Governors of the Federal 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. 2. An officer or employee of a financial institution that is registered with and examined by the Securities and Exchange Commission or Commodity Futures Trading Commission is not required to report signature authority over a foreign financial account owned or maintained by the financial institution. 3. An officer or employee of an Authorized Service Provider is not required to report signature authority over a foreign financial account 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. 4. An officer or employee of an entity that has a class of equity securities listed (or American depository receipts listed) on any United States national securities exchange is not required to report signature authority over a foreign financial account of such entity. 5. An officer or employee of a United States subsidiary is not required to report signature authority over a foreign financial account of the 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. 6. An officer or employee of an entity that has a class of equity securities registered (or American depository receipts in respect of 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. 7 Trust Beneficiaries. A trust beneficiary with a financial interest described in section (2)(e) of the financial interest definition is not 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. A financial account maintained with a financial institution located on a United States military installation is not required to be reported, even if that military installation is outside of the United States. Filing Information: When and Where to File. The FBAR is an annual report and must be filed on or before April 15th of the year following the calendar year being reported. The FBAR must be filed electronically through FinCEN's BSA E-Filing System. The application to file electronically is available at http://bsaefiling.fincen.treas.gov/ . For help in applying, contact the E-Filing Help Desk by calling 1-866-346-9478 (option 1) or via E-mail sent to BSAEFilingHelp@fincen.gov. Note: The FBAR filing deadline will follow the Federal income tax due date guidance, which notes that when the Federal income tax due date falls on a Saturday, Sunday, or legal holiday, a return is considered timely filed if filed on the next succeeding day that is not a Saturday, Sunday, or legal holiday. Extension of Time to File. FinCEN will grant filers failing to meet the FBAR annual due date of April 15th an automatic extension to October 15th each year. Accordingly, specific requests for an extension are not required. Record Keeping Requirements. Persons required to file an FBAR must retain records that contain the name in which each account is 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 period of 5 years from April 15th of the year following the calendar year reported, or the date filed if after April 15th, 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. Recording information: Complete each FBAR by providing as much information as possible. Although all items should be completed fully and accurately, items marked with an asterisk (*) in the instructions must be completed. NOTE: Throughout these instructions the phrase \"check box\" and similar wording is used to denote checking an appropriate box in certain data items on the electronic discrete FBAR. This is deemed equivalent to instructions in the Electronic Filing Requirements to enter appropriate codes in the same data items in transmission files. For example, the requirement to check a box in Item 2 \"Type of Filer\" in the discrete FBAR is the equivalent of entering one of the 8 codes A through E in \"Type of Filer\" in the Electronic Filing Requirements Filer Information (2A) Record. Amended reports: If you filed your FBAR through the BSA E-Filing website and you need to amend your FBAR to correct any information, please fill out a new FBAR completely and check the Amend box in Item 1. You will need to provide your Prior Report BSA Identifier after selecting the Amend box. Your Prior Report BSA Identifier was provided to you either through email or via the BSA E-Filing System's secure messaging feature. If your Prior Report BSA Identifier is not known, please enter 00000000000000 in the Prior Report BSA Identifier field. If your FBAR was filed using batch mode, an amended report must be filed whenever errors are discovered in a previously-filed FBAR. Please refer to the BSA Electronic Filing Requirements Attachment B - Error Correction Instructions (http://bsaefiling.fincen.treas.gov/docs/FinCENFBARElectronicFilingRequirements.pdf) for information regarding filing amended FBARs. Addresses: For addresses in the U.S., Canada, or Mexico enter the permanent street address, city, two or three letter state/territory/province abbreviation or code, ZIP Code or foreign postal code, and two letter country code. Provide the apartment number or suite number, if known, following the street address. A non-location address such as a post office box or rural route number should be used only if no other street address information is available. ZIP Codes must be five or nine digits. Nine-digit ZIP Codes cannot end with four zeroes or four nines. ZIP Codes and foreign postal codes must be entered without formatting or special characters such as spaces or hyphens. For example, the ZIP Code 12354-6120 would be entered as 123546120. The foreign postal code HKW 702 would be entered HKW702. For other foreign addresses enter the street address, city, postal code, and two letter country code or address equivalents. Leave the state item blank. If a foreign address contains address information that does not conform to the FBAR address format, record equivalent address information in the FBAR address items (except state). Enter as much of any non-conforming data as will fit in the 100-character street address field. Complete any address item that is known, even if some address items cannot be completed because of incompatible formats (e.g. state codes). No abbreviations are permitted in city names, which must be completely spelled out. A U.S. city name should match the city name used by the U.S. Postal Service for the associated state and ZIP Code. For U.S. address use only the authorized U.S. Postal Service state, territory, or military address abbreviations found at https://www.usps.com/ship/official-abbreviations.htm. For Canadian provinces and territories use the Canada Post Corporation codes found at http://www.canadapost.ca/tools/pg/manual/PGaddress-e.asp#1380608. For Mexican states and territories use the ISO 3166-2 three-letter codes found at http://www.commondatahub.com/live/geography/state_province_region/iso_3166_2_state_co des. For all countries use the ISO 3166-1 two-letter country codes found at http://www.iso.org/iso/country_names_and_code_elements. Additional information about ISO 3166 codes can be found on the BSA E-Filing Program website. Note: The ISO 3166-1 country list includes entries for all U.S. territories. Do not use these U.S. territory entries, which match the U.S. Postal Service abbreviations required in state fields, in any country field. 9 Telephone numbers: Record all telephone numbers as a single number string without formatting or special characters such as parentheses, spaces, or hyphens. For example, a number in the format (NNN) NNN-NNNN would be recorded as NNNNNNNNNN. Telephone numbers that are part of the North American Numbering Plan used by the U.S., Canada, many Caribbean countries, and present/former U.S. Pacific island protectorates must consist of an area code and seven-digit telephone number. Telephone numbers that are part of the North American Numbering Plan should not be preceded with a \"1.\" Identifying numbers: Enter all identifying numbers as a single text string without formatting or special characters such as hyphens or periods. An identifying number in the format NNNNN- NNNN would be entered as NNNNNNNNN. Such numbers may include letter and number characters. Common identifying numbers include account numbers, alien registration numbers, Employer Identification Numbers (EIN), passport numbers, Social Security Numbers (SSN), and foreign TIN's. Monetary amounts: When recording the maximum value of accounts, record all amounts as U.S. Dollar amounts rounded up to the next whole dollar. The amount $15,265.25 would be recorded as $15,266. The maximum value of the account can be determined using the following steps. NOTE: After determining the value of the account, as described below, if the value results in a negative (minus) value, enter zero (0) in item 15, \"Maximum account value.\" Step 1. Determine the maximum value of each account (in the currency of that account) during the calendar year being reported. The maximum 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. For an account denominated in U.S. Dollars, the maximum value of the account is the largest U.S. Dollar value of the account during the report year. Step 2. In the case of non-United States currency, convert the maximum account value for each account into United States dollars. Convert foreign currency by using the Treasury's Financial Management Service rate (select Exchange Rates under Reference & Guidance at www.fms.treas.gov) for 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 maximum account value of a single account or aggregate of the maximum account values of multiple accounts exceeds $10,000, an FBAR must be filed. An FBAR is not required 10 to be filed if the person did not have $10,000 of maximum value or aggregate maximum 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 the appropriate Part II, III, IV, or V section for each of these accounts and check the \"amount unknown\" box, item 15a. Prohibited Entries: The following entries and their variations are prohibited in text fields. a. AKA b. COMPUTER GENERATED c. DBA d. NONE e. NOT APPLICABLE f. OTHER g. SAME h. SAME AS ABOVE i. SEE ABOVE j. SIGNATURE CARD k. UNKNOWN l. VARIOUS m. XX Name Editing Instructions: Because many names do not consist of a single first name, middle name, and last name, care must be taken to ensure these names are entered properly in the FBAR. This is especially important when there are separate fields for the last name, first name, and middle name. Some names have multiple surnames (family names) or given names. Others may not be written in [first name] [middle name] [last name] order. Multiple surnames must be entered in the last name field. For example, Spanish names may be written in the order of given name, father's last name, and mother's last name, e.g., \"Juan Vega Santiago.\" Thus the surname \"VEGA SANTIAGO\" would be entered in the last name field with\"JUAN\" entered in the first name field. Some Spanish surnames consist of three names (e.g., father's last name, mother's last name, and husband's first last name). In that case all three would be entered in a last name field. In some cultures names consist of multiple first names and a single family name, not necessarily in (first name) (last name) order. For example, the Korean name \"Kim, Chun Nam\" consists of the family name \"Kim\" and the first name \"Chun Nam\" separated by a comma and space. There is no middle name. In this case \"KIM\" would be entered in the last name field and \"CHUN NAM\" would be entered in the first name field. Nothing is entered in the middle name field. When an individual name is entered in a single name field it should be entered in [first name] [middle name] [last name] order regardless of any foreign naming conventions. Thus, \"Kim, Chun Nam\" would be entered as \"CHUN NAM KIM\" in a single field. Filing by Third Party Preparer: An FBARs may be completed and filed on behalf of the filer 11 and/or owner of the foreign account(s) by a third party preparer. The filer or owner who is using a third party preparer should complete and maintain a record of FinCEN Form 114a, FinCEN BSA E-Filing Signature Authorization Record, to authorize the third party filing. Do not file or send the completed Form 114a to FinCEN. Form 114a must be maintained by the filer or owner and made available to FinCEN or IRS on request. The third party preparer will complete FBAR Parts I through V and the Signature section using the following Item Instructions. NOTE: Spouses filing a joint FBAR also may use the form 114a to approve/designate which spouse will sign the report. (http://www.fincen.gov/forms/files/FBAREFileAuth114aRecordSP.pdf) Item Instructions: Filers must use the BSA E-Filing website (http://bsaefiling.fincen.treas.gov/) to file an FBAR. Individuals do not have to register to file an FBAR. Institutions are required to register for a UserID and password prior to submitting an FBAR. For more information on this requirement, reference the FAQs posted at http://bsaefiling.fincen.treas.gov/docs/FBAR_EFILING_FAQ.pdf. Once a new FBAR is opened via the BSA E-Filing System a header/cover page will display the FBAR version number, OMB control number, and several other items of information. 1. Filing Name: The filer will enter a unique name for the report being filed. Filers will use this name to track the status of the report in the BSA E-Filing system. Select a name such as \"John's 2013 FBAR\" or \"entity name 2013 FBAR\" etc. This is a filer determined name. 2. Select the appropriate check box for submission type; New report or Amendment 3. If an authorized third party is filing this report, check the box provided and complete the third party section on the first page of the report. 4. If this report is being late filed (i.e., filed after October 15th of the year following the reporting year) make selection from the drop-down list to indicate the reason. If one of the provided selections does not explain the reason, select \"other\" and provide a written explanation in the text box provided. NOTE: If you are filing this report late because an earlier FinCEN filing waiver applied to you, check box \"z\" other and identify the waiver by number (e.g., FinCEN notice 2011-1 etc.) in the text field provided. Scroll down to or select page one of the report (page following the header/cover page) 1. *Calendar year - This report is for calendar year ended 12/31 (Check if) Amended Item 1. Enter the calendar year being reported as a numeric 4-position entry in the format: YYYY, e.g. 2012. If the FBAR amends a prior report, select "Amendment" from the Submission Type drop-down menu on the FBAR Header page. You will need to provide your Prior Report BSA Identifier after selecting the Amend box. Your Prior Report BSA Identifier was provided to you either through email or via the BSA E-Filing System's secure messaging 12 feature. If your Prior Report BSA Identifier is not known, please enter 00000000000000 in the Prior Report BSA Identifier field. Part I Filer information 2. *Type of filer a. b. c. d. e. (Check if) Individual (Check if) Partnership (Check if) Corporation (Check if) Consolidation (Check if) Fiduciary or other (* and specify type in space provided) Item 2. Check the box that describes the filer. Individuals, including those reporting only signature authority, should check box \"a\". If filing a consolidated FBAR, check box \"d\". To determine if a consolidated FBAR can be filed, see the instructions for Part V. A corporation which owns directly or indirectly more than a 50 percent interest in one or more other entities required to file this report will be permitted to file a consolidated report. If the type of filer is not covered by options \"a\" through \"d,\" check box \"e\" and record the type of filer in the associated text field. Consolidated reports should be signed by an authorized official of the parent entity. 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.)\". 3. *U.S. Taxpayer Identification Number If filer has no U.S. Identification Number complete Item 4. Item 3. Provide the filer's U.S. Taxpayer Identification Number (TIN). Generally, this is the filer's Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN), or Employer Identification Number (EIN). If the filer does NOT have a U.S. TIN, complete Item 4. 3a TIN type. Select the appropriate entry to indicate the type of number entered in item 3. 4. Foreign identification (*Complete only if item 3 is not applicable) a. Select Passport or Foreign TIN or Other If Other is selected enter a description b. Number c. Country of issue (Two letter designation from the dropdown Country code lists) Item 4. Complete Item 4 only if the filer does NOT have a United States Taxpayer Identification Number. Item 4 requires the filer to provide information from an official foreign government document to verify the filer's nationality or residence. Check the appropriate type of document, either Passport, Foreign TIN, or Other. If \"Other\" is checked provide the type of document in 13 the associated text field. Enter the document number followed by the country of issuance. 5. Individual's date of birth Item 5. Enter the filer's date of birth in the format MM/DD/YYYY where MM is the month, DD is the day, and YYYY is the year. Zero (0) should precede any single digit number. For example, if the filer's date of birth is June 1, 1948, enter 06/01/1948 in Item 5. 6-8. Filer name 6. Last name or organization name 7. First name 8. Middle initial 8a. Suffix Items 6-8a. Enter the name of the filer. If the filer is an organization, enter the name in Item 6 and leave Items 7, 8 and 8a blank. If the filer is an individual, enter the filer's last name in Item 6, first name in Item 7, middle initial in Item 8, and any name suffix in 8a. If there is no middle initial, leave Item 8 blank. If there is no name suffix leave Item 8a blank. See the Name Editing Instructions in the General Instructions section above for additional information on entering names in fields. 9-13. Filer address 9. Mailing address (number, street, and apt. or suite no.) 10. City 11. State 12. ZIP/Postal Code 13. Country Items 9-13. Enter the filer's address. An individual residing in the United States must enter the street address of the 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. See the Address instructions in the General Instruction section above for additional information on entering address data in fields. 14. a) Does the filer have a financial interest in 25 or more financial accounts? (Check if) Yes (*Enter total number of accounts in space provided) Do not complete Part II or Part III, but maintain records of the information. (Check if) No 14 b) Does the filer have signature authority over but no financial interest in 25 or more financial accounts? (Check if) Yes (*Enter total number of accounts in space provided) Complete Part IV, items 34 through 43 for each person on whose behalf the filer has signature authority. (Check if) No Item 14. If the filer has a financial interest in over 25 or more foreign financial accounts check the yes box, and enter the total number of accounts in 14a. Leave blank Part II (Continuation of Separate Accounts) or Part III (Joint Accounts) of this report, but maintain records of the information. If filing a consolidated FBAR, the United States person should not complete Part II or Part III but should complete Part V, Items 34-42, for each United States entity included in the consolidated FBAR. If the filer has signature authority only (no financial interest), over 25 or more foreign financial accounts check the yes box, and enter the total number of accounts in 14b. Complete only items 34-43 of Part IV for each person on whose behalf the filer has signature authority. If the group of entities covered by a consolidated report has a financial interest in 25 or more foreign financial accounts, the reporting parent corporation need only complete Part V (for consolidated reporting) Items 34 through 42, for the identity information of the account owners, but need not complete the account information. Detailed information about each account, including all information called for on this report, must be recorded and retained for five years from April 15th of the year following the calendar year reported, or the date filed if after April 15th. Any person who reports 25 or more foreign financial accounts in item 14a or item 14b, must provide all the information omitted from Parts II, III, IV or V, as appropriate, if the information is requested by FinCEN or the IRS. Filers must comply with applicable recording keeping requirements. See Record Keeping Requirements under Filing Information in the General Instructions above. Part II Information on financial account(s) owned separately Part II records information on accounts owned separately by the filer. It should not be used to record information on jointly-owned accounts (Part III), signature authority but no financial interest accounts (Part IV), or accounts involved in a consolidated report (Part V). 15. Maximum value of account during calendar year. Item 15. Enter the maximum value of the account in U.S. Dollars during the calendar year being reported. See the General Instructions on Monetary Amounts for guidance on determining the maximum value of an account. Use the end of the year conversion rate. 15a. Amount unknown. Check this box if the value of the account cannot be determined. 16. Type of account 15 From the dropdown list select Bank, Securities, or Other. If other is selected specify type in space provided. Item 16. Check the appropriate box to describe the type of account. If "Other" is checked, enter a brief description of the account in the associated text field. 17. Name of financial institution in which account is held Item 17. Provide the full name of the financial institution in which account is held. 18. Account number or other designation Item 18. Provide the account number used by the financial institution to designate the account. 19-23. Financial institution address 19. Mailing address (number, street, suite number) of financial institution in which account is held 20. City 21. State, if known 22. Foreign Postal Code, if known 23. Country Items 19-23. Provide the complete mailing address of the financial institution where the account is held. See the General Instruction on Addresses for further information on entering address data. Part III Information on financial account(s) owned jointly Note: If jointly filing with a spouse, both parties should complete and sign Form 114a. Completing the Form 114a with both spouses signing the form completes the necessary requirement that will permit one spouse to electronically sign (PIN) a single report for both parties instead of filing two FBARs. The Form 114a is available on the FinCEN (under the forms tab) and BSA E-File websites. Keep this form for your records, do not send to FinCEN. Enter information in the applicable parts of the report only. If there is not enough space to provide all account information, click the \"+\" sign on the electronic report to add additional Part III's and complete additional pages of the required Part as necessary. 15-23. Account information 16 Items 15-23. Enter the information about the account and the financial institution in which the account is held. See Part II for instructions on Items 15-23. Each joint owner must report the entire value of the account as determined under Item 15. 24. Number of joint owners for this account Item 24. Enter the number of joint owners for the account. If the exact number is not known, provide an estimate. Do not count the filer when determining the number of joint owners. 25-33. Joint owner information Items 25-33. Use the identifying information of the principal joint owner (excluding the filer) to complete Items 25-33. Leave blank items for 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 on line 26 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. 25. Taxpayer Identification Number (TIN) of principle joint owner, if known. Item 25. Taxpayer Identification Number (TIN) of Principle Joint Owner. Enter the TIN of the principle joint owner on the account; this can be either an SSN (individual) or EIN (entity) or foreign. Numbers should be entered as a single number string without formatting or special characters such as parentheses, spaces, or hyphens. 25a. TIN type. Select the appropriate entry to indicate the type on number entered in item 25. 26-28 Joint owner name 26. Last name or organization name of principle joint owner 27. First name of principle joint owner, if known 28. Middle initial, if known 28a. Suffix Items 26-28a. Enter the name of the organization/individual of the principle joint owner. If the principle joint owner is an individual, enter the individual's last name in Item 26, first name in Item 27, middle initial in Item 28 and name suffix in 28a. If there is no middle initial, leave Item 28 blank. If there is no suffix leave item 28a blank. 29-33. Principle joint owner mailing address 29. Mailing address (number, street, suite number) of principal joint owner, if known 30. City, if known 17 31. State, if known 32. ZIP/Postal Code, if known 33. Country Items 29-33. Enter the address of the principal joint owner. If the principal joint owner resides in the United States, enter the street address of the joint owner's United States residence, not a post office box. If the principal joint owner resides outside the United States, enter the joint owner's United States mailing address. If the principal joint owner has no U.S. mailing address the filer may provide a foreign address. Enter an organization joint owner's United States mailing address. See the Addresses instructions in the General Instruction section above for additional information on entering address data in fields. Part IV Information on financial account(s) where filer has signature authority but no financial interest in the account(s) Part IV records information on foreign financial accounts where a filer with signature authority over the accounts but has no financial interest in the accounts. Filers with signature authority over 25 or more foreign financial accounts must complete only Items 34-43 for each person on whose behalf the filer has signature authority. In addition, United States person who (1) resides outside of the United States, (2) is an officer or employee of an employer who is physically located outside of the United States, and (3) has signature authority over a foreign financial account that is owned or maintained by the individual's employer should only complete Part I and Items 34-43 of Part IV. Part IV should only be completed one time with information about the individual's employer. If additional Part IV's are required, click on the \"+\" sign on the electronic report to add copies. 15-23. Account information Items 15-23. Enter the information about the account and the financial institution in which the account is held. See Part II for instructions on Items 15-23. Each joint owner must report the entire value of the account as determined under Item 15. Items 34-42. Provide the name, address, and identifying number of the owner of the foreign financial account for which the individual filer has 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). 34, 36, 37. Account owner name 34. Last name or organization name of account owner 36. First name 37. Middle initial 37a. Suffix 18 Items 34, 36, 37. Enter the name of the account owner. If the owner is an entity, enter the name in Item 34 and leave Items 36 and 37 blank. If the owner is an individual, enter the owner's last name in Item 34, first name in Item 36, middle initial in Item 37 and any name suffix in item 37a. If there is no middle initial, leave Item 37 blank. If there is not name suffix, leave item 37a blank. See the Name Editing Instructions in the General Instructions section above for additional information on entering names in fields. 35. Tax identification number of account owner Item 35. Enter the Taxpayer Identification Number of the account owner. Numbers should be entered as a single number string without formatting or special characters such as parentheses, spaces, or hyphens. Item 35a. TIN type. Select the appropriate entry to indicate the type on number entered in item 35. 38-42. Account owner mailing address 38. Mailing address (number, street, and apt. or suite no.) 39. City 40. State 41. ZIP/Postal Code 42. Country Items 38- 42. Enter the address of the account owner. If the individual account owner resides in the United States, enter the street address of the individual account owner's United States residence, not a post office box. If the individual account owner resides outside the United States, enter the individual account owner's United States mailing address. If the account owner has no U.S. mailing address the filer may provide a foreign address. Enter an organization account owner's United States mailing address. See the Addresses instructions in the General Instruction section above for additional information on entering address data in fields. 43. Filer's title with this owner Item 43. Enter filer's title for the position which gives him signature authority over the owner's account. Part V Information on financial account(s) where filer is filing a consolidated report An entity that is a United States person that owns directly or indirectly a greater than 50 percent interest in another entity that is required to file an FBAR is permitted to file a consolidated 19 FBAR on behalf of itself and such other entity. Check box \"2d\" in Part I and complete Part V. If filing a consolidated FBAR and reporting 25 or more foreign financial accounts, complete only Part V Items 34-42 for each entity included in the consolidated FBAR. If additional Part V's are required, click on the \"+\" sign on the electronic report to add copies. 15-23. Account Information Items 15-23. Enter the information about the account and the financial institution in which the account is held. See Part II for instructions on Items 15-23. 34. Organization name of account owner Item 34. Organization name of account owner. Enter the entities name of the account owner as shown on the books of the financial institution. 35. Tax Identification Number of Account Owner Item 35. Taxpayer identification number (TIN) of account owner. Numbers should be entered with no spaces, dashes, or other punctuation. Item 35a. TIN type. Check the appropriate box to indicate the type on number entered in item 35. 38-42. Account owner mailing address Items 38-42. Enter the account owner's mailing address. See Part III for instructions on Items 38-42. Signature 44. Filer Signature Item 44. A discrete or batch-filed FBAR is considered signed by the filer when electronically signed on the header/cover page of the discrete FBAR or completion of the 2A record in the batch file. 44a. Check here if this report is completed by a third party preparer. Item 44a. Check this box if the FBAR has been completed by a third party preparer. Complete in the Third Party Preparer Use Only section all of Items 47 through 59 that apply. 45. Filer Title, if not reporting a personal account. If filing for a child enter \"Parent/Guardian filing for child.\" Item 45. Enter the filer's title when the individual that is filing the FBAR has signature authority over the account(s) or is authorized to file on behalf of a legal entity, such as a corporation, which is shown as the filer. Leave Item 45 blank if the filer is reporting as an 20 individual because of a personal financial interest in the account(s). An individual filing because of a financial interest in his individual accounts is filing as an individual. 46. Date (MM/DD/YYYY) Item 46. This item will auto-populate with the current date when a discrete FBAR is signed on the header/cover page. In a batch-filed FBAR this date is the date recorded in Date of Signature (Item 46) in the Filer Information (2A) Record. Note: When the FBAR is completed, return to the header/cover page to validate the report, save a copy of the report, print a copy for your records. Then sign and submit the report. Third party preparer information Note: Completion of this section is not required for spouses filing jointly. 47-49. Third party preparer name 47. Preparer's last name 48. First name 49. MI Items 47. Enter the name of the preparation firm employee or of the self-employed preparer that prepared the FBAR. If the preparer has no middle initial, leave that field blank. See the Name Editing Instructions under General Instructions for additional information on entering names. 50. Check if self-employed Item 50. Check this box if the third party preparer is a self-employed individual. Leave Items 53 \"Firm's name\" and 54 \"Firm's EIN\" blank. 51. TIN Item 51. Enter the personal TIN of the preparation firm's employee or the self-employed preparer. This should be the Preparer Tax Identification Number (PTIN) issued to the preparer by the IRS. If the preparer has no PTIN, enter the preparer's Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). The TIN should be entered as a single number string without formatting or special characters such as parentheses, spaces, or hyphens. Item 51a. TIN type. Select the appropriate entry to indicate the type of number entered in item 51. 52. Contact phone no. 52a. Ext. 21 Item 52-52a. Enter the paid preparer's contact telephone number in Item 53 and the telephone extension number, if any, in Item 52a. Enter all numbers with no formatting such as spaces, dashes, or other punctuation. 53. Firm's name Item 53. Enter the name of the preparing firm. Leave Item 53 blank if the self-employment box in Item 50 was checked. 54. Firm's TIN Item 54. Enter the preparing firm's TIN. Leave Item 54 blank if the self-employment box in Item 50 was checked. Item 54a. TIN type. Select the appropriate entry to indicate the type of number entered in item 54. 55-59. Preparer's address 55. Mailing address (number, street, apt. or suite no.) 56. City 57. State 58. ZIP/Postal Code 59. Country Items 55-59. Enter the preparing firm's or self-employed preparer's address. Follow the Addresses instructions in the General Instructions for additional information on entering addresses in these items. 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 per violation. 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. 22 REPORT OF FOREIGN BANK AND FINANCIAL ACCOUNTS FinCEN Form 114 Department of the Treasury OMB no. 1506-0009 (Rev. September 2013) Filer information Part I 1 This report is for calendar year ended 12/31 2016 Do NOT file with your Federal Tax Return Do not use previous editions of this form Amended 2 Type of filer a Individual b Partnership c Corporation Consolidated e Fiduciary or other - Enter type 4 Foreign identification (Complete only if item 3 is not applicable) 3 U.S. Taxpayer Identification Number 3a TIN type If filer has no U.S. Identification number complete item 4 d SSN/ITIN EIN a Type: Passport b Number 5 Individual's date of birth MM/DD/YYYY Foreign TIN Other c Country of Issue 7First name 6 Last name or organization name 8 Middle initial 8a Suffix 9 Mailing address (number, street, and apt. or suite no.) 10 City 14 a) 11 State 12 ZIP/Postal Code 13 Country Does the filer have a financial interest in 25 or more financial accounts? Yes Enter number of accounts Do not complete Part II or Part III, but maintain records of the information. No b) Does the filer have signature authority over but no financial interest in 25 or more financial accounts? Comp. Part IV, items 34 through 43 for each person on whose behalf the filer has sign. authority. Yes Enter number of accounts No Part II Information on financial account(s) owned separately 15 Maximum value of account during calendar year 15a Amount 16 Type of account a unknown Bank b Securities c Other - Enter type below 17 Name of financial institution in which account is held 18 Account number or other designation 19 Mailing address (number, street, apt. or suite no.) of financial institution in which account is held 20 City 21 State, if known Signature 44a 44 Filer signature Check here if this report is completed by a third party preparer and complete the third party preparer section. 45 Filer title, if not reporting a personal account 46 Date (MM/DD/YYYY) The report will be electronically signed when filed Third Party Preparer Use Only 22 Foreign postal code, if known 23 Country 49 MI 50 Check if 51 TIN self-employed 53 Firm's name 54 Firm's TIN 47 Preparer's last name 48 First name 52 Contact phone no. 52a Ext. 55 Mailing address (number, street, apt. or suite no.) 56 City 57 State This date will auto-fill when the FBAR is electronically signed 51a TIN type SSN/ITIN 54a TIN type 58 ZIP/Postal Code PTIN Foreign EIN Foreign 59 Country 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. 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 FinCEN Form 114 in accordance with 5 USC 552a (e) is Public Law 91-508; 31 USC 5314; 5 USC 301; 31 CFR 1010.350. 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, for failure to 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. 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 60 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 Financial Crimes Enforcement Network, P.O. Box 39, Vienna, VA 22183, Attn: Office of Regulatory Policy. 423141 05-01-14 Rev 5.7 - 6/3/2013 Part II Continued - Information on Financial Account(s) Owned Separately Complete a Separate Block for Each Account Owned Separately 1 Filing for calendar year 3-4 Check appropriate Identification Number FORM 114 Page Number of 6 Last Name or Organization Name Taxpayer Identification Number Foreign Identification Number Enter identification number here: 15 Maximum value of account during calendar year 15a Amount Unknown 16 Type of account a Bank b Securities c Other - Enter type below 17 Name of Financial Institution in which account is held 18 Account number or other designation 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 20 City 21 State, if known 15 Maximum value of account during calendar year 15a Amount Unknown 22 ZIP/Postal Code, if known 16 Type of account 23 Country a Bank b Securities c Other - Enter type below 17 Name of Financial Institution in which account is held 18 Account number or other designation 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 20 City 21 State, if known 15 Maximum value of account during calendar year 15a Amount Unknown 22 ZIP/Postal Code, if known 16 Type of account 23 Country a Bank b Securities c Other - Enter type below 17 Name of Financial Institution in which account is held 18 Account number or other designation 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 20 City 21 State, if known 15 Maximum value of account during calendar year 15a Amount Unknown 22 ZIP/Postal Code, if known 16 Type of account 23 Country a Bank b Securities c Other - Enter type below 17 Name of Financial Institution in which account is held 18 Account number or other designation 19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held 20 City 21 State, if known 15 Maximum value of account during calendar year 15a Amount