Form FFIEC 030S FFIEC 030S Foreign Branch Report of Condition

DRAFT

Board of Governors of the Federal Reserve System
Office of the Comptroller of the Currency
Federal Deposit Insurance Corporation

Abbreviated Foreign Branch Report of
ConditionFFIEC 030S
At close of business on December 31, 20

This report is required by law (12 U.S.C. 602 (FRB); 12 U.S.C. 602 (0CC); and
12 U.S.C. 1828 (FDIC)).
The Federal Financial Institutions Examination Council regards the information
provided by each respondent as confidential. If it should subsequently be determined that any information collected on this form must be released, respondents
will be notified.

FFIEC
OMB No. (FRB) 7100-0071 Expires November 30, 2012
(0CC) 1557-0099 Expires November 30, 2012
(FDIC) 3064-0011 Expires November 30, 2012

REPORTING BURDEN
Public reporting burden for this collection of information is estimated to average
0.5 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Send comments regarding this burden
estimate, including suggestions for reducing this burden, to the Office of Information
and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503,
and to one of the following:
Secretary
Board of Governors of the Federal Reserve System
20th and C Streets, N.W.
Washington, D.C. 20551
Legislative and Regulatory Activities
Office of the Comptroller of the Currency
250 E Street, S.W
Washington, D.C. 20219

A Federal agency may not conduct or sponsor, and an organization is not required
to respond to, a collection of information unless it displays a currently valid OMB
control number.

Assistant Executive Secretary
Federal Deposit Insurance Corporation
550 17th Street, N.W.
Washington, D.C. 20429

Unless the context indicates otherwise, the term "bank"
in this report form refers to both banks and savings
associations.

CONSOLIDATION OPTION
Banks may, at their option, consolidate the figures for all other
branches located in the same country on the report form, using the
name and address of the principal branch. When the bank elects
to consolidate, statement A or B below should be completed, as
appropriate.

NAME OF BANK
Name

Street Address

City

State

FOREIGN BRANCH

A. No figures are shown for this branch because of consolidation
with those reported for the
branch.

Name

Street Address

B. Figures reported in this report are a consolidation of all
Number

City/Town

branches in
Country

Country

Please list the consolidated branches on the lines below:

Street Address

City

Street Address

City

Street Address

city

Street Address

City

Street Address

City

Street Address

City

Street Address

City

(If more space is needed, please list addresses for the other branches on a separate page.)
and savings associations
All banks4Ot&te Me be Dank3, National Danks, and State Nonmomber Banks)-should submit completed and signed original
hard copy report forms to the appropriate Federal Reserve District Bank.

FFIEC 030S
Page 2
Charter

Country

City

Branch

Name of Bank and Branch

Amounts in U.S. Dollars FORB
FINANCIAL DATA
1. Gross due from related institutions .................................................................................
2. Total assets ........................................................................................................................
3. Gross due to related institutions ......................................................................................
4. Total gross notional amount of derivative contracts ......................................................
5. Commercial and similar letters of credit, standby letters of credit, and foreign
office guarantees ...............................................................................................................

I,

Bil

Mil

Thou

3002
2170
3001
F156

1.
2.
3.
4.

F157

5.

, of the above-named bank do hereby declare that this report
Name and Title of Officer Authorized to Sign Report

of condition is true and correct to the best of my knowledge and belief.

Signature of Officer Authorized to Sign Report