G-FIN Notice by Financial Institutions of Government Securitie

Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of the Comptroller of the Currency
Securities and Exchange Commission

OMB Number 7100-0224
OMB Number 3064-0093
OMB Number 1557-0184
OMB Number 3235-0083

Approval expires April 30, 2016
Approval expires December 31, 2015
Approval expires May 31, 2016
Approval expires October 31, 2013
Page 1 of 3

Notice by Financial Institutions of Government Securities Broker
or Government Securities Dealer Activities—Form G-FIN
This notice is required by law (15 U.S.C. § 78o-5(a)(1)(B)).
This notice must be filed by all financial institutions that are government securities brokers or government securities dealers that
are not exempt from the notice requirement under regulations of
the Department of the Treasury. Generally, a financial institution will
not be required to file as a government securities broker or dealer
if its only government securities activities are to (1) Buy or sell government securities solely for investment for its own account; (2)
Buy or sell government securities for fiduciary accounts; (3) Handle
savings bond transactions; (4) Submit tenders for the account of

customers for purchase on original issue of U.S. Treasury securities; (5) Enter into repurchase or reverse repurchase agreements; (6) Effect fewer than 500 government securities brokerage transactions per year; (7) Effect brokerage transactions only
through another government securities broker or dealer on a
fully disclosed basis; or (8) Effect brokerage transactions that do
not involve active solicitations.
An agency may not conduct or sponsor, and an organization (or a
person) is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.

For further information on the requirements to file this notice, please refer to the instructions.
Public reporting burden for this collection of information is estimated to average 1 hour 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 or any other aspect of the collection of information, including suggestions for reducing this burden, to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503, and to one of the following: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551; Assistant Executive Secretary (Administration), Room F-400,
Federal Deposit Insurance Corporation, 550 17th Street, NW, Washington, DC 20429; Legislative and Regulatory Analysis Division, Office of the Comptroller of the Currency, 400 7th Street,
SW, Washington, DC 20219; or to Securities and Exchange Commission, 450 Fifth Street, NW, Washington, DC 20549.
04/2013

OFFICIAL USE

Form G-FIN
Page 2 of 3

Notice of Government Securities Broker or Government Securities Dealer
Activities to be Filed by a Financial Institution under Section 15C(a)(1)(B)
of the Securities Exchange Act of 1934
1. Check appropriate regulatory agency (ARA):

2. Conducts business as:

A.

Comptroller of the Currency

A.

Government Securities Broker

B.

Board of Governors of the Federal Reserve System

B.

Government Securities Dealer

C.

Federal Deposit Insurance Corporation

C.

Government Securities Broker and Dealer

D.

Securities and Exchange Commission

3. Filing status of notice:
A.

Notice

B.

Amendment

4. A. Full name of the financial institution
B. Address of principal office of financial institution:
Address
State

City

Zip Code

C. Address of principal office where government securities broker or government securities dealer activities will be conducted
(if different from item (B)):
Address
City

State

Zip Code

State

Zip Code

D. Mailing address if different from (B) or (C):
Address
City

E. Name, title, and telephone number of contact person with respect to this notice:
Name

Title

Area Code / Phone Number

5. Does financial institution conduct, or will it conduct, government securities broker or government securities dealer activities at any
Yes
B.
No
A.
location other than given in Question 4 above?
(If yes, provide addresses and describe activities.)

Address

City

State

Zip Code

Describe Activities

Address

City

State

Zip Code

Describe Activities

Address

City

State

Zip Code

Describe Activities

Address

City

State

Zip Code

Describe Activities
04/2013

Form G-FIN
Page 3 of 3

6. Furnish the name and title of each person who is directly engaged in the management, direction, or supervision of any of the
financial institution's government securities broker or government securities dealer activities:
Full Name
Last / First / Middle

Title

Last / First / Middle

Title

Last / First / Middle

Title

Last / First / Middle

Title

Last / First / Middle

Title

NOTE: Attach a separate Form G-FIN-4 (or, if previously filed, a copy of Form MSD-4 or Form U-4) for each person
named in item 6.
7. Has any “associated person” (see definition in paragraph A.7. of the instructions) responded “yes” to any question in Item 17 of
Form G-FIN-4, or “yes” to one or more questions in Items 23 through 26 of Form MSD-4 or Item 22 on Form U-4?
A.

Yes

B.

No

NOTE: The financial institution and the person executing this form are responsible for making an inquiry of all other
employers of any associated person during the immediately preceding three years for the purpose of verifying the
accuracy of the information furnished on Form G-FIN-4. (See 17 C.F.R. § 400.4(c)). Similar requirements are applicable to
Form MSD-4 and Form U-4.
8. The financial institution submitting this notice and the person executing it represent that all of the information contained
herein is true, current, and complete.
Please print name and title of person executing this notice:

Name (First, Middle, Last)
Title
Signature

Date

01/2011