Reporting Form G-FIN

Board of Governors of the Federal Reserve System 0MB Number 7100-0224
Federal Deposit Insurance Corporation
0MB Number 3064-0093
Office of the Comptroller of the Currency
0MB Number 1557-0184
Securities and Exchange Commission
0MB Number 3235-0083

Board of Governors of the Federal Reserve System

Approval expires August 31, 2019
Approval expires March 31, 2019
Approval expires July 31, 2019
Approval expires December 31, 2016
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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 gov­
ernment 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 gov­
ernment 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 secu­
rities; (5) Enter into repurchase or reverse repurchase agree­
ments; (6) Effect fewer than 500 government securities broker­
age 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 0MB control number.

DRAFT
100 F Street, NE,
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 infor­
mation, 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 fol­
lowing: Secretary, Board of Governors of the Federal Reserve System, 2oth 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 Activities 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.
08/2016

xxxx 2019

Form G-FIN

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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/ Mid die

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.

16

7. Has any "associated person" (see definition in paragraph A.7. of the instructions) responded "yes" to any question in Item __
17 of
__
__of Form MSD-4 or_______
Form G-FIN-4, or "yes" to one or more questions in Items 23 through 26
Item 22 on Form U-4?
A.

D Yes

B.

D

20

No

25

on Page 22 of

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.

DRAFT

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

xxxx 2019