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pdfOMB No. 1124-0002; Expires May 30, 2020
U.S. Department of Justice
Washington, DC 20530
Supplemental Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended
INSTRUCTION SHEET-READ CAREFULLY
1.
Use. All persons registered under this Act shall use this form in submitting supplemental statements required by Section 2(b).
Upon termination of the agency which required registration, a final statement shall be filed on this form for the final period of the
agency not covered by the previous statements, as required by Rule 205.
2.
Read Act and Rules. Registrant should carefully read the Act and the Rules thereunder before completing this form.
3.
Attachments. Inserts and riders of less than full page size shall not be used. Whenever insufficient space is provided for
response to any item, reference shall be made in such space to a full insert page or pages on which the item number and
inquiry shall be restated and a complete answer given.
4.
Answer. Unless otherwise specifically instructed in this form, a registrant shall answer every item on this form. Whenever the
item is inapplicable or the appropriate response to an item is "none", an express statement to that effect shall be made.
5.
Incorporation by Reference. This statement shall be complete in and of itself. Incorporation of information by reference to
statements previously filed is not permissible.
6.
Filing. The completed statement, including all exhibits, shall be filed in electronic form with the Registration Unit,
Counterintelligence and Export Control Section, National Security Division, U.S. Department of Justice at https://www.fara.gov .
The statement must be filed in accordance with 28 U.S.C. § 1746. A copy should be retained by the registrant.
7.
Filing Fee. The filing of this document requires the payment of a filing fee for each listed foreign principal as set forth in Rule
5(d)(1), 28 C.F.R. § 5.5(d)(1).
8.
Filing Date. This statement must be filed within 30 days after the expiration of the six-month reporting period. This period of
time may be extended, for good cause shown, upon written application by the registrant prior to the expiration of the 30 day
period.
9.
Privacy Act Statement. The filing of this document is required for the Foreign Agents Registration Act of 1938, as amended, 22
U.S.C. § 611 et seq., for the purposes of registration under the Act and public disclosure. Provision of the information requested
is mandatory, and failure to provide the information is subject to the penalty and enforcement provisions established in Section 8
of the Act. Every registration statement, short form registration statement, supplemental statement, exhibit, amendment, copy of
informational materials or other document or information filed with the Attorney General under this Act is a public record open to
public examination, inspection and copying during the posted business hours of the Registration Unit in Washington, DC.
Statements are also available online at the Registration Unit’s webpage: https://www.fara.gov. One copy of every such document,
other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and
copies of any and all documents are routinely made available to other agencies, departments and Congress pursuant to Section
6(c) of the Act. The Attorney General also transmits a semi-annual report to Congress on the administration of the Act which lists
the names of all agents registered under the Act and the foreign principals they represent. This report is available to the public in
print and online at: https://www.fara.gov .
10. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average 1.17 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 or any other
aspect of this collection of information, including suggestions for reducing this burden to Chief, Registration Unit,
Counterintelligence and Export Control Section, National Security Division, U.S. Department of Justice, Washington, DC 20530;
and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
__________
Note: Omit this instruction sheet when filing this Statement.
FORM NSD-2
Revised 06/19
OMB No. 1124-0002; Expires May 30, 2020
Supplemental Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended
U.S. Department of Justice
Washington, DC 20530
For 6 Month Period Ending ________________
(Insert date)
I - REGISTRANT
1. (a) Name of Registrant
(b) Registration Number
(c) Business Address(es) of Registrant
2. Has there been a change in the information previously furnished in connection with the following?
(a) If an individual:
No
(1) Residence address(es)
Yes
(2) Citizenship
Yes
No
(3) Occupation
Yes
No
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(b) If an organization:
(1) Name
(2) Ownership or control
(3) Branch offices
Yes
Yes
Yes
□
□
□
□
□
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No
No
No
□
□
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(c) Explain fully all changes, if any, indicated in Items (a) and (b) above.
IF THE REGISTRANT IS AN INDIVIDUAL, OMIT RESPONSE TO ITEMS 3, 4, AND 5(a).
3. If you have previously filed Exhibit C1, state whether any changes therein have occurred during this 6 month reporting period.
□
□
Yes
No
If yes, have you filed an updated Exhibit C?
Yes
□
No
□
If no, please attach the updated Exhibit C.
1 The Exhibit C, for which no printed form is provided, consists of a true copy of the charter, articles of incorporation, association, and by laws of a registrant that is an
organization. (A waiver of the requirement to file an Exhibit C may be obtained for good cause upon written application to the Assistant Attorney General, National Security
Division, U.S. Department of Justice, Washington, DC 20530.)
FORM NSD-2
Revised 06/19
(PAGE 2)
4. (a) Have any persons become partners, officers, directors or similar officials during this 6 month reporting period?
Yes
□
No
□
If yes, furnish the following information:
Residence Address
Name
Citizenship
Position
Date Assumed
(b) Have any persons ceased acting as partners, officers, directors or similar officials of the registrant during this 6 month reporting period?
Yes
No
If yes, furnish the following information:
Name
Position
Date Ceased
□
□
5. (a) Has any person named in Item 4(a) rendered services directly in furtherance of the interests of any foreign principal?
No
Yes
If yes, identify each such person and describe the service rendered.
□
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(b) During this 6 month reporting period, has the registrant hired as employees or in any other capacity, any persons who rendered
or will render services to the registrant directly in furtherance of the interests of any foreign principal(s) in other than a clerical or
No
secretarial, or in a related or similar capacity?
Yes
□
Name
Residence Address
□
Citizenship
Position
Date Assumed
(c) Have any employees or individuals, who have filed a short form registration statement, terminated their employment or
No
connection with the registrant during this 6 month reporting period? Yes
If yes, furnish the following information:
□
Name
Position or Connection
□
Date Terminated
(d) Have any employees or individuals, who have filed a short form registration statement, terminated their connection with any foreign
No
principal during this 6 month reporting period? Yes
□
□
If yes, furnish the following information:
Name
Position or Connection
Foreign Principal
Date Terminated
6. Have short form registration statements been previously filed by all of the persons named in Items 5(a) and 5(b) of the supplemental
statement or submitted with this filing?
Yes
No
□
□
If no, list names of persons who have not previously filed the required statement or are not submitting a short form with this filing.
(PAGE 3)
II - FOREIGN PRINCIPAL
7. Has your connection with any foreign principal(s) ended during this 6 month reporting period?
If yes, furnish the following information:
Yes
□
No
□
Date of Termination
Foreign Principal
8. Have you acquired any new foreign principal(s)2 during this 6 month reporting period?
Yes
If yes, furnish the following information:
□
No
□
Date Acquired
Foreign Principal
9. In addition to those named in Items 7 and 8, if any, list the foreign principal(s) 2 whom you continued to represent during the 6
month reporting period.
10. (a) Have you filed Exhibits A and B for the newly acquired foreign principal(s), if any, listed in Item 8?
NA
Yes
No
Exhibit A3
4
Exhibit B
Yes
No
NA
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□
□
□
□
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If no, please file the required exhibit.
(b) Have there been any changes in the Exhibits A and B previously filed for any foreign principal(s) whom you
represented during this 6 month period?
Yes
No
If yes, have you filed an amendment to these exhibits?
Yes
No
□
□
□
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If no, please file the required amendment.
2 The term "foreign principal" includes, in addition to those defined in Section 1(b) of the Act, an individual organization any of whose activities are directly or indirectly
supervised, directed, controlled, financed, or subsidized in whole or in major part by a foreign government, foreign political party, foreign organization or foreign individual.
(See Rule 100(a) (9)). A registrant who represents more than one foreign principal is required to list in the statements he files under the Act only those principals for whom he
is not entitled to claim exemption under Section 3 of the Act. (See Rule 208.)
3 The Exhibit A, which is filed on Form NSD-3, sets forth the information required to be disclosed concerning each foreign principal.
4 The Exhibit B, which is filed on Form NSD-4, sets forth the information concerning the agreement or understanding between the registrant and the foreign principal.
(PAGE 4)
III - ACTIVITIES
11. During this 6 month reporting period, have you engaged in any activities for or rendered any services to any foreign principal
named in Items 7, 8, or 9 of this statement?
Yes
No
□
□
If yes, identify each foreign principal and describe in full detail all activities and services:
Foreign Principal
Activities/Services
12. During this 6 month reporting period, have you on behalf of any foreign principal engaged in political activity5 as defined below?
No
Yes
□
□
If yes, identify each foreign principal and describe in full detail all such political activity, indicating, among other things,
the relations, interests and policies sought to be influenced and the means employed to achieve this purpose. If the registrant
arranged, sponsored or delivered speeches, lectures, social media, internet postings, or media broadcasts, give details as to dates,
places of delivery, names of speakers and subject matter. The response must include, but not be limited to, activities involving
lobbying, promotion, perception management, public relations, economic development, and preparation and dissemination of
informational materials.
Foreign Principal
Date
Contact
Method
Purpose
13. In addition to the above described activities, if any, have you engaged in activity or rendered any services on your own
behalf which benefits your foreign principal(s)?
Yes
No
□
□
If yes, describe fully.
Foreign Principal
Activity
5 "Political activity," as defined in Section 1(o) of the Act, means any activity that the person engaging in believes will, or that the person intends to, in any way influence any
agency or official of the Government of the United States or any section of the public within the United States with reference to formulating, adopting or changing the domestic
or foreign policies of the United States or with reference to political or public interests, policies, or relations of a government of a foreign country or a foreign political party.
(PAGE 5)
IV - FINANCIAL INFORMATION
14. (a) RECEIPTS-MONIES
During this 6 month reporting period, have you received from any foreign principal named in Items 7, 8, or 9 of this
statement, or from any other source, for or in the interests of any such foreign principal, any contributions, income or
money either as compensation or otherwise?
Yes
No
□
□
If no, please explain why no monies were received.
If yes, set forth below in the required detail and separately for each foreign principal an account of such monies.6
Foreign Principal
From Whom
Date Received
Purpose
Amount
______________
Total
(b) RECEIPTS - FUNDRAISING CAMPAIGN
During this 6 month reporting period, have you received, as part of a fundraising campaign7, any money on behalf of any
foreign principal named in Items 7, 8, or 9 of this statement?
Yes
No
8
If yes, have you previously filed an Exhibit D to your registration?
If yes, indicate the date the Exhibit D was filed.
□
Yes □
□
No □
Date ____________________
If no, please attach the required Exhibit D.
(c) RECEIPTS-THINGS OF VALUE
During this 6 month reporting period, have you received any thing of value9 other than money from any foreign principal
named in Items 7, 8, or 9 of this statement, or from any other source, for or in the interests of any such foreign principal?
Yes
No
□
□
If yes, furnish the following information:
Foreign Principal
From Whom
Date Received
Purpose
Thing of Value
6, 7 A registrant is required to file an Exhibit D if he/she collects or receives contributions, loans, moneys, or other things of value for a foreign principal, as part of a fundraising
campaign. (See Rule 201(e)).
8 An Exhibit D, for which no printed form is provided, sets forth an account of money collected or received as a result of a fundraising campaign and transmitted for a foreign
principal.
9 Things of value include but are not limited to gifts, interest free loans, expense free travel, favored stock purchases, exclusive rights, favored treatment over competitors,
"kickbacks," and the like.
(PAGE 6)
15. (a) DISBURSEMENTS-MONIES
During this 6 month reporting period, have you
(1) disbursed or expended monies in connection with activity on behalf of any foreign principal named in Items 7, 8, or 9
No
of this statement?
Yes
□
□
(2) transmitted monies to any such foreign principal?
Yes
□
No
□
If no, explain in full detail why there were no disbursements made on behalf of any foreign principal.
If yes, set forth below in the required detail and separately for each foreign principal an account of such monies, including
monies transmitted, if any, to each foreign principal.
Foreign Principal
Date
To Whom
Purpose
Amount
_______________
Total
(PAGE 7)
(b) DISBURSEMENTS-THINGS OF VALUE
During this 6 month reporting period, have you disposed of anything of value10 other than money in furtherance of or in
connection with activities on behalf of any foreign principal named in Items 7, 8, or 9 of this statement?
No
Yes
□
□
If yes, furnish the following information:
Foreign Principal
Date
Purpose
Recipient
Thing of Value
(c) DISBURSEMENTS-POLITICAL CONTRIBUTIONS
During this 6 month reporting period, have you from your own funds and on your own behalf either directly or through any
other person, made any contributions of money or other things of value11 in connection with an election to any political
office, or in connection with any primary election, convention, or caucus held to select candidates for political office?
Yes
□
No
□
If yes, furnish the following information:
Date
Political Organization/Candidate
Method
Amount or Thing of Value
10, 11 Things of value include but are not limited to gifts, interest free loans, expense free travel, favored stock purchases, exclusive rights, favored treatment over competitors,
"kickbacks," and the like.
(PAGE 8)
V - INFORMATIONAL MATERIALS
16. (a) During this 6 month reporting period, did you disseminate or cause to be disseminated any informational materials? 12
Yes
No
If Yes, go to Item 17.
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17. Identify each such foreign principal(s).
18. During this 6 month reporting period, has any foreign principal established a budget or allocated a specified sum of money to
finance your activities in preparing or disseminating informational materials?
Yes
No
□
If yes, identify each such foreign principal, specify amount, and indicate for what period of time.
□
19. During this 6 month reporting period, did your activities in disseminating or causing the dissemination of informational
materials include the use of any of the following:
Press releases
Pamphlets or other publications
Magazine or newspaper
Advertising campaigns
Lectures or speeches
Radio or TV broadcasts
Motion picture films
Letters or telegrams
Email
Website URL(s): _______________________________________________________________________________________
Social media websites URL(s): ____________________________________________________________________________
Other (specify) ________________________________________________________________________________________
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20. During this 6 month reporting period, did you disseminate or cause to be disseminated informational materials among any of
the following groups:
□ Public officials
□ Newspapers
□ Legislators
□ Editors
□ Government agencies
□ Civic groups or associations
□ Other (specify)________________________________________
□ Libraries
□ Educational institutions
□ Nationality groups
21. What language was used in the informational materials:
□ English
□ Other (specify) _______________________________________
22. Did you file with the Registration Unit, U.S. Department of Justice a copy of each item of such informational materials
disseminated or caused to be disseminated during this 6 month reporting period?
Yes
No
□
□
If no, please explain why the filing was not required or attach the required informational materials.
12 The term informational materials includes any oral, visual, graphic, written, or pictorial information or matter of any kind, including that published by means of advertising,
books, periodicals, newspapers, lectures, broadcasts, motion pictures, or any means or instrumentality of interstate or foreign commerce or otherwise. Informational materials
disseminated by an agent of a foreign principal as part of an activity in itself exempt from registration, or an activity which by itself would not require registration, need not be
filed pursuant to Section 4(b) of the Act.
(PAGE 9)
23. Did you label each item of such informational materials with the statement required by Section 4(b) of the Act?
No
Yes
□
□
If no, please explain why the informational materials were not labeled.
VI - EXECUTION
In accordance with 28 U.S.C. § 1746, the undersigned swear(s) or affirm(s) under penalty of perjury that he/she has (they have) read
the information set forth in this registration statement and the attached exhibits and that he/she is (they are) familiar with the contents
thereof and that such contents are in their entirety true and accurate to the best of his/her (their) knowledge and belief, except that the
undersigned make(s) no representation as to truth or accuracy of the information contained in the attached Short Form Registration
Statement(s), if any, insofar as such information is not within his/her (their) personal knowledge.
Date
Signature
13
_____________________________________
Sign
_____________________________________
_____________________________________
Sign
_____________________________________
_____________________________________
Sign
_____________________________________
_____________________________________
Sign
_____________________________________
13 This statement shall be signed by the individual agent, if the registrant is an individual, or by a majority of those partners, officers, directors or persons performing similar
functions, if the registrant is an organization, except that the organization can, by power of attorney, authorize one or more individuals to execute this statement on its behalf.
| File Type | application/pdf |
| Subject | Version 1.3 |
| Author | AMUDD |
| File Modified | 2019-06-20 |
| File Created | 2014-04-24 |