NSD-3 Webform OMB 1124 0006 Change Request 2019

OMB No. 1124-0006; Expires May 30, 2020

U.S. Department of Justice
Washington, DC 20530

Exhibit A to Registration Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended

INSTRUCTIONS. Furnish this exhibit for EACH foreign principal listed in an initial statement and for EACH additional foreign principal acquired
subsequently. The filing of this document requires the payment of a filing fee as set forth in Rule (d)(1), 28 C.F.R. § 5.5(d)(1). Compliance is
accomplished by filing an electronic Exhibit A form at https://www.fara.gov.
Privacy Act Statement. The filing of this document is required by 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 this
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.
Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .22 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.

2. Registration Number

1. Name of Registrant

3. Primary Address of Registrant

5. Address of Foreign Principal

4. Name of Foreign Principal
6. Country/Region Represented

7. Indicate whether the foreign principal is one of the following:
Government of a foreign country 1
Foreign political party

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Foreign or domestic organization: If either, check one of the following:
Partnership
Committee
Corporation
Voluntary group
Association
Other (specify) __________________________________________
Individual-State nationality ____________________________________________________________________________

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8. If the foreign principal is a foreign government, state:
a) Branch or agency represented by the registrant
b) Name and title of official with whom registrant engages
c) Aim, mission or objective of engagement
1 "Government of a foreign country," as defined in Section 1(e) of the Act, includes any person or group of persons exercising sovereign de facto or de jure political jurisdiction
over any country, other than the United States, or over any part of such country, and includes any subdivision of any such group and any group or agency to which such sovereign de
facto or de jure authority or functions are directly or indirectly delegated. Such term shall include any faction or body of insurgents within a country assuming to exercise
governmental authority whether such faction or body of insurgents has or has not been recognized by the United States.

FORM NSD-3
Revised 06/19

9. If the foreign principal is a foreign political party, state:
a)

Name and title of official with whom registrant engages

b) Aim, mission or objective of engagement

10. If the foreign principal is not a foreign government or a foreign political party:
a) State the nature of the business or activity of this foreign principal.

b) Is this foreign principal:
Supervised by a foreign government, foreign political party, or other foreign principal
Owned by a foreign government, foreign political party, or other foreign principal
Directed by a foreign government, foreign political party, or other foreign principal
Controlled by a foreign government, foreign political party, or other foreign principal
Financed by a foreign government, foreign political party, or other foreign principal
Subsidized in part by a foreign government, foreign political party, or other foreign principal

□ No □
Yes □ No □
Yes □ No □
Yes □ No □
Yes □ No □
Yes □ No □

Yes

11. Explain fully all items answered "Yes" in Item 10(b).

12. If the foreign principal is an organization and is not owned or controlled by a foreign government, foreign political party or other
foreign principal, state who owns and controls it.

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 Exhibit A to the registration statement 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.
Date

Printed Name

Signature

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Sign
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