(Check if) Yes (*Enter total number of accounts in space provided) Complete Part IV, items 34
through 43 for each person on whose behalf the filer has signature authority.
(Check if) No
Item 14. If the filer has a financial interest in over 25 or more foreign financial accounts check
the yes box, and enter the total number of accounts in 14a. Leave blank Part II (Continuation of
Separate Accounts) or Part III (Joint Accounts) of this report, but maintain records of the
information. If filing a consolidated FBAR, the United States person should not complete Part
II or Part III but should complete Part V, Items 34-42, for each United States entity included in
the consolidated FBAR.
If the filer has signature authority only (no financial interest), over 25 or more foreign financial
accounts check the yes box, and enter the total number of accounts in 14b. Complete only items
34-43 of Part IV for each person on whose behalf the filer has signature authority. If the group of
entities covered by a consolidated report has a financial interest in 25 or more foreign financial
accounts, the reporting parent corporation need only complete Part V (for consolidated
reporting) Items 34 through 42, for the identity information of the account owners, but need not
complete the account information. Detailed information about each account, including all
information called for on this report, must be recorded and retained for five years from June 30
of the year following the calendar year reported. Any person who reports 25 or more foreign
financial accounts in item 14a or item 14b, must provide all the information omitted from Parts
II, III, IV or V, as appropriate, if the information is requested by FinCEN or the IRS. Filers must
comply with applicable recording keeping requirements. See Record Keeping Requirements
under Filing Information in the General Instructions above.
Part II — Information on financial account(s) owned separately
Part II records information on accounts owned separately by the filer. It should not be used to
record information on jointly-owned accounts (Part III), signature authority but no financial
interest accounts (Part IV), or accounts involved in a consolidated report (Part V).
15. Maximum value of account during calendar year.
Item 15. Enter the maximum value of the account in U.S. Dollars during the calendar year being
reported. See the General Instructions on Monetary Amounts for guidance on determining the
maximum value of an account. Use the end of the year conversion rate.
15a. Amount unknown. Check this box if the value of the account cannot be determined.
16. Type of account
From the dropdown list select
Securities, or Other. If other is selected specify type
in space provided.
Item 16. Check the appropriate box to describe the type of account. If "Other" is checked, enter a