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I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 1 of 10
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 406mm (16") 279mm (11"), FOLD TO 203mm (8") 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Date
(Rev. January 2007)
Department of the Treasury
2
Signature
O.K. to print
Revised proofs
requested
OMB No. 1545-0009
1 This Report is for Calendar
Year Ended 12/31
Do NOT file with your Federal Tax Return
Amended
Filer Information
Type of Filer
a
3
Date
REPORT OF FOREIGN BANK
AND FINANCIAL ACCOUNTS
TD F 90-22.1
Part I
Action
Individual
b
Partnership
U.S. Taxpayer Identification Number
c
4
Corporation
d
Consolidated e
Foreign identification (Complete only if item 3 is not applicable.)
c Type:
6
Last Name or Organization Name
9
Address (Number, Street, and Apt. or Suite No.)
Passport
Individual’s Date of Birth
MM/DD/YYYY
8
Middle Initial
Other
7
First Name
f
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10
City
11 State
14
Does the filer have a financial interest in 25 or more financial accounts
Yes
5
b Country of Issue
a Number
If filer has no U.S. Identification
Number complete Item 4.
Fiduciary or Other—Enter type
12 Zip/Postal Code
13 Country
If Yes enter total number of accounts
(If Yes is checked, do not complete Part II or Part III, but retain records of this information)
No
Part II
Information on Financial Account(s) Owned Separately
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
(s
21 State, if known
22 Zip/Postal Code, if known
23 Country
Signature
Filer Signature
Filer Title, if not reporting a personal account
Date (MM/DD/YYYY)
File this form with: U.S. Department of the Treasury, P.O. Box 32621, Detroit, MI 48232-0621
This form should be used to report a financial interest in, signature authority, or other authority over one or more financial accounts in foreign
countries, as required by the Department of the Treasury Regulations (31 CFR 103). No report is required if the aggregate value of the accounts
did not exceed $10,000. See Instructions For Definitions.
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
Pursuant to the requirements of Public Law 93-579 (Privacy Act of 1974), notice is hereby given that the authority to collect information on TD F
90-22.1 in accordance with 5 USC 552a (e) is Public Law 91-508; 31 USC 5314; 5 USC 301; 31 CFR 103.
The principal purpose for collecting the information is to assure maintenance of reports where such reports or records have a high degree of
usefulness in criminal, tax, or regulatory investigations or proceedings. The information collected may be provided to those officers and
employees of any constituent unit of the Department of the Treasury who have a need for the records in the performance of their duties. The
records may be referred to any other department or agency of the United States upon the request of the head of such department or agency for
use in a criminal, tax, or regulatory investigation or proceeding. The information collected may also be provided to appropriate state, local, and
foreign law enforcement and regulatory personnel in the performance of their official duties. Disclosure of this information is mandatory. Civil and
criminal penalties, including in certain circumstances a fine of not more than $500,000 and imprisonment of not more than five years, are
provided for failure to file a report, supply information, and for filing a false or fraudulent report. Disclosure of the Social Security number is
mandatory. The authority to collect is 31 CFR 103. The Social Security number will be used as a means to identify the individual who files the
report.
The estimated average burden associated with this collection of information is 20 minutes per respondent or record keeper, depending on
individual circumstances. Comments regarding the accuracy of this burden estimate, and suggestions for reducing the burden should be
directed to the Internal Revenue Service, Bank Secrecy Act Policy, 5000 Ellin Road C-3-242, Lanham MD 20706.
Cat. No. 12996D
Form
TD F 90-22.1
(Rev. 1-2007)
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 2 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Continued—Information on Financial Account(s) Owned Separately
Part II
Complete a Separate Block for Each Account Owned Separately
Form TD F 90-22.1
Page Number
of
This side can be copied as many times as necessary in order to provide information on all accounts.
1
Filing for calendar
year
3–4 Check appropriate Identification Number
6
Last Name or Organization Name
Taxpayer Identification Number
Foreign Identification Number
Amended
Enter identification number here:
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
21 State, if known
17
Name of Financial Institution with which account is held
18
Account number or other designation
21 State, if known
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
22 Zip/Postal Code, if known
23 Country
21 State, if known
(s
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
Bank b
Securities c
Other—Enter type below
22 Zip/Postal Code, if known
16 Type of account a
23 Country
Bank b
Securities c
Other—Enter type below
22 Zip/Postal Code, if known
16 Type of account a
23 Country
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
15
20 City
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
15
22 Zip/Postal Code, if known
16 Type of account a
23 Country
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
Securities c
f
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P a r y to ch
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J a ubj
Maximum value of account during calendar year reported
20 City
Bank b
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
15
20 City
16 Type of account a
22 Zip/Postal Code, if known
16 Type of account a
23 Country
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
22 Zip/Postal Code, if known
23 Country
Form
TD F 90-22.1
(Rev. 1-2007)
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 3 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Part III
Information on Financial Account(s) Owned Jointly
Form TD F 90-22.1
Page Number
Complete a Separate Block for Each Account Owned Jointly
of
This side can be copied as many times as necessary in order to provide information on all accounts.
1
Filing for calendar
year
3–4 Check appropriate Identification Number
6
Last Name or Organization Name
Taxpayer Identification Number
Foreign Identification Number
Amended
Enter identification number here:
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
22 Zip/Postal Code, if known
23 Country
f
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J a ubj
Last Name or Organization Name of principal joint owner
29
Address (Number, Street, Suite or Apartment) of principal joint owner, if known
31 State, if known
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
24 Number of joint owners for this account
27 First Name of principal joint owner, if known
32 Zip/Postal Code, if known
16 Type of account a
21 State, if known
33 Country, if known
Bank b
22 Zip/Postal Code, if known
Securities c
Other—Enter type below
23 Country
(s
25 Taxpayer Identification Number of principal joint owner, if known. See instructions
Last Name or Organization Name of principal joint owner
29
Address (Number, Street, Suite or Apartment) of principal joint owner, if known
31 State, if known
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
27 First Name of principal joint owner, if known
32 Zip/Postal Code, if known
16 Type of account a
28 Middle initial, if
known
33 Country, if known
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
20 City
21 State, if known
24 Number of joint owners for this account
25 Taxpayer Identification Number of principal joint owner, if known. See instructions
22 Zip/Postal Code, if known
26
Last Name or Organization Name of principal joint owner
29
Address (Number, Street, Suite or Apartment) of principal joint owner, if known
30 City, if known
28 Middle initial, if
known
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
26
30 City, if known
Other—Enter type below
25 Taxpayer Identification Number of principal joint owner, if known. See instructions
26
20 City
Securities c
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
24 Number of joint owners for this account
30 City, if known
Bank b
31 State, if known
23 Country
27 First Name of principal joint owner, if known
32 Zip/Postal Code, if known
28 Middle initial, if
known
33 Country, if known
Form
TD F 90-22.1
(Rev. 1-2007)
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 4 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Part IV
Information on Financial Account(s) Where Filer has Signature or Other
Authority but No Financial Interest in the Account(s)
Complete a Separate Block for Each Account
Form TD F 90-22.1
Page Number
of
This side can be copied as many times as necessary in order to provide information on all accounts.
1
Filing for calendar
year
3–4 Check appropriate Identification Number
6
Last Name or Organization Name
Taxpayer Identification Number
Foreign Identification Number
Amended
Enter identification number here:
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
Bank b
First Name
39 City
43 Filer’s Title with this Owner
21 State, if known
22 Zip/Postal Code, if known
f
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P a r y to ch
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J a ubj
37 Middle initial
40 State
38 Address (Number, Street, and Apt. or Suite No.)
41 Zip/Postal Code
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
16 Type of account a
42 Country
Bank b
21 State, if known
22 Zip/Postal Code, if known
(s
First Name
39 City
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
37 Middle initial
40 State
23 Country
35 Taxpayer Identification Number of Account Owner
34 Last Name or Organization Name of Account Owner
36
23 Country
35 Taxpayer Identification Number of Account Owner
15
20 City
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
34 Last Name or Organization Name of Account Owner
36
Securities c
38 Address (Number, Street, and Apt. or Suite No.)
41 Zip/Postal Code
42 Country
43 Filer’s Title with this Owner
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
21 State, if known
First Name
39 City
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
22 Zip/Postal Code, if known
37 Middle initial
40 State
23 Country
35 Taxpayer Identification Number of Account Owner
34 Last Name or Organization Name of Account Owner
36
Bank b
38 Address (Number, Street, and Apt. or Suite No.)
41 Zip/Postal Code
42 Country
43 Filer’s Title with this Owner
Form
TD F 90-22.1
(Rev. 1-2007)
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 5 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Information on Financial Account(s) Where Corporate Filer Is Filing a
Consolidated Report
Complete a Separate Block for Each Account
Part V
Form TD F 90-22.1
Page Number
of
This side can be copied as many times as necessary in order to provide information on all accounts.
1
Filing for calendar
year
3–4 Check appropriate Identification Number
6
Last Name or Organization Name
Taxpayer Identification Number
Foreign Identification Number
Amended
Enter identification number here:
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
16 Type of account a
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
22 Zip/Postal Code, if known
23 Country
f
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J a ubj
34 Corporate Name of Account Owner
35 Taxpayer Identification Number of Account Owner
38 Address (Number, Street, and Apt. or Suite No.)
39 City
40 State
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
41 Zip/Postal Code
16 Type of account a
42 Country
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
22 Zip/Postal Code, if known
34 Corporate Name of Account Owner
23 Country
35 Taxpayer Identification Number of Account Owner
(s
38 Address (Number, Street, and Apt. or Suite No.)
39 City
40 State
15
Maximum value of account during calendar year reported
17
Name of Financial Institution with which account is held
18
Account number or other designation
20 City
41 Zip/Postal Code
16 Type of account a
42 Country
Bank b
Securities c
Other—Enter type below
19 Mailing Address (Number, Street, Suite Number) of financial institution in which account is held
21 State, if known
22 Zip/Postal Code, if known
23 Country
35 Taxpayer Identification Number of Account Owner
34 Corporate Name of Account Owner
38 Address (Number, Street, and Apt. or Suite No.)
39 City
40 State
41 Zip/Postal Code
42 Country
Form
TD F 90-22.1
(Rev. 1-2007)
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 6 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form TD F 90-22.1 (Rev. 1-2007)
General Instructions
Who Must File this Report. Each United States person who
has a financial interest in or signature or other authority over
any foreign financial account, including bank, securities, or
other types of financial accounts, in a foreign country, if the
aggregate value of these financial accounts exceeds $10,000
at any time during the calendar year, must report that
relationship each calendar year by filing this report with the
Department of the Treasury on or before June 30, of the
succeeding year.
Exceptions
An officer or employee of a bank which is currently examined
by Federal bank supervisory agencies for soundness and
safety need not report that he has signature or other
authority over a foreign bank, securities or other financial
account maintained by the bank, if the officer or employee
has NO personal financial interest in the account.
An officer or employee of a domestic corporation whose
equity securities are listed upon any United States national
securities exchange or which has assets exceeding $10
million and 500 or more shareholders of record need not file
such a report concerning signature or other authority over a
foreign financial account of the corporation, if he has NO
personal financial interest in the account and he has been
advised in writing by the chief financial officer or similar
responsible officer of the corporation that the corporation has
filed a current report, which includes that account. An officer
or employee of a domestic subsidiary of such a domestic
corporation need not file this report concerning signature or
other authority over the foreign financial account if the
domestic parent meets the above requirements, he has no
personal financial interest in the account, and he has been
advised in writing by the responsible officer of the parent that
the subsidiary has filed a current report which includes that
account. If a United States subsidiary is named in a
consolidated FBAR of the parent, the subsidiary will be
deemed to have filed a report for purposes of this exception.
An officer or employee of a foreign subsidiary more than
50% owned by such a domestic corporation need not file
this report concerning signature or other authority over the
foreign financial account if the employee or officer has no
personal financial interest in the account, and he has been
advised in writing by the responsible officer of the parent that
the parent has filed a current report which includes that
account.
General Definitions
United States Person. The term “United States person”
means a citizen or resident of the United States, or a person
in and doing business in the United States. See 31 C.F.R.
103.11(z) for a complete definition of “person.” The United
States includes the states, territories and possessions of the
United States. See the definition of United States at 31
C.F.R. 103.11(nn) for a complete definition of United States.
A resident of the United States is a permanent resident or
any person treated for tax purposes as a resident alien under
Section 7701(b) of the Internal Revenue Code. A resident
alien is required to file this report. A foreign subsidiary of a
United States person is not required to file this report,
although its United States parent corporation may be
required to do so. A branch of a foreign entity that is
Page
6
doing business in the United States is required to file this
report even if not separately incorporated under U.S. law.
Financial Account. This term includes any bank, securities,
securities derivatives or other financial instruments accounts.
Such accounts generally also encompass any accounts in
which the assets are held in a commingled fund, and the
account owner holds an equity interest in the fund. The term
also means any savings, demand, checking, deposit, time
deposit, or any other account (including prepaid credit card
and debit card) maintained with a financial institution or other
person engaged in the business of a financial institution.
Individual bonds, notes, or stock certificates held by the filer
are not a financial account nor is an unsecured loan to a
foreign trade or business that is not a financial institution.
Account in a Foreign Country. A “foreign country” includes
all geographical areas located outside the United States. See
“United States Person” above for a definition of United
States. The geographical location of the account, not the
nationality of the financial entity in which the account is
found determines whether it is in a foreign country. Report
any financial account (except a military banking facility) that
is located in a foreign country, even if it is held at an affiliate
of a United States bank or other financial institution. Do not
report any account maintained with a branch, agency, or
other office of a foreign bank of other institution that is
located in the United States.
Military Banking Facility. Do not consider as an account in
a foreign country, an account in an institution known as a
“United States military banking facility” (or “United States
military finance facility”) operated by a United States financial
institution designated by the United States Government to
serve U.S. Government installations abroad, even if the
United States military banking facility is located in a foreign
country.
Financial Interest. A financial interest in a bank, securities,
or other financial account in a foreign country means an
interest described in either of the following two paragraphs:
1. A United States person has a financial interest in each
account for which such person is the owner of record or has
legal title, whether the account is maintained for his or her
own benefit or for the benefit of others including non-United
States persons.
If an account is maintained in the name of two persons
jointly, or if several persons each own a partial interest in an
account, each of those United States persons has a financial
interest in that account and each person must file this report.
The individual reporting requirement means that even
persons who file joint tax returns must file separate Foreign
Bank and Financial Accounts Reports.
2. A United States person has a financial interest in each
bank, securities, or other financial account in a foreign
country for which the owner of record or holder of legal title
is: (a) a person acting as an agent, nominee, attorney, or in
some other capacity on behalf of the U.S. person; (b) a
corporation in which the United States person owns directly
or indirectly more than 50 percent of the total value of shares
of stock; (c) a partnership in which the United States person
owns an interest in more than 50 percent of the profits
(distributive share of income); or (d) a trust in which the
United States person either has a present beneficial interest
in more than 50 percent of the assets or from which such
person receives more than 50 percent of the current income.
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 7 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form TD F 90-22.1 (Rev. 1-2007)
Generally speaking, a bank is only required to file an FBAR
with respect to an account maintained in a foreign-located
bank for the bank’s own investment purposes, or for any
other purpose on behalf of the bank. A bank is not required
to file an FBAR with respect to a financial account that is
held in a foreign-located financial institution in the name of,
or on behalf of, a particular customer of the bank, or that is
used solely for the transactions of a particular bank
customer. The bank is not required to file with respect to
accounts held in the names of, or on behalf of several
specific bank customers for, as an example, the investment
purposes of the customer(s). With respect to such accounts,
it is the obligation of the customer(s) to file an FBAR if
required. Bank correspondent or “nostro” accounts are not
subject to the foreign financial account report, but are
subject to other Bank Secrecy Act filing requirements. This
exception is intended to encompass those accounts utilized
for bank-to-bank settlement purposes only.
Signature or Other Authority Over an Account. A person
has signature authority over an account if such person can
control the disposition of money or other property in it by
delivery of a document containing his or her signature (or his
or her signature and that of one or more other persons) to
the bank or other person with whom the account is
maintained. Other authority exists in a person who can
exercise comparable power over an account by
communication with the bank or other person with whom the
account is maintained, either directly or through an agent,
nominee, attorney or in some other capacity on behalf of the
U.S. person, either orally or by some other means.
Filing Information—Do NOT file with your
Federal Tax Return
When and where to file. This report must be filed on or
before June 30 of the year following the calendar year
reported. The report is required annually for as long as the
account is maintained. File by mailing this report to the
Department of the Treasury, Post Office Box 32621, Detroit,
MI 48232-0621, or it may be hand carried to any local office
of the Internal Revenue Service for forwarding to the
Department of the Treasury, Detroit, MI. Tax attaches are
located in the U.S. embassies in some countries. The filing
date is the date received.
A filer can receive instructions for verifying that a report
has been filed by calling the Detroit Computing Center
Hotline at 1-800-800-2877.
Extensions filed for federal tax returns do not extend the
time for filing this report. There is no extension available
for filing this report. If a delinquent FBAR is filed, also
attach an explanation giving the reasons that the filing was
not made timely. Mail to the filing address provided on the
form, the Department of the Treasury, Post Office Box
32621, Detroit, MI 48232-0621 or it may be hand carried to
any local office of the Internal Revenue Service for forwarding
to the Department of the Treasury, Detroit, MI.
Amendment of a previously filed FBAR is accomplished by
checking the box for amended return just under calendar
year at the top of a new form, adding/correcting the
information about the account, and then stapling it to a copy
of the original form. Please also attach a statement
explaining the changes. If the amendment is delinquent, also
attach an explanation giving the reasons that the amendment
was not made timely. Mail to the filing address provided on
Page
7
the form, the Department of the Treasury, Post Office Box
32621, Detroit, MI 48232-0621 or it may be hand carried to
any local office of the Internal Revenue Service for forwarding
to the Department of the Treasury, Detroit, MI.
Record Keeping Requirements. If this Report is required
certain records must be retained in accordance with 31
C.F.R. 103.32. Such records shall contain the name in which
each such account is maintained, the number or other
designation of such account, the name and address of the
foreign bank or other person with whom such account is
maintained, the type of such account, and the maximum
value of each such account during the reporting period.
Retaining filed copies of this Report will help to meet these
requirements. The records shall be retained for a period of
five years and shall be kept at all times available for
inspection as provided by law. A filer, who is able to provide
these documents within a reasonable time after inspection is
requested, will be deemed to have met this requirement,
although the filer has not personally retained the records.
Explanations for Specific Items
Part I
Item 1. The Report of Foreign Bank and Financial Accounts
(FBAR) is an annual report. It must be filed for each calendar
year during which at any time the filer has a financial interest
in or signature or other authority over the foreign financial
account. Enter the calendar (filing) year being reported.
Amendment of a previously filed FBAR is accomplished by
checking the box for amended return just under calendar
year at the top of a new report, adding/correcting the
information about the account, and then stapling it to a copy
of the original report. If the amendment is delinquent, also
attach an explanation giving the reasons that the amendment
was not made timely. Mail to the filing address provided on
the form, the Department of the Treasury, Post Office Box
32621, Detroit, MI 48232-0621. Alternatively the report may
be hand carried to any local office of the Internal Revenue
Service for forwarding to the Department of the Treasury,
Detroit, MI.
Item 2. Check the appropriate box describing the filer. A
corporation which owns directly or indirectly more than 50
percent interest in one or more other entities required to file
this report will be permitted to file a consolidated report on
TD F 90-22.1, on behalf of itself and such other entities.
Check box “d” in Item 2 and complete Part V. Consolidated
reports should be signed by an authorized official of the
parent corporation. Trusts and other entities, including
tax-exempt organizations, should check box “e” and
describe the filer on the line following box “e.”
Item 3. A filer should provide the filer’s taxpayer identification
number. Generally this is the filer’s U.S. social security
number (SSN), employer identification number (EIN) or
Individual Taxpayer Identification Number (ITIN). Numbers
should be entered left to right with no spaces, dashes or
other punctuation throughout this report. If the filer does not
possess such U.S. identification, the filer should complete
Item 4.
Item 4. Complete Item 4 only if the filer has no U.S. taxpayer
identification number. Item 4 requires the filer to provide the
information about an official foreign government document
evidencing the filer’s nationality or residence. The filer should
write in the document number followed by the country of
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 8 OF 10
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form TD F 90-22.1 (Rev. 1-2007)
issuance. The filer may check off the type of document. If
“other” is checked, the filer should write in the type of
document. For example, a resident alien filer would provide a
passport number, the name of the country of issuance, and
check off “passport”.
Item 5. Enter the date of birth of the filer using the month,
day, and year convention.
Items 6, 7 and 8. Enter the name of the filer. Usually a single
last name is entered in the space for Last Name. The last
name entered is the last name usually used by the filer. An
individual using a hyphenated last name should enter the
hyphenated last name as it is usually used by the filer. An
organization should enter the entire official organization name
in the Last Name space.
Items 9, 10, 11, 12 and 13. Enter the address of the filer.
Filer should enter the filer’s United States address. An
individual filer residing in the United States should enter the
street address of filer’s United States residence, not a Post
Office Box. An individual filer residing outside the United
States should enter the filer’s United States mailing address.
If the filer has no U.S. mailing address the filer may provide a
foreign address. An organization should enter its United
States mailing address.
Item 14. If the filer has a financial interest in 25 or more
foreign financial accounts, the filer should check the yes box,
sign and date the report (Items 44, 45 and 46) and leave
blank Part II (Continuation of Separate Accounts) or Part III
(Joint Accounts) of the report. Part IV (for filers with Signature
or other Authority) must still be completed. 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 must,
when requested by the Department of the Treasury, provide
all the information omitted from Part II, III or V as
appropriate.
Part II
Item 15. Provide the maximum value of the account during
the calendar year being reported. The maximum value of an
account is the largest amount of currency or non-monetary
assets that appear on any quarterly or more frequent account
statement issued for the applicable year. If periodic account
statements are not so issued, the maximum account asset
value is the largest amount of currency and non-monetary
assets in the account at any time during the year.
Convert foreign currency by using the official exchange
rate at the end of the year. In valuing currency of a country
that uses multiple exchange rates, use the rate which would
apply if the currency in the account were converted into
United States dollars at the close of the calendar year.
The value of stock, other securities or other non-monetary
assets in an account reported on TD F 90-22.1 is the fair
market value at the end of the calendar year, or if withdrawn
from the account, at the time of the withdrawal. For purposes
Page
8
of Item 15, if the filer had a financial interest in more than
one account, each account is to be valued separately
inaccordance with the foregoing two paragraphs. If the filer
had a financial interest in one or more but fewer than 25
accounts, and is unable to determine whether the maximum
value of these accounts exceeded $10,000 at any time
during the year, complete Part II, III, or V for each of these
accounts and enter “value unknown” in Item 15 for these
accounts.
Item 16. Indicate the type of account. If “Other” is selected
describe the account.
Item 17. Provide the name of the financial institution with
which the account is held.
Item 18. Provide the account number which the financial
institution uses to designate the account. This is not the
bank routing number.
Item 19–23. Provide the complete mailing address of the
financial institution where the account is located. If the
foreign state or postal code is not known leave them blank.
Part III
Item 24. Enter the number of joint owners for the account. If
the exact number is not known, estimate. In determining the
number of joint owners, the filer is not counted.
Items 25–33. Enter this identity information about the joint
owner. If there is more than one joint owner, enter the
identity information about the principal joint owner. Filer may
leave blank items for which no information is available.
A spouse having a joint financial interest in an account
with the filing spouse should be included as a joint account
owner in Part III of this report. Filer should write (spouse) on
Line 26 after the last name of the joint spousal owner. If the
only reportable accounts of the included spouse are those
reported as joint accounts by the other spouse, the included
spouse need not file a separate report. If the included
spouse is not filing a separate report, the included spouse
should also sign the report. See the instructions for Item 44.
If the included spouse has a financial interest in other
accounts that are not jointly owned with the filing spouse or
has signature or other authority over other accounts, the
included spouse should file a separate report for all accounts
including those owned jointly with the other spouse.
Part IV—No Financial Interest in Account
Item 34. You must provide the name, address, and
identifying number of the owner of a foreign financial account
over which you had signature or other authority but no
financial interest in the account, except as provided in the
remainder of this Item instruction.
If there is more than one owner of the account over which
you have authority, provide the information in Items 34-43 for
the primary owner for which you have authority.
If you complete Part IV for accounts owned by a domestic
corporation and its domestic and/or foreign subsidiaries, you
may treat them as one owner and write in the space
provided, the name of the parent corporation, followed by
“and related entities,” and the identifying number and
address of the parent corporation.
1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM TD F 90-22.1, PAGE 9 OF 10 (Page 10 is blank)
MARGINS; TOP 13mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216mm (81⁄2 ") x 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form TD F 90-22.1 (Rev. 1-2007)
If you complete Items 34–43 for one or more accounts in
which no United States person had a financial interest, you
may state in Item 34 in lieu of supplying information about
the owner “No U.S. person had any financial interest in the
foreign account.” This statement must be based upon the
actual belief of the person filing this form, after he or she has
taken reasonable measures to ensure its correctness.
If you complete the account information for more than one
account of the same owner, you need identify the owner only
once. Write “Same Owner” in Item 34 for the succeeding
accounts of the same owner.
Item 35. Provide the taxpayer identification number of the
owner of the account.
Items 36–42. Provide the identity information of the owner of
the account.
Item 43. Enter filer’s title for the position which gives him
authority over the account.
Part V—Consolidated Report for Corporate
Parent & Subsidiary Corporations
A corporation which owns directly or indirectly more than 50
percent interest in one or more other entities required to file
this report will be permitted to file a consolidated report on
TD F 90-22.1, on behalf of itself and such other entities.
Check box “d” in Item 2 and complete the Items below.
Item 34. You must provide the corporate name, identifying
number and address of the owner of the foreign financial
account as shown on the books of the financial institution.
The owner may be the parent corporation or subsidiary
owner of a foreign financial account for which you are filing
the consolidated report except as provided in the remainder
of this Item instruction.
If more than one subsidiary owns the account for which
you are filing the consolidated report, provide the information
in Items 34-42 for each subsidiary.
Page
9
If you complete Part V for accounts owned by a domestic
subsidiary corporation and its domestic and/or foreign
subsidiaries, you may treat them as one owner and write in
the space provided, the name of the domestic subsidiary
corporation for which you are filing the report, followed by
“and related entities,” and the identifying number and
address of the domestic subsidiary corporation for which you
are filing the report.
If you complete the account information for more than one
account of the same owner you need identify the owner only
once. Write “Same Owner” in Item 34 for the succeeding
accounts of the same owner.
Item 35. Provide the taxpayer identification number of the
owner of the account.
Items 36–42. Provide the address of the owner of the
account.
Signatures
This report must be signed by the person named in Part I. If
the report is being filed on behalf of a partnership,
corporation or fiduciary it must be signed by an authorized
individual. A spouse included as a joint owner, who elects
not to file a separate report in accordance with the
instructions in Part III, must also sign this report. See the
instructions for Part III.
Enter the title of the individual signing for a legal, entity
such as a corporation, which is shown as the filer. Leave
Filer’s Title blank if the filer is only reporting as an individual.
An individual filing because of a financial interest in his
individual accounts is filing as an individual. An individual
filing because of signature or other authority over a foreign
financial account is filing as an individual. The latter filer
should enter the title giving him authority in Part IV Item 42,
Filer’s Title with this Owner, to show his relationship to the
account.
Enter the actual date signed.
| File Type | application/pdf |
| File Modified | 2006-09-01 |
| File Created | 2006-01-27 |