BE-12 Claim for No BE-12 Claim for Not Filing

FORM

BE-12(X)

(REV. 5/2007)

BEA Identification Number

OMB No. 0608-0042: Approval Expires xx/xx/xxxx

MANDATORY — CONFIDENTIAL

BENCHMARK SURVEY OF FOREIGN DIRECT INVESTMENT IN
THE UNITED STATES – 2007
CLAIM FOR EXEMPTION FROM FILING FORM BE-12(LF), BE-12(SF), BE-12 Mini, OR BE-12 BANK

DUE DATE: MAY 31, 2008
ELECTRONIC
FILING:

Go to www.bea.gov/efile for details

MAIL
REPORTS
TO:

OR
U.S. Department of Commerce
Bureau of Economic Analysis
BE-49(A)
Washington, DC 20230

A. Name and address of U.S. business enterprise – If a label has
been affixed, make any changes directly on the label. If a label has not
been affixed, enter the BEA Identification Number of this U.S. affiliate,
if available, in the box at the upper right hand corner of this page.
Name of U.S. affiliate
1002 0

c/o (care of)
1010 0

OR
DELIVER
REPORTS
TO:

Street or P.O. Box

U.S. Department of Commerce
Bureau of Economic Analysis, BE-49(A)
Shipping and Receiving Section, M100
1441 L Street, NW
Washington, DC 20005

1003 0

City and State
1004 0

OR
(202) 606-5319

FAX
REPORTS
TO:

ZIP Code

Foreign Postal Code

1005 0

OR

0

B. Enter Employer Identification Number(s) used by the U.S.
business enterprise to file income and payroll taxes.

ASSISTANCE
be12/[email protected]
Email:
(202) 606-5577
Telephone:
(202) 606-5319
FAX:
Copies of blank forms:

Primary
1006 1

Other
2

–

–

http://www.bea.gov/surveys/fdiusurv.htm
Definitions of key terms – See page 3.
RESPONSE REQUIRED
Section 806.4 of 15 CFR, Chapter VIII, requires that all persons subject to the reporting requirements of the BE-12 Survey
respond, whether or not they are contacted by BEA. It also requires that persons who are contacted by BEA about reporting in
this survey, must respond in writing. They may respond by:
• filing the properly completed Form BE-12(LF), BE-12(SF),
• certifying in writing, by May 31, 2008 to the fact that the
BE-12 Mini, or BE-12 BANK by May 31, 2008, as required;
person had no direct investment within the purview of the
or
reporting requirements of the BE-12 survey;
• completing and returning the Form BE-12(X) – Claim for
Exemption From Filing Form BE-12(LF), BE-12(SF), BE-12
Mini, or BE-12 BANK, by May 31, 2008;

• using BEA’s E-File system to complete Form BE-12(LF),
BE-12(SF), BE-12 Mini, or BE-12 BANK by May 31, 2008.
Go to www.bea.gov/efile for details.

WHICH SECTIONS TO COMPLETE?
Complete items A and B above, and the Person to Consult Concerning Questions About This Report and the Certification at the
bottom of this page. Also, please review the questions below to determine the additional information required.
I Were at least 10 percent of the voting rights in your business directly or indirectly owned by a foreign person
or entity at the end of your fiscal year that ended in calendar year 2007?
Yes – Continue with question II below. Note: Your business is hereinafter referred to as a "U.S. affiliate."
No – Complete item (a) or (b) or (c) or (d) or (e) on page 2. If your business has been liquidated or dissolved,
complete 2(a) or (b) or (c).
II Were more than 50 percent of the voting rights in this U.S. affiliate owned by another U.S. affiliate, or was this U.S. affiliate
merged into another U.S. affiliate before the end of this U.S. affiliate’s fiscal year that ended in calendar year 2007?
Yes – Continue with question III below.
No – You are not eligible to file Form BE-15 Supplement C and must file either a
Form BE-12(LF), BE-12(SF), BE-12 Bank, or BE-12 Mini. Copies of blank forms
may be found at: http://www.bea.gov/surveys/fdiusurv.htm
III Will the data for this U.S. affiliate be consolidated into the 2007 BE-12 report filed for the U.S. affiliate that owns it more than
50 percent, or be included on the 2007 BE-12 report filed for the U.S. affiliate into which it was merged?
Yes – Complete item (f)(1) or (f)(2) on page 2.
No – Contact BEA for guidance.
MANDATORY
CONFIDENTIALITY
PENALTIES

佡

This survey is being conducted under the International Investment and Trade in Services Survey Act (P.L. 94-472, 90
Stat. 2059, 22 U.S.C. 3101-3108, as amended). The filing of reports is mandatory and the Act provides that your report
to this Bureau is confidential. Whoever fails to report may be subject to penalties. See page 3 for more details.

PERSON TO CONSULT CONCERNING QUESTIONS ABOUT THIS
REPORT — Enter name and address

CERTIFICATION — The undersigned official certifies that this report
has been prepared in accordance with the applicable instructions, is
complete, and is substantially accurate except that estimates may have
been provided where data are not available from customary accounting
records or precise data could not be obtained without undue burden.

1000 0

Name

Address 1029 0
1030 0

Authorized official’s signature

1031 0

TELEPHONE
NUMBER
FAX NUMBER

1001

0 Area code

Number

0999

0 Area code

Number

Date

Print or type name and title

Extension

Telephone number

FAX number

May we use e-mail to correspond with you to discuss questions relating to this Form BE-12(X), including questions that may contain
information about your company that you may consider confidential? (Note that electronic mail is not inherently confidential; we will treat
information we receive as confidential, but your e-mail is not necessarily secure against interception by a third party.)
1027

1
1

1
2

Yes (If yes, please print your e-mail address.)
No

Base prints black

E-mail address (Please print)
0
1028

BE-12(X), Page 1, Pantone 115 Yellow, 20%

BASIS OF CLAIM FOR EXEMPTION
Select one type of exemption based on one of the reasons listed below. Please check the box
corresponding to the type of exemption you are claiming.
This U.S. business enterprise is exempt from filing Form BE-12(LF), BE-12(SF), BE-12 Bank, or BE-12 Mini because:
(a)

This U.S. business enterprise was a U.S. affiliate of a foreign person or entity at some time during calendar year
2007, but ceased to be a U.S. affiliate before the end of its fiscal year that ended in calendar year 2007.

00170 1

Give date foreign ownership ceased or went below 10 percent,
or when the business was liquidated or dissolved.
7012

Month

Day

Year

1

(b)

This U.S. business enterprise was not a U.S. affiliate of a foreign person or entity at any time during calendar
year 2007 but had been a U.S. affiliate of a foreign person or entity at some time between January 1, 2002 and
the beginning of calendar year 2007.

00110 1

Give date foreign ownership ceased or went below 10 percent,
or when the business was liquidated or dissolved.
7010

Month

Day

Year

1

(c)

This U.S. business enterprise was not a U.S. affiliate of a foreign person at any time after
December 31, 2001 but was a U.S. affiliate sometime prior to January 1, 2002.

00111 1

Give date foreign ownership ceased or went below 10 percent,
or when the business was liquidated or dissolved.
xxxx

Month

Day

Year

1

(d)

This U.S. business enterprise is a U.S. affiliate of a foreign person or entity, but became a U.S. affiliate after
the end of its fiscal year that ended in calendar year 2007, or if a newly formed company, its first fiscal year
did not or will not end until after the end of calendar year 2007. Complete items (1) and (2) below.

00180 1

(1) Give date when the U.S. business enterprise became a U.S. affiliate of a foreign person.
7013

Month

Day

Year

1

Note that a Form BE-13 should have been filed to reflect the
acquisition. Copies of blank forms can be found at:
www.bea.gov/bea/surveys/fdiusurv.htm

(2) Give the ending date of the U.S. business enterprise’s fiscal year that ended in calendar year 2007.
If a newly formed company give the ending date of the U.S. business enterprise’s first fiscal year.
NOTE: For a newly formed company this must be a date in calendar year 2008.
7014

Month

Day

Year

1

(e)

This U.S. business is enterprise exempt from filing because its owners are citizens of the United States who
are resident abroad as a result of official employment by the U.S. Government (including the immediate
family of such persons), or its owners have been and expect to be resident abroad for less than one year.

00160 1

(f) This U.S. business enterprise was a U.S. affiliate of a foreign person or entity during the fiscal year that
ended in calendar year 2007 but was (please check appropriate box (1) or (2)):
(1)

00112

1

1

Fully consolidated into the
2007 BE-12 report filed for
another U.S. affiliate;

OR

(2)

00112

2

1

Merged into another U.S. affiliate and its
operations are included on the 2007 BE-12
report filed for the other U.S. affiliate.

On the lines below give the name, address, and BEA Identification Number of the U.S. affiliate
into which this U.S. affiliate is fully consolidated or merged.
Name
00120 0

Street or P.O. Box
00130 0

City and State

ZIP Code

00140 0

00150 0

BEA Identification Number of the U.S. affiliate into which this U.S. affiliate is fully consolidated or merged.
7011 0

(g)

00190 1

Other – Specify and include reference to section of regulations or
instructions on which claim is based.
7015 0

Remarks

FORM BE-12(X) (REV. 5/2007)

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Authority – This survey is being conducted under the International Investment and Trade in
Services Survey Act (P.L. 94-472, 90 Stat. 2059, 22 U.S.C. 3101-3108, as amended), and the filing
of reports is MANDATORY pursuant to Section 5(b)(2) of the Act (22 U.S.C. 3104). The
implementing regulations are contained in Title 15, CFR, Part 806.
Penalties – Whoever fails to report may be subject to a civil penalty of not less than $2,500, and
not more than $25,000, and to injunctive relief commanding such person to comply, or both. The
civil penalties are subject to inflationary adjustments. Those adjustments are found in 15 CFR
6.4. Whoever willfully fails to report shall be fined not more than $10,000 and, if an individual,
may be imprisoned for not more than one year, or both. Any officer, director, employee, or
agent of any corporation who knowingly participates in such violation, upon conviction, may be
punished by a like fine, imprisonment, or both. (22 U.S.C. 3105)
Notwithstanding any other provision of the law, no person is required to respond to, nor shall
any person be subject to a penalty for failure to comply with, a collection of information subject
to the requirements of the Paperwork Reduction Act, unless that collection of information
displays a currently valid OMB Control Number. The control number for this survey is at the top
of page 1 of this form.
Respondent Burden – Public reporting burden for this form is estimated to vary from xx to xx
minutes per response with an average of x xxxx 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: Director, Bureau of Economic Analysis (BE-1), U.S. Department of Commerce,
Washington, DC 20230; and to the Office of Management and Budget, Paperwork Reduction
Project 0608-0042, Washington, DC 20503.
Confidentiality – The Act provides that your report to this Bureau is CONFIDENTIAL and may
be used only for analytical or statistical purposes. Without your prior written permission, the
information filed in your report CANNOT be presented in a manner that allows it to be
individually identified. Your report CANNOT be used for purposes of taxation, investigation, or
regulation. Copies retained in your files are immune from legal process.

DEFINITIONS OF KEY TERMS
Affiliate means a business enterprise located in one country that is directly or indirectly owned
or controlled by a person or entity of another country to the extent of 10 percent or more of its
voting stock for an incorporated business or an equivalent interest for an unincorporated
business, including a branch.
Direct investment means the ownership or control, directly or indirectly, by one person or
entity of 10 percent or more of the voting securities of an incorporated business enterprise or an
equivalent interest in an unincorporated business enterprise.
U.S. affiliate means an affiliate located in the United States in which a foreign person or entity
has a direct investment.

FORM BE-12(X) (REV. 5/2007)

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