Form G-FIN Notice by Financial Institutions of Government Securitie

Form G-FIN
Reporting Burden—Public reporting burden for this collection of information is estimated to average 1 hour 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 the collection of information, including suggestions for reducing this burden, to the Office of Information and Regulatory Affairs,
Office of Management and Budget, Washington, DC 20503, and to one of the following: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets,
NW, Washington, DC 20551; Assistant Executive Secretary (Administration), Room F-400, Federal Deposit Insurance Corporation, Washington, DC 20429; Legislative
and Regulatory Analysis Division, Office of the Comptroller of the Currency, Washington, DC 20219; Chief Counsel’s Office, Office of Thrift Supervision, 1700 G Street,
NW, Washington, DC 20552; or to Securities and Exchange Commission, 450 Fifth Street, NW, Washington, DC 20549.
An agency may not conduct or sponsor, and an organization (or a person) is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.

Notice By Financial Institutions of
Government Securities Broker or Government
Securities Dealer Activities
(This booklet includes instructions and blank forms.)
Board of Governors of the Federal Reserve System
OMB No. 7100-0224

Federal Deposit Insurance Corporation
OMB No. 3064-0093

Office of the Comptroller of the Currency
OMB No. 1557-0184

Office of Thrift Supervision
OMB No. 1550-0019

Securities and Exchange Commission
OMB No. 3235-0083

This notice is required by law [15 U.S.C. 78o-5(a)(1)(B)].

NOTICE REQUIREMENTS
This notice must be filed by all financial institutions that are
government securities brokers or government securities
dealers that are not exempt from the notice requirement
under regulations of the Department of the Treasury. Generally,
a financial institution will not be required to file as a government
securities broker or dealer if its only government securities
activities are to: (1) Buy or sell government securities solely
for investment for its own account; (2) Buy or sell government
securities for fiduciary accounts; (3) Handle savings bond trans-

actions; (4) Submit tenders for the account of customers for
purchase on original issue of U.S. Treasury securities;
(5) Enter into repurchase or reverse repurchase agreements; (6)
Effect fewer than 500 government securities brokerage transactions per year; (7) Effect brokerage transactions only through
another government securities broker or dealer on a fully disclosed basis; or (8) Effect brokerage transactions that do not
involve active solicitations.

For further information on the requirements to file this notice, please refer to the instructions.

Form G-FIN

FR G-FIN
OMB No. 7100–0224
Average hours per response: 1.0
Approval expires April 30, 2010
OFFICIAL USE

Notice of Government Securities Broker or Government Securities Dealer Activities
To Be Filed by a Financial Institution Under Section 15C(a)(1)(B)
of the Securities Exchange Act of 1934
1. Check appropriate regulatory agency (ARA):
A.
B.
C.
D.
E.

2. Conducts business as:

Comptroller of the Currency
Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of Thrift Supervision
Securities and Exchange Commission

A.
B.
C.

Government Securities Broker
Government Securities Dealer
Government Securities Broker and Dealer

3. Filing status of notice:
A.
B.

Notice
Amendment

4. A. Full name of the financial institution:

B. Address of principal office of financial institution:

C. Address of principal office where government securities broker or government securities dealer activities will be conducted
(if different from item (B)):

D. Mailing address if different from (B) or (C):

E. Name, title and telephone number of contact person with respect to this notice:

Name

Title

Telephone

5. Does financial institution conduct, or will it conduct, government securities broker or government securities dealer activities at any location
other than given in Question 4 above?
A.
Yes
B.
No
(If yes, provide addresses and describe activities.)

FR G-FIN
OMB No. 7100–0224
Approval expires April 30, 2010

6. Furnish the name and title of each person who is directly engaged in the management, direction or supervision of any of the financial
institution's government securities broker or government securities dealer activities:
Full Name
Last

First

Middle

Title

Last

First

Middle

Title

Last

First

Middle

Title

Last

First

Middle

Title

Last

First

Middle

Title

Note: Attach a separate Form G-FIN-4 (or, if previously filed, a copy of Form MSD-4 or Form U-4) for each person named in
item 6.

7. Has any “associated person” (see definition in paragraph A.7. of the instructions) responded “yes” to any question in Item 17
of Form G-FIN-4, or “yes” to one or more questions in Items 23 through 26 of Form MSD-4 or Item 22 on Form U-4?
A.

Yes

B.

No

Note: The financial institution and the person executing this form are responsible for making an inquiry of all other employers
of any associated person during the immediately preceding three years for the purpose of verifying the accuracy of the
information furnished on Form G-FIN-4. (See 17 C.F.R. 400.4(c).) Similar requirements are applicable to Form MSD-4 and
Form U-4.

8. The financial institution submitting this notice and the person executing it represent that all of the information contained
herein is true, current and complete.
Please print name and title of person executing this notice:

First

Manual Signature

Middle

Last

Title

Date