Form TD-F-90-22.50 Report of Blocked Property

ANNUAL REPORT OF BLOCKED PROPERTY
TD F 90-22.50
Office of Foreign Assets Control
Department of the Treasury
Washington, D.C. 20220
The Office of Foreign Assets Control (OFAC) requires an annual report of all property
blocked or funds retained under OFAC Regulations found in Title 31 of the Code of
Federal Regulations, Parts 500 through 599. This information is needed by the United
States Government for planning purposes and to verify compliance with OFAC Regulations.
The report is to be submitted annually by September 30 to the Compliance Programs
Division, OFAC, Department of the Treasury, Washington, D.C. 20220.
General Instructions
Any person holding property blocked or funds retained under OFAC Regulations is required
to submit a report on this form concerning such property. Reports filed in accordance
with OFAC Regulations are regarded as containing commercial and financial information
which is privileged and confidential. Requests to submit reports in alternative formats
will be considered on a case-by-case basis. For additional copies of the form, as well
as other information of interest to holders of blocked property, call OFAC's fax-ondemand service at (202) 622-0077.
Part A - U.S. Person Holding Property.
State reporter's corporate name and address and the name and telephone number of an
individual corporate official to contact regarding this report.
Name:
Address:

Individual to contact regarding this report:

(name)

(title)

(telephone number)

Total number of accounts or items reported on Part B:
Complete the certification where applicable.
certification.
I,

The report is not valid without the

, certify that I am the
(name)

(title)

of the

, that I am authorized to make this
(corporate name)

certification, and that, to the best of my knowledge and belief, the statements set
forth in this report, including any papers attached hereto or filed herewith, are true
and accurate, and that all material facts in connection with said report have been set
forth herein.

(signature)

(date)

PAPERWORK REDUCTION ACT STATEMENT: The paperwork requirement has been cleared under the Paperwork Reduction Act
of 1980. The Office of Foreign Assets Control of the Department of the Treasury requires this information be
furnished pursuant to 50 U.S.C. 1701, and CFR Parts 500 to 600. The information collected will be used for U.S.
Government planning purposes and to verify compliance with OFAC Regulations. The information will be held
confidential. The estimated burden associated with this collection of information is 4 hours per respondent or
record keeper. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden
should be directed to the Compliance Programs Division, Office of Foreign Assets Control, Department of the
Treasury, Washington, D.C. 20220 and the Office of Management and Budget, paperwork Reduction Project (1505-0164),
Washington, D.C. 20503. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a valid control number assigned by OMB.

Part B - Property Reported
Identify each account or item of property separately in the spaces provided below. Use additional photocopies of Part B as needed. Use
supplemental attachments if the space provided is inadequate. Be sure to indicate the number of accounts or items reported on Part B in the
appropriate space on Part A.
Owner.
Description.
Value.
Location.
Regulations.

Owner

Identify the owner of the property.
Provide a brief but comprehensive description of the property.
Include account type, number, and currency (if other than U.S. Dollars) where applicable.
Provide the value (or an estimate) of the property as of June 30.
If a value date other than June 30 is reported, so indicate.
List the location or branch where the property is held, if different than the address shown in Part A.
Identify the Part of Title 31 of the Code of Federal Regulations under which this property is blocked.

Description

Value

Location

Regulations