Form FR U-1 FR U-1 Statement of Purpose for an Extension of Credit Secured

FR U-1
OMB No. 7100-0115
Approval expires January 31, 2014

BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM

Statement of Purpose for an Extension of Credit Secured by Margin Stock
(Federal Reserve Form U-1)
Name of Bank

This form is required by law (15 U.S.C. 78g and 78w; 12 CFR 221).
The Federal Reserve 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.
Public reporting burden for this collection of information is estimated to average
10 minutes per response, including the time to gather and maintain data in the

required form and to review instructions and complete the information collection.
Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden to: Secretary, Board of
Governors of the Federal Reserve System, 20th and C Streets, N.W., Washington,
DC 20551; and to the Office of Management and Budget, Paperwork Reduction
Project (7100-0019), Washington, DC 20503.

Instructions
1. This form must be completed when a bank extends credit in excess of $100,000 secured directly or indirectly, in whole or in part,
by any margin stock.
2. The term “margin stock” is defined in Regulation U (12 CFR 221) and includes, principally: (1) stocks that are registered on a
national securities exchange or any over-the-counter security designated for trading in the National Market System; (2) debt
securities (bonds) that are convertible into margin stocks; and (3) shares of most mutual funds.
3. Please print or type (if space is inadequate, attach separate sheet).

Part I To be completed by borrower(s)
1. What is the amount of the credit being extended?
2. Will any part of this credit be used to purchase or carry margin stock?

Yes

No

If the answer is “no,” describe the specific purpose of the credit.

I (We) have read this form and certify that to the best of my (our) knowledge and belief the information given is true, accurate, and
complete, and that the margin stock and any other securities collateralizing this credit are authentic, genuine, unaltered, and not stolen,
forged, or counterfeit.
Signed:
Signed:
Borrower’s signature

Print or type name

Date
Borrower’s signature

Date

Print or type name

This form should not be signed if blank.
A borrower who falsely certifies the purpose of a credit on this form or otherwise willfully or intentionally evades
the provisions of Regualtion U will also violate Federal Reserve Regulation X, “Borrowers of Securities Credit.”

FR U-1
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Part II To be completed by bank only if the purpose of the credit is to purchase or carry margin securities (Part I(2) answered
“yes”)
1. List the margin stock securing this credit; do not include debt securities convertible into margin stock. The manimum loan value of
margin stock is 50 per cent of its current market value under the current Supplement to Regulation U.
No. of
shares

Market price
per share

Issue

Date and source
Total market
of valuation
value per issue
(See note below)

2. List the debt securities convertible into margin stock securing this credit. The maximum loan value of such debt securities is 50 per
cent of the current market value under the current Supplement to Regulation U.
Principal
amount

Issue

Market price

Date and source
Total market
of valuation
(See note below) value per issue

3. List other collateral including nonmargin stock securing this credit.
Market price

Describe briefly

Date and source
of valuation
(See note below)

Good faith
loan value

Note: Bank need not complete “Date and source of valuation” if the market value was obtained from regularly published information in a journal of general circulation or an
an automated quotation system.

Part III To be signed by a bank officer in all instances.
I am a duly authorized representative of the bank and understand
that this credit secured by margin stock may be subject to the
credit restrictions of Regulation U. I have read this form and any
attachments, and I have accepted the customer’s statement in
Part I in good faith as required by Regulation U*; and I certify that
to the best of my knowledge and belief, all the information given
is true, accurate, and complete. I also certify that if any securities
that directly secure the credit are not or will not be registered in
the name of the borrower or its nominee, I have or will cause

to have examined the written consent of the registered owner
to pledge such securities. I further certify that any securities
that have been or will be physically delivered to the bank in
connection with this credit have been or will be examined, that all
validation procedures required by bank policy and the Securities
Exchange Act of 1934 (section 17(f), as amended) have been
or will be performed, and that I am satisfied to the best of my
knowledge and belief that such securities are genuine and not
stolen or forged and their faces have not been altered.
Signed:

Date

Bank officer’s signature

Title

Print or type name

* To accept the customer’s statement in good faith, the duly authorized representative of the creditor must be alert to the circumstances surrounding the credit and, if in
possession of any information that would cause a prudent person not to accept the statement without inquiry, must have investigated and be satisfied that the statement is
truthful. Among the facts which would require such investigation are receipt of the statement through the mail or from a third party.

This form must be retained by the lender for three years after the credit is extinguished.