Abbreviated Foreign Branch Report of Condition

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Board of Governors of the Federal Reserve System OMB Number: 7100-0071
Federal Deposit Insurance Corporation
OMB Number: 3064-0011
Office of the Comptroller of the Currency
OMB Number: 1557-0099
Approval Expires December 31, 2015
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Federal Financial Institutions Examination Council

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Abbreviated Foreign Branch Report of Condition—
FFIEC 030S
Report at the close of business December 31,
Year

This report is required by law (12 U.S.C. § 321, 324, and 602 (FRB);
12 U.S.C.§ 161 and 602 (OCC); and 12 U.S.C. § 1828 (FDIC)).

collected on this form must be released, respondents will be
notified.

The Federal Financial Institutions Examination Council regards
the information provided by each respondent as confidential.
If it should subsequently be determined that any information

A Federal agency may not conduct or sponsor, and an organiMove "Consolidation Option"
zation is not required to respond to, a collection of information
including
for consolidated
unless it displays a currently valid OMB
controllines
number.

Name of Bank

Consolidation Option

Name

Street Address

City

State

branches to new page 2.

Banks may, at their option, consolidate the figures for all other
branches located in the same country on the report form,
using the name and address of the principal branch. When If
the bank elects to consolidate, complete the following
statement. A or B below should be com-pleted, as
appropriate.
A. No figures are shown for this branch because of consolidation
branch.
with those reported for the
Name of Country's Principal Branch

Foreign Branch

B. Figures reported in this report are a consolidation of all
branches in
Name
Street Address

Number

Country

Please list the consolidated branches on the lines below

City / Town

Country

For consolidation option B, please list the consolidated branches on the lines below:
Street Address

City

Street Address

City

Street Address

City

Street Address

City

Street Address

City

Street Address

City

(If more space is needed, please list addresses for the other branches on a separate page.)
All banks and savings associations should submit completed and signed original hard copy report forms
to the appropriate Federal Reserve District Bank.
Insert 1 in space above (see page 2).
Public reporting burden for this collection of information is estimated to average 0.5 hours 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, 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; Legislative and Regulatory Activities, Office of the Comptroller of the Currency, 250 E Street, SW, Washington, DC 20219; Assistant
Executive Secretary, Federal Deposit Insurance Corporation, 550 17th Street, NW, Washington, DC 20429.
12/2012

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FFIEC 030S
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For Agency Use Only
Charter

Country

City

Name of Bank

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Branch

Branch

U.S. Dollar Amounts in Thousands
Financial Data
1. Gross due from related institutions ..........................................................................................
2. Total assets........................................................................................................................
3. Gross due to related institutions .............................................................................................
4. Total gross notional amount of derivative contracts .....................................................................
5. Commercial and similar letters of credit, standby letters of credit, and foreign office guarantees .............

I,

,
Name of Officer Authorized to Sign Report

FORB

Bil

Mil

Thou

3002
2170
3001

1.
2.
3.
4.
5.

F156
F157

of the above-named bank do hereby declare that this report
Title

of condition is true and correct to the best of my knowledge and belief.

Signature of Officer Authorized to Sign Report

Page 1, insert 1
The FFIEC 030S is to be prepared in accordance with federal regulatory authority instructions and must be signed by an
authorized officer of the parent U.S. institution. The authorized officer may be the chief financial officer or equivalent
senior officer.
I, the undersigned authorized officer of the named parent U.S. institution attest that the FFIEC 030S report (including
any consolidated branches) for this report date has been prepared in conformance with the instructions issued by the
federal regulatory authority and is true and correct to the best of my knowledge and belief.
[Printed Name of Authorized Officer (FORB C490)]
[Signature of Senior Officer]
[Title of Officer (FORB C491)]
[Date of Signature (MM/DD/YYYY) (FORB J196)]

12/2012