Webform OMB 1124 0004 Change Request 2019

OMB No. 1124-0004; Expires May 30, 2020

U.S. Department of Justice
Washington, DC 20530

Exhibit B to Registration Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended

INSTRUCTIONS. A registrant must furnish as an Exhibit B copies of each written agreement and the terms and conditions of each oral agreement
with his foreign principal, including all modifications of such agreements, or, where no contract exists, a full statement of all the circumstances by
reason of which the registrant is acting as an agent of a foreign principal. Compliance is accomplished by filing an electronic Exhibit B form at
https://www.fara.gov.
Privacy Act Statement. The filing of this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 et seq.,
for the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide
the information is subject to the penalty and enforcement provisions established in Section 8 of the Act. Every registration statement, short form
registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or information filed with the
Attorney General under this Act is a public record open to public examination, inspection and copying during the posted business hours of the
Registration Unit in Washington, DC. Statements are also available online at the Registration Unit’s webpage: https://www.fara.gov . One copy of
every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act, and
copies of any and all documents are routinely made available to other agencies, departments and Congress pursuant to Section 6(c) of the Act. The
Attorney General also transmits a semi-annual report to Congress on the administration of the Act which lists the names of all agents registered under
the Act and the foreign principals they represent. This report is available to the public in print and online at: https://www.fara.gov.
Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .32 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 or any other aspect of this collection of information, including suggestions
for reducing this burden to Chief, Registration Unit, Counterintelligence and Export Control Section, National Security Division, U.S. Department
of Justice, Washington, DC 20530; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC
20503.

1. Name of Registrant

2. Registration Number

3. Name of Foreign Principal

Check Appropriate Box:
4.

□

5.

□

6.

□

The agreement between the registrant and the above-named foreign principal is a formal written contract. If this box is
checked, attach a copy of the contract to this exhibit.
There is no formal written contract between the registrant and the foreign principal. The agreement with the above-named
foreign principal has resulted from an exchange of correspondence. If this box is checked, attach a copy of all pertinent
correspondence, including a copy of any initial proposal which has been adopted by reference in such correspondence.
The agreement or understanding between the registrant and the foreign principal is the result of neither a formal written
contract nor an exchange of correspondence between the parties. If this box is checked, give a complete description below of
the terms and conditions of the oral agreement or understanding, its duration, the fees and expenses, if any, to be received.

7. What is the date of the contract or agreement with the foreign principal?
8. Describe fully the nature and method of performance of the above indicated agreement or understanding.

FORM NSD-4
Revised 06/19

9. Describe fully the activities the registrant engages in or proposes to engage in on behalf of the above foreign principal.

10. Will the activities on behalf of the above foreign principal include political activities as defined in Section 1(o) of the Act 1 .
Yes

□

No

□

If yes, describe all such political activities indicating, among other things, the relations, interests or policies to be influenced
together with the means to be employed to achieve this purpose. The response must include, but not be limited to, activities
involving lobbying, promotion, perception management, public relations, economic development, and preparation or
dissemination of informational materials.

11. Prior to the date of your registration2 for this foreign principal to the time of filing this exhibit, did the registrant engage in any
activities, including political activities, for or render any services to the foreign principal?
Yes

□

No

□

If yes, describe in full detail all such activities. The response should include, among other things, the relations, interests, and
policies sought to be influenced and the means employed to achieve this purpose. If the registrant arranged, sponsored, or
delivered speeches, lectures, social media, internet postings, or media broadcasts, give details as to dates, places of delivery,
names of speakers, and subject matter. The response must also include, but not be limited to, activities involving lobbying,
promotion, perception management, public relations, economic development, and preparation and dissemination of
informational materials.
Set forth below a general description of your activities.

Set forth below in the required detail your political activities.
Date

Contact

Method

Purpose

12. During the period beginning 60 days prior to the date of your obligation to register 3 for this foreign principal to the time of filing
this exhibit, did you receive from the foreign principal any contribution, income, money, or thing of value either as compensation
or for disbursement or otherwise? Yes
No

□

□

If yes, set forth below in the required detail an account of such monies or things of value.
Date Received From Whom

Purpose

Amount/Thing of Value

Total
13. During the period beginning 60 days prior to the date of your obligation to register 4 for this foreign principal to the time of filing
this exhibit, did you spend or disburse any money in furtherance of or in connection with your activities on behalf of the foreign
principal?
Yes

□

No

□

If yes, set forth below in the required detail and separately an account of such monies, including monies transmitted, if any.
Date

To Whom

Purpose

Amount

1 "Political activity," as defined in Section 1(o) of the Act, means any activity which the person engaging in believes will, or that the person intends to, in any way influence

any agency or official of the Government of the United States or any section of the public within the United States with reference to formulating, adopting, or changing the
domestic or foreign policies of the United States or with reference to the political or public interests, policies, or relations of a government of a foreign country or a foreign
political party.
2,3,4 Pursuant to Section 2(a) of the Act, an agent must register within ten days of becoming an agent, and before acting as such.

EXECUTION
In accordance with 28 U.S.C. § 1746, the undersigned swear(s) or affirm(s) under penalty of perjury that he/she has (they have) read
the information set forth in this Exhibit B to the registration statement and that he/she is (they are) familiar with the contents thereof
and that such contents are in their entirety true and accurate to the best of his/her (their) knowledge and belief.
Date

Printed Name

Signature

Sign

Sign
Sign

Sign