NSD-5 Webform Amendment to Registration and Supplemental State

OMB No. 1124-0003; Expires June 30, 2023

U.S. Department of Justice
Washington, DC 20530

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

INSTRUCTIONS. File this amendment form for any changes to a registration. Compliance is accomplished by filing an electronic amendment to
registration statement and uploading any supporting documents 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
FARA Unit in Washington, DC. Statements are also available online at the FARA 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 .75 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, FARA 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. This amendment is filed to accomplish the following indicated purpose(es):

□ To give a 10-day notice of change in information as required by Section 2(b) of the Act.
□ To correct a deficiency in
□ Initial Statement
□ Supplemental Statement for the 6 month period ending _______________________________
□ Other purpose (specify) ____________________________________________________
□ To give notice of change in an exhibit previously filed.

4. If this amendment requires the filing of a document or documents, please list:

5. Each item checked above must be explained below in full detail together with, where appropriate, specific reference to and identity
of the item in the registration statement to which it pertains.

FORM NSD-5
Revised 05/20

EXECUTION
In accordance with 28 U.S.C. § 1746, and subject to the penalties of 18 U.S.C. § 1001 and 22 U.S.C. § 618, the undersigned swears or
affirms under penalty of perjury that he/she has read the information set forth in this Amendment to Registration Statement, that he/
she is familiar with the contents thereof, and that such contents are in their entirety true and accurate to the best of his/her knowledge
and belief.
Date

Printed Name

Signature 1

Sign
Sign
Sign

Sign

¹ This statement shall be signed by the individual agent, if the registrant is an individual, or by a majority of those partners, officers, directors or persons performing similar
functions, if the registrant is an organization, except that the organization can, by power of attorney, authorize one or more individuals to execute this statement on its behalf.