Form TIC-SHC/SHCA SHC Sched 1, Sched 2, sched 3

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

Report of U.S. Ownership of Foreign Securities, Including Selected Money Market Instruments
(SHC)

SCHEDULE 1: REPORTER CONTACT IDENTIFICATION AND
SUMMARY OF FINANCIAL INFORMATION
REPORTER CONTACT INFORMATION
1.

Reporter Identification Number (RSSD): ………………………………………….…… … ….

2.

Organization Name:

3. Street Address:

4. City:

5. State:

6. Zip Code:

7. Reporting Status:……………………………………………………………………………………………………..….
1 = Exempt
2 = Only Schedule 2(s) are being submitted

3 = Only Schedule 3(s) are being submitted
4 = Schedules 2(s) and 3(s) are being submitted

8. Reporter Type :………………………………………………………………………………….…...……….….…… …
1 = Depository Institution
2 = Fund /Fund Manager/Sponsor
(excluding pension fund)
3 = Pension Fund

4 = Insurance Company
7 = Foundation, trust, estate
5 = Other Financial Organization
8 = Institution of higher learning
(including BHC, FHC, IHC, broker/dealers)
(e.g., university)
6 = Non-Financial Organization
9 = Other (not listed above)

If you would like to provide more than one contact name, please attach additional copies of page 1, Schedule 1, with
items 9 through 13 completed.
Business Contact Information:
9.

Name:

10. Title:
11. Telephone Number:
12. Email Address:
13. Name of Service Provider or Vendor Used (if applicable):
Technical Contact Information:
14. Name:

15. Title:

16. Telephone Number:

17. Email Address:

SHC

Schedule 1, Page 1 of 3

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

Reporter Identification Number……………………………..……………………………
18. Valuation Technique(s) Used to Determine Fair Values
For each reporting unit, please describe the valuation technique(s) used to determine reported fair values. If securities are
automatically valued at zero after a specified time period of inactivity, please specify the time period and whether this applies
to the security or to the client’s holdings of the security. Also, please specify how securities not actively traded on the report
date and those with internally generated security identification numbers are valued.
Reporting Unit

SHC

Valuation Description

Schedule 1, Page 2 of 3

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

Reporter Identification Number (RSSD)…………………………………………...……..
SUMMARY OF SCHEDULE 2 INFORMATION
19. Total Number of Schedule 2s Submitted……………………….……………………………..

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,

20. Total US$ Fair Value of All Equity Securities ……………….
Reported on Schedule 2(s)

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,

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,

21. Total US$ Fair Value of All Short-Term Debt Securities…
(excluding asset-backed securities) Reported on Schedule 2(s)

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,

,

,

22. Total US$ Fair Value of All Long-Term Debt Securities….
(excluding asset-backed securities) Reported on Schedule 2(s)

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,

23. Total US$ Fair Value of All Asset-Backed……………….
Securities Reported on Schedule 2(s)

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,

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,

SUMMARY OF SCHEDULE 3 INFORMATION
24. Total Number of Schedule 3s Submitted…..…………………………………………………………….….

,

25. Total US$ Fair Value of All Equity Securities …………………….
Reported on Schedule 3(s)

,

,

,

,

26. Total US$ Fair Value of All Short-Term Debt Securities…………..
(excluding asset-backed securities) Reported on Schedule 3(s)

,

,

,

,

27. Total US$ Fair Value of All Long-Term Debt Securities..................
(excluding asset-backed securities) Reported on Schedule 3(s)

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,

,

,

28. Total US$ Fair Value of All Asset-Backed……………………….....
Securities Reported on Schedule 3(s)

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CERTIFYING
By signing the certification below you acknowledge that:
•
•
•

You have read and understood the reporting requirements of this survey.
You are aware that both civil and criminal penalties may be imposed for filing a false report; and
You are sufficiently knowledgeable about the activities and functions of your organization that you can knowingly and
with reasonable confidence certify that the information provided in this report is both accurate and complete.

Certifier's Signature:

29. Date Signed:

30. Certifier's Name:
31. Certifier's Title:
32. Certifier's Telephone Number:
33. Certifier's Email Address:
SHC

Schedule 1, Page 3 of 3

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

SCHEDULE 2: DETAILS OF SECURITIES
1.

Reporter Identification Number (RSSD):……………….……………………..…………

2.

Sequence Number: …………………………………………………………………………..… … , ,

3.

Reporting Unit:……………………………………………………………..………….………….…………..…… …..

4.

Name of Reporting Unit:

, ,

5. Reporting As:…………………………………………………………………………………………………………………
1 = End-investor

2 = Custodian

6.

Security ID:………………………………………………………………..………

7.

Security ID System:….………………………………………………………..…………………………………………….
1 = CUSIP
2 = ISIN
6 = Internally Generated

3 = CINS
4 = Common Code
7 = Other (Provide answer to 8)

5 = SEDOL

8.

For code of Other (7) enter the name of the organization or system that assigned the Security ID:

9.

Security Description:

10. Name of Issuer:
11. Type of Foreign Issuer:…………………………………………………………………………………………………… …
1 = Foreign Official Institutions

2 = All Other Foreign Residents

12. Security Type: ……………………………………………………………………………………………………… …
Equities
1 = Common stock
2 = Preferred stock
3 = Fund shares
4 = All other equity

Debt (excluding asset-backed securities)
5 = Commercial paper
6 = Negotiable CD
7 = Convertible debt security
8 = Zero-coupon bond or note

9 = Bond or note, unstripped
10 = Bond or note, stripped
11 = All other debt

Asset-Backed Securities
12 = Asset-backed security

13. Country of Residence of Issuer: (Refer to Appendix C)……………………………………………………………… … .… .
14. Currency of Denomination: (Refer to Appendix E)………………………………………………………………… … …..
15. Type of U.S. Owner: …………………………………………………………………………………………..….…………
1 = Depository Institution
2 = Fund or Other Investment Vehicle
(excluding pension and mutual funds)
3 = Pension Fund

4= Mutual Fund
5 = Insurance company
6 = Other Financial Organization (including BHC, FHC, IHC)
7 = Nonfinancial Organization (including individual/household)

16. Depositary Receipt/Share: ……………………………………………………………………………………..….…………
1 = Yes, the security is a Depositary Receipt/Share
2 = No, the security is NOT a Depositary Receipt/Share
SHC

Schedule 2, Page 1 of 2

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

Reporter Identification Number (RSSD): …………………………………………….………

17. US$ Fair Value of Security:….………………….……………………… … …

… ,

18. Fair Value of Security in the Currency of Denomination:……………… ……

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FOR EQUITIES ONLY
(Security Types 1, 2, 3 or 4)
19. Number of Shares:………………………………………………………….….

FOR ALL DEBT SECURITIES
(NON-ASSET-BACKED AND ASSET-BACKED SECURITIES)
(Security Types 5, 6, 7, 8, 9, 10, 11, or 12)
20. Face Value (for non-ABS) or Remaining Principal Outstanding (for ABS)
in the Currency of Denomination: ……………….…………………..…

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, ,

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FOR ASSET-BACKED SECURITIES ONLY
(Security Type 12)
21.

Original Face Value in the Currency of Denomination: ……………….… …..

FOR ALL DEBT SECURITIES
(NON-ASSET-BACKED AND ASSET-BACKED SECURITIES)
(Security Types 5, 6, 7, 8, 9, 10, 11, or 12)

22.

Issue Date: (MMDDYYYY)……………………………………………………………………

23.

Maturity Date: (MMDDYYYY)…………………….………………………………………….

SHC

Schedule 2, Page 2 of 2

,

Department of the Treasury

OMB Control Number 1505-0146

Approval Expires 10/31/2024

SCHEDULE 3: CUSTODIANS USED

1. Reporter Identification Number (RSSD):.…….….…….….…….…………..……. …
2.

Sequence Number: ..……………….…………………………………………………………… ……

3

Custodian Code: (Refer to Appendix F)………………………………………………………………………… ………. .

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If the U.S.-resident custodian used is not in the Appendix, please enter 99 and complete items 9 through 14.

4.

Total US$ Fair Value of Foreign Equity Securities
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,

,

,

5. Total US$ Fair Value of Foreign Short-Term Debt
Securities (excluding asset-backed securities).……………………

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,

,

,

6. Total US$ Fair Value of Foreign Long-Term Debt
Securities (excluding asset-backed securities) ……………….…….

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,

,

,

7.

Total US$ Fair Value of Foreign Asset-Backed Securities …… ..…

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8.

Reporting As: ………………………………….………..………………………………………………………………
1 = U.S.-resident end-investor (as defined in Appendix G – Glossary)
2 = U.S.-resident custodian (as defined in Appendix G – Glossary), who is in turn entrusting these securities to
another U.S.-resident custodian that knows the identities of its customers

Complete items 9 through 14, identifying the U.S.-Resident Custodian, only if the Custodian Code in Item 3 is 99:
9.

Name of U.S.-Resident Custodian:

10. Street Address of U.S.-Resident Custodian:

11. City:

12. State:

14. Telephone Number of U.S.-Resident Custodian:

SHC

Schedule 3, Page 1 of 1

13. Zip Code: