Form FR G-1 FR G-1 Registration Statement for Persons Who Extend Credit Sec

FR G-1
OMB Number 7100-0011
Approval expires July 31, 2018
Page 1 of 4

Board of Governors of the Federal Reserve System

Registration Statement for Persons Who Extend Credit
Secured by Margin Stock (Other Than Banks, Brokers, or
Dealers)—FR G-1
This registration statement is required by law (15 U.S.C. § 78g and
78w; 12 C.F.R. § 221) and remains in effect until a deregistration
statement is filed.
The Federal Reserve Board regards the information provided by each
respondent as confidential. If it should be determined subsequently that

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

Name of Registrant:
IRS Identification Number*

Name under which business is conducted, if different from above:
Address of principal place of business:
(Do not use P.O. Box Number)

Street

County

City

Zip Code

State

Mailing address, if different from above:
County

Street

City

State

Zip Code

General Instructions

Definitions

Who must file: Section 221.3(b)(1) of Federal Reserve Regulation U
requires that FR Form G-1 be completed by every person (other than
commercial banks, brokers, or dealers) who during any calendar
quarter extends a total of $200,000 or more, or has outstanding a
total of $500,000 or more, in credit secured directly or indirectly, in
whole or in part, by collateral that includes any margin stock.

Terms used in this form are explained below. Precise definitions may
be found in Section 221.2 of Regulation U.

When and where to file: The form should be filed in duplicate with
the Federal Reserve Bank of the district in which the principal office
of subject person is located within 30 days following the end of such
quarter in which credit has been extended or is outstanding in
accordance with Section 221.3(b)(1). This registration statement will
remain in effect until an FR Form G-2 (deregistration statement) is
approved by the Board of Governors of the Federal Reserve System.
What to file: All persons subject to the registration requirements of
Section 221.3(b)(1) should (i) supply the background information
specified below; (ii) complete Schedule A; and (iii) submit two copies
of a balance sheet, certified by an independent public accountant, for
the registrant's latest fiscal year. If the registrant is subject to
supervision by a state or federal regulatory authority, a copy of the
latest balance sheet filed with such authority may be used. If neither
is available, the registrant should complete Schedule B on page 4.

* A registrant who is an individual is not required to disclose his or her
Social Security number.

Person: Any individual, corporation, partnership, association, joint
stock company, business trust, or unincorporated organization.
Purpose credit: Credit extended for the purpose of purchasing or
carrying margin stock, or to reduce or retire indebtedness previously
incurred for that purpose.
In the ordinary course of business: Occurring or reasonably
expected to occur from time to time in the course of any activity of a
person for profit or the management and preservation of property or,
in the case of a person other than an individual, carrying out or in
furtherance of any business purpose.
Margin stock: 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 stock,
and (3) shares of most mutual funds.
Indirectly secured: In general, credit is indirectly secured by margin
stock if there is any understanding between the borrower and the
lender (1) which is designated to make the margin stock more
available to the lender in case of default than to the borrower's other
creditors, or (2) which limits the borrower from exercising full
dominion over the margin stock to sell, pledge, or donate them, or
determining where they shall be placed physically.

Registration forms will be returned to registrants for corrections if all items have not been answered in the manner required
or if the forms are otherwise unacceptable for filing.
Public reporting burden for this collection of information is estimated to average 2.5 hours 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, NW, Washington, DC 20551; and to the Office of Management and Budget, Paperwork
Reduction Project (7100-0011), Washington, DC 20503.
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FR G-1
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Background Information
1. Principal lines of business:

2. Registrant is: (check one)
Sole proprietorship

Private investor

Partnership

Other (specify)

Corporation
a. If registrant is a sole proprietor, private investor, or other, state full residence address:
Address

City

State

Zip Code

b. If registrant is a corporation, state date and place of incorporation:
Date

Place

c. Person responsible for maintaining records in connection with Regulation U:
Name

Title

Area Code / Phone Number

3. If any of the accounts or records of registrant are kept or maintained by anyone other than the person named in 2(c), furnish the
name and address of the other individual, firm, or organization:
Full Name

Address

City

State

Zip Code

4. a. Does any person not named in items 2(c) or 3 above exercise or have power to exercise a controlling influence over the
management or policies of registrant, directly or indirectly, through stock ownership, agreement, or otherwise?
Yes

No

b. If "Yes", state the name of such person and describe the agreement, arrangement, or nature of the controlling influence:

5. a. Does the registrant extend credit in connection with an employee stock option or stock purchase plan pursuant to the
special "plan-lender" provision set forth in Section 221.4(a) of Regulation U? If so, submit two copies of documents
establishing the plan, a prospectus, and other information which supports adherence to plan-lender limitations.
Yes

No

b. Does the registrant extend credit to an employee stock ownership plan (ESOP) qualified under section 401 of the Internal
Revenue Code (26 U.S.C. § 401), as set forth in Section 221.4(c) of Regulation U? If so, submit two copies of documents
establishing the plan and any other pertinent supporting information.
Yes

No

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Schedule A—Securities Credit
As of
(Month / Day / Year)

Dollar Amounts in Dollars
A. Credit to purchase or carry margin stock (Purpose Loans):
1. Secured directly by margin stock:
a. Listed stocks and OTC margin stocks .............................................................
b. Debt securities convertible into margin stock ....................................................
c. Mutual funds and other margin stock ..............................................................
2. Secured indirectly by margin stock ....................................................................
3. Total (Purpose Credit).....................................................................................
B. Other credit (Nonpurpose Loans):
1. Secured directly by margin stock:
a. Listed stocks and OTC margin stocks .............................................................
b. Debt securities convertible into margin stock ....................................................
c. Mutual funds and other margin stock ..............................................................
2. Secured indirectly by margin stock ....................................................................
3. Total (Nonpurpose Credit)................................................................................

Total Credit
Outstanding
at End of Quarter
(Dollars)¹

Credit Extended
During Quarter
(Dollars)²

Amount

Amount

1.a.
1.b.
1.c.
2.
3.

1.a.
1.b.
1.c.
2.
3.

1. "Credit outstanding" includes credit extended by the registrant during the quarter covered by this report, and during previous quarters, that has not been
extinguished before the end of the quarter covered by this report.
2. "Credit extended" is credit extended by the registrant at any time during the quarter covered by this report. The second column includes new credit
extended during the quarter regardless of whether such credit was extinguished at the end of the quarter. An increase in an existing loan is new credit.

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Schedule B—Balance Sheet
As of
(Month / Day / Year)

This schedule is to be completed only by lenders not submitting corporate balance sheets certified by an independent public
accountant or used to meet reporting requirements of a state or federal regulatory authority.
($ Thousands)
Assets

Liabilities and Net Worth

Cash and bank deposits

Short-term bank borrowings

Trade accounts and notes receivable
(net allowance for bad debts of
)

Other notes and accounts payable
Long-term debt

Other accounts and notes receivable
(include credit to executives and employees)

All other liabilities

Marketable securities

Total Liabilities

Inventories

Capital stock

Investments in non-consolidated subsidiaries

Additional paid-in capital

Fixed assets (net of depreciation)

Retained earnings/undivided profits

All other assets

Total Equity Capital¹

Total Assets

Total Liabilities and Equity Capital

1. Registrants not reporting capital stock, additional paid-in capital, or retained earnings/undivided profits must nevertheless indicate total equity capital.

Certification
The registrant filing this registration form and any attachments thereto and the person by whom it is executed represent hereby that all
information contained therein is true and complete.

Signature of Sole Proprietor, General Partner, Managing Agent, or Principal Officer

Date

Print or Type Name

Area Code / Phone Number

Title

This mandatory report is used to elicit certain background and financial information about a Regulation U lender and the types
and amount of credit activities engaged in that are secured by margin stock.
Honest, accurate, and timely statements are required by law.
(15 U.S.C. § 78ff; 18 U.S.C. § 1001)
01/2011