Webform Registration Statement

Webform_OMB_1124_0001_Registration_Statement_May_2020.pdf

Registration Statement of Individuals (Foreign Agents)

Webform Registration Statement

OMB: 1124-0001

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OMB No. 1124-0001; Expires June 30, 2023

U.S. Department of Justice
Washington, DC 20530

Registration Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended
INSTRUCTION SHEET-READ CAREFULLY

1.

Use. All persons required to register under this Act shall use this form in submitting the information required by Section
2(a).

2.

Read Act and Rules. Registrant should carefully read the Act and the Rules thereunder before completing this form.

3.

Answer. Unless otherwise specifically instructed in this form, a registrant shall answer every item on this form. Whenever
the item is inapplicable or the appropriate response to an item is "none", an express statement to that effect shall be made.

4.

Filing. The completed statement, including all exhibits, shall be filed in electronic form with the FARA Unit,
Counterintelligence and Export Control Section, National Security Division, U.S. Department of Justice at
https://www.fara.gov. The statement must be filed in accordance with 28 U.S.C. § 1746. A copy should be retained by the
registrant.

5.

Filing Fee. The filing of this document requires the payment of a filing fee for each listed foreign principal as set forth in
Rule 5(d)(1), 28 C.F.R. § 5.5(d)(1).

6.

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
.

7. 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.
__________
Note: Omit this instruction sheet when filing this Statement.

FORM NSD-1
Revised 05/20

OMB No. 1124-0001; Expires June 30, 2023

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

U.S. Department of Justice
Washington, DC 20530

I--REGISTRANT
1. Name of Registrant

2. Registration Number (To be assigned by the FARA Unit)

3. Primary Business Address

4. If the registrant is an individual, furnish the following information:
(a) Residence address(es)

(b) Nationality
(c) Year of birth
(d) Present citizenship
(e) If present citizenship not acquired by birth, state when, where and how acquired
(f) Occupation
5. If the registrant is not an individual, furnish the following information:
(a) Type of organization: Committee
Corporation
(b) Date and place of organization

□
□

Association

□

Partnership

□

Voluntary group

□

Other (specify) _______________________________________________

(c) Name of responsible individual
(e.g., officer, director or partner)
(d) Other business address(es), if any, including
locations of branch or local offices

(e) If a membership organization, provide number of members

FORM NSD-1
Revised 05/20

(PAGE 2)

(f) List all partners, officers, directors or persons performing the functions of an officer or director of the registrant.
Name

Citizenship

Residence Address

Position

(g) Which of the above named persons renders services directly in furtherance of the interests of any of the foreign principals?
Name

Foreign Principal(s)

Services

(h) Describe the nature of the registrant's regular business or activity.

(i) Give a complete description of the ownership and control structure of the registrant.

6. List all individuals, other than those listed in Item 5(g), who render services or will render services to the registrant directly in
furtherance of the interests of any foreign principal(s) in other than a clerical, secretarial, or in a related or similar capacity.
Name

Residence Address

Foreign Principal(s)

Services

(PAGE 3)

II--FOREIGN PRINCIPAL
7. List every foreign principal for whom the registrant is acting or has agreed to act.
1

Foreign Principal

Foreign Principal Address

III--ACTIVITIES
8. In addition to the activities described in any Exhibit B to this statement, will the registrant engage or is the registrant engaging
now in activity or rendering services on its own behalf which benefits any or all of its foreign principals?
Yes

□

No

□

If yes, describe fully.
Foreign Principal

Activities/Services

IV--FINANCIAL INFORMATION
9. (a) RECEIPTS-MONIES
During the period beginning 60 days prior to the date of the registrant's obligation to register 2 under FARA, has the registrant
received from any foreign principal named in Item 7 of this statement, or from any other source, for or in the interests of any
such foreign principal, any contributions, income, or money either as compensation, or for disbursement or otherwise?
Yes

□

No

□

If yes, set forth below in the required detail and separately for each such foreign principal an account of such monies. 3
Foreign Principal

Date Received

From Whom

Purpose

Amount

Total
1 The term "foreign principal," as defined in Section 1(b) of the Act, includes a foreign government, foreign political party, foreign organization, foreign individual and, for the
purpose of registration, an organization or an individual any of whose activities are directly or indirectly supervised, directed, controlled, financed, or subsidized in whole or in
major part by a foreign government, foreign political party, foreign organization or foreign individual.
2 An agent must register within 10 days of becoming an agent, and before acting as such.
3 A registrant is required to file an Exhibit D if he collects or receives contributions, loans, monies, or other things of value for a foreign principal, as part of a fundraising
campaign. There is no printed form for this exhibit. (See Rule 201(e), 28 C.F.R. § 5.201(e)).

(PAGE 4)

(b) RECEIPTS-THINGS OF VALUE
During the period beginning 60 days prior to the date of the registrant's obligation to register 4 under FARA, has the registrant
received anything of value 5 other than money, from any foreign principal named in Item 7 of this statement, or from any other
source, for or in the interests of any such foreign principal?
Yes

□

No

□

If yes, furnish the following information:
Date Received

Foreign Principal

From Whom

Purpose

Thing of Value

10. (a) DISBURSEMENTS-MONIES
During the period beginning 60 days prior to the date of the registrant's obligation to register 6 under FARA, has the registrant
disbursed or expended monies in connection with activity on behalf of any foreign principal named in Item 7 of this statement
or transmitted monies to any such foreign principal?
Yes

□

No

□

If yes, set forth below in the required detail and separately for each such foreign principal named including monies transmitted,
if any, to each foreign principal.
Foreign Principal

Date

Recipient

Purpose

Amount

(b) DISBURSEMENTS-THINGS OF VALUE
During the period beginning 60 days prior to the date of the registrant's obligation to register 7 under FARA, has the registrant
disposed of any thing of value 8 other than money in furtherance of or in connection with its activities on behalf of any foreign
No
Yes
principal named in Item 7 of this statement?

□

□

If yes, furnish the following information:

Foreign Principal

Recipient

Date

Purpose

Thing of Value

(c) DISBURSEMENTS-POLITICAL CONTRIBUTIONS
During the period beginning 60 days prior to the date of the registrant's obligation to register 9 under FARA, has the registrant
(or any short form registrant) made any contribution of money or other thing of value from its own funds and on its own behalf
in connection with an election to any political office or in connection with any primary election, convention, or caucus held to
select candidates for any political office?
Yes
No

□

□

If yes, furnish the following information:
Date

Donor

Political Organization/Candidate

Method

Amount/Thing of Value

4, 6, 7 and 9 See Footnote 2, on page 3.
5 and 8 Things of value include but are not limited to gifts, interest-free loans, expense-free travel, favored stock purchases, exclusive rights, favored treatment over competitors,
"kickbacks", and the like.

(PAGE 5)

V--INFORMATIONAL MATERIALS

10

11. Prior to the time of filing this statement,11 has the registrant prepared, disseminated, or caused to be disseminated, any
informational materials on behalf of any foreign principal listed in Item 7 of this statement?
Yes
No

□

□

If yes, identify each foreign principal and attach the informational materials.
Foreign Principal

Informational Materials Attached

Type

12. (a) Will the activities of the registrant on behalf of any foreign principal include the preparation or dissemination of
informational materials?
Yes

□

No

□

(b) Identify each such foreign principal.

13. Has a budget been established or specified sum of money allocated to finance the registrant's activities in preparing or
disseminating informational materials?
Yes
No

□

□

If yes, identify each foreign principal, and specify the period of time and the amount.
Foreign Principal
Period of Time

Amount

14. Will any individuals or organizations, including public relations firms or publicity agents, participate in the preparation or
dissemination of such informational materials?
No
Yes

□

□

If yes, furnish the names and addresses of such individuals or organizations.
Name

Address

Foreign Principal(s)

15. Activities in preparing or disseminating informational materials will include the use of the following:

□ Magazine or newspaper □ Advertising campaigns
□ Press releases
□ Pamphlets or other publications
Lectures
or
speeches
Radio
or
TV
broadcasts
Motion
picture
films
□
□
□
□ Letters or telegrams
□ Email
□ Website URL(s): _____________________________________________________________________________________________
□ Social Media website URL(s): ________________________________________________________________________________
□ Other (specify) _______________________________________________________________________________________________
10 The term informational materials includes any oral, visual, graphic, written, or pictorial information or matter of any kind, including that published by means of advertising,
books, periodicals, newspapers, lectures, broadcasts, motion pictures, electronic communications, or any means or instrumentality of interstate or foreign commerce or
otherwise. Informational materials disseminated by an agent of a foreign principal as part of an activity in itself exempt from registration, or an activity which by itself would
not require registration, need not be filed pursuant to Section 4(b) of the Act.
11 See Footnote 2, on page 3.

(PAGE 6)

16. Informational materials will be disseminated among the following groups:
Public officials
Civic groups or associations
Legislators
Libraries
Government agencies
Educational groups
Newspapers
Nationality groups
Editors
Other (specify) _____________________________

□
□
□
□
□

□
□
□
□
□

17. Indicate the language to be used in the informational materials:
English
Other (specify) ___________________________

□

□

VI--EXHIBITS AND ATTACHMENTS
18. (a) The following described exhibits shall be filed with a Registration Statement:
Exhibit A-

This exhibit, which is filed on Form NSD-3, sets forth the information required to be disclosed concerning each
foreign principal named in Item 6.

Exhibit B-

This exhibit, which is filed on Form NSD-4, sets forth the information concerning the agreement or understanding
between the registrant and the foreign principal.

(b) An Exhibit C shall be filed when applicable. This exhibit, for which no printed form is provided, consists of a true copy of
the charter, articles of incorporation, association, constitution, and bylaws of a registrant that is an organization. A waiver of
the requirement to file an Exhibit C may be obtained for good cause shown upon written application to the Assistant Attorney
General, National Security Division, U.S. Department of Justice, Washington, DC 20530. (See Rule 201(c) and (d)).
(c) An Exhibit D shall be filed when applicable. This exhibit, for which no printed form is provided, sets forth an account of
money collected or received as a result of a fundraising campaign and transmitted for a foreign principal. (See Rule 201 (e)).

VII--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 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 12
Sign

Sign
Sign
Sign

12 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.


File Typeapplication/pdf
SubjectVersion 1.3
AuthorAMUDD
File Modified2020-05-12
File Created2019-10-22

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