BE-10 Claim BE-10 Claim For Not Filing

FORM

BE-10 Claim for Not Filing

OMB No. 0608-0049: Approval Expires 11/30/2022

(REV. 01/2020)

2019 BENCHMARK SURVEY OF U.S. DIRECT INVESTMENT ABROAD
MANDATORY — CONFIDENTIAL

BE-10 Claim for Not Filing
Reporter ID Number
Electronic Filing: Go to www.bea.gov/efile for details
Mail reports to:

Bureau of Economic Analysis
Direct Investment Division, BE-69(A)
4600 Silver Hill Road
Washington, DC 20233

Deliver reports to: Bureau of Economic Analysis
Direct Investment Division, BE-69(A)
4600 Silver Hill Road
Suitland, MD 20746

NOTE: If you were NOT contacted by BEA about reporting in this survey, and
you do NOT meet BE-10 filing requirements, no action is necessary. If you were
contacted by BEA but are exempt from filing, enter the Reporter name, address,
and BEA assigned Identification Number (Reporter ID).

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Fax reports to:
Assistance:

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*Do not enter Social Security Number in Reporter ID box

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Name and address of U.S. Reporter

900 Name of U.S. Reporter:
1
900 c/o (care of):
2

(301) 278-9502

E-mail:
be10/[email protected]
Telephone:
(301) 278-9418
Copies of form: www.bea.gov/dia

Please include your BEA Identification Number
with all requests.

900 Street or P.O. Box:
3
900 City
4

900 State
5

A 2019 BE-10, Benchmark Survey of U.S. Direct Investment Abroad,
is required from any U.S. person that had a foreign affiliate — that is,
that had direct or indirect ownership or control of at least 10 percent of
the voting stock of an incorporated foreign business enterprise or an
equivalent interest in an unincorporated foreign business enterprise — at
the end of, or for, its 2019 fiscal year. (The U.S. person’s 2019 fiscal year
is defined to be the person’s financial reporting year that has an ending
date in calendar year 2019.)

900 Zip
6

It also requires that persons, or their agents, who are contacted
by BEA about reporting in this survey, either by sending them
report forms or by written inquiry, must respond in writing. They
may respond by:
• filing the properly completed BE-10 report by May 29, or June
30, 2020, as required;
• completing and returning the “BE-10 Claim for Not Filing” by May
29, 2020; or

Section 801.8 of 15 CFR, Chapter VIII , requires that all persons subject
to the reporting requirements of the BE-10 survey respond, whether or
not they are contacted by BEA.

• certifying in writing, by May 29, 2020, to the fact that the person
had no direct investment within the purview of the reporting
requirements of the BE-10 survey.

CONTACT INFORMATION
Provide information of person to consult about this report:
Name
0990

0

Street 1
0991

Telephone Number

0

0994

Street 2
0992

0

Extension

Fax Number

0

City
0993

0

0997

State

Zip

0

E-mail Address
0999

0

NOTE: BEA uses a Secure Messaging System to correspond with you via encrypted message to discuss questions relating to this form. We may use
your e-mail address for survey-related announcements and to inform you about secure messages. When communicating with BEA by e-mail,
please do not include any confidential business or personal information. This includes your Social Security Number which
should never be provided to BEA via any method of transmission.

CERTIFICATION
The undersigned official certifies that the information contained in this claim is correct and complete to the best of his/her knowledge.
Signature of Authorized Official

Date

Telephone Number
0996

Name
0995

0

Title

1

Fax Number
1001

1

Extension

BE-10 Claim for Not Filing
BASIS OF CLAIM FOR NOT FILING — Mark (X) and complete either Part I or Part II
Part I. Basis of Claim for Not Filing BE-10 Forms
1002

A.

B.

1

1

1

This U.S. person did not own or control 10 percent or more of the voting securities of an incorporated foreign business enterprise, or an
equivalent interest in an unincorporated foreign business enterprise (including a branch or real estate held for other than personal use) at
the end of its 2019 fiscal year.

2

2

1

But did file the 2018 BE-11, Annual Survey of U.S. Direct Investment Abroad with this Bureau.

2

2

And did not file the 2018 BE-11, Annual Survey of U.S. Direct Investment Abroad with this Bureau.

.

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This U.S. person did own or control 10 percent or more of the voting securities of an incorporated foreign business enterprise, or an
equivalent interest in an unincorporated foreign business enterprise (including a branch or real estate held for other than personal use),
at the end of the 2019 fiscal year, but (Mark (X) one) –

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3

1

The owners are citizens of a foreign country who (a) are residing in the U.S. as a result of official employment by a foreign
government (including the immediate family of such persons), or (b) have been and expect to be residing in the U.S. for less than
one year.

3

2

Is fully consolidated in the BE-10 report
of another U.S. person — Give name
and address of that person and their
BEA Identification Number, if known.

Name

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Address – Number and street or P.O. Box
City

State

ZIP Code

BEA Identification
Number

3

3

Other — Specify and include reference to section of regulations or instructions on which the claim is based.

Part II. Basis of Claim for Not Filing for Foreign Affiliate(s)

A. Did this U.S. Reporter have one or more foreign affiliates identified by BEA as required to file a 2019 BE-10B, BE-10C, or BE-10D form but the
U.S. Reporter no longer owns or controls, directly or indirectly, 10 percent or more of the voting securities of the incorporated foreign business
enterprise (or an equivalent interest in an unincorporated foreign business enterprise)?
1003 1
1
1

2

Yes — Please complete page 3 of this Claim form for each of these foreign affiliates and check the corresponding box.
Do not list foreign affiliates that BEA did not identify to file.
No

B. Did this U.S. Reporter own one or more foreign affiliates identified by BEA as required to file a 2019 BE-10B, BE-10C, or BE-10D form but
for which ALL of the following apply: 1) the foreign affiliate is a private fund, AND 2) the private fund foreign affiliate does not own, directly
or indirectly through another business enterprise, an “operating company” — i.e., a business enterprise that is not a private fund or a holding
company — in which the consolidated U.S. Reporter owns at least 10 percent of the voting interest, AND 3) If the U.S. Reporter owns the
private fund indirectly (through one or more other business enterprises), there are no “operating companies” between the consolidated U.S.
Reporter and the indirectly-owned foreign private fund? For more information regarding private funds visit www.bea.gov/privatefunds.
1004 1
1

1

2

Yes — Please complete page 3 of this Claim form for each of these foreign affiliates and check the corresponding box.
Do not list foreign affiliates that BEA did not identify to file.
The U.S. Reporter’s investment in the foreign private fund may be required to be reported on Treasury International Capital
(TIC) surveys, review reporting requirements for TIC surveys at www.treasury.gov/tic.
No

MANDATORY — This survey is being conducted under the International Investment and Trade in Services Survey Act ( P.L. 94-472, 90 Stat. 2059, 22
 U.S.C. 3101–3108 , as amended – hereinafter “the Act”), and the filing of reports is mandatory under Section 5(b)(2) of the Act (22 U.S.C. 3104).
CONFIDENTIALITY — The Act provides that your report to this Bureau is CONFIDENTIAL and may be used only for analytical or statistical purposes.
Without your prior written permission, the information filed in your report CANNOT be presented in a manner that allows it to be individually identified.
Your report CANNOT be used for purposes of taxation, investigation, or regulation. Copies retained in your files are immune from legal process. Per the
Cybersecurity Enhancement Act of 2015, your data are protected from cybersecurity risks through security monitoring of the BEA information systems.
PENALTIES — Whoever fails to report shall be subject to a civil penalty and to injunctive relief commanding such person to comply, or both. Whoever
willfully fails to report shall be fined and, if an individual, may be imprisoned for not more than one year, or both. Any officer, director, employee, or agent
of any corporation who knowingly participates in such violations, upon conviction, may be punished by a like fine, imprisonment, or both  (22 U.S.C. 3105) .
The civil penalties are subject to inflationary adjustments. Those adjustments are found in  15 C.F.R. 6.3 .
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply
with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently
valid OMB Control Number.
Page 2

FORM BE-10 Claim for Not Filing (REV. 01/2020)

If you are claiming exemption based upon the criteria on page 2, Part II, complete the items below for those affiliates identified by BEA as required to file.
NOTE: Mark only one choice for each foreign affiliate listed.
5001

1 Name of foreign affiliate:

2

1

■ This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0
2

2

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

.

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1
2

3

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____/____/_______ .

■ This affiliate was sold on

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____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

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5002

3

2 Name of foreign affiliate:

Address:

2

1

This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

2

2

This affiliate was liquidated, seized, or the U.S. Reporter’s direct and
indirect ownership interest in the affiliate otherwise fell below 10 percent

0

as of

Affiliate ID:
1

5003

3 Name of foreign affiliate:

2

1

2

2

____/____/_______ .
3

This affiliate was sold on ____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

3

2

3

4

Name:

5

Address:

This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1
2

5004

4 Name of foreign affiliate:

2

3

1

3

____/____/_______ .

■ This affiliate was sold on

3

____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

5

Address:

■ This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0
2

2

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1

FORM BE-10 Claim for Not Filing (REV. 01/2020)

2

3

3

____/____/_______ .

■ This affiliate was sold on

3

____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

5

Address:

Page 3

If you are claiming exemption based upon the criteria on page 2, Part II, complete the items below for those affiliates identified by BEA as required to file.
NOTE: Mark only one choice for each foreign affiliate listed.
5005

5 Name of foreign affiliate:

2

1

■ This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0
2

2

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

.

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1
2

3

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____/____/_______ .

■ This affiliate was sold on

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____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

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5006

3

6 Name of foreign affiliate:

Address:

2

1

This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

2

2

This affiliate was liquidated, seized, or the U.S. Reporter’s direct and
indirect ownership interest in the affiliate otherwise fell below 10 percent

0

as of

Affiliate ID:
1

5007

7 Name of foreign affiliate:

2

1

2

2

____/____/_______ .
3

This affiliate was sold on ____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

3

2

3

4

Name:

5

Address:

This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1
2

5008

8 Name of foreign affiliate:

2

3

1

3

____/____/_______ .

■ This affiliate was sold on

3

____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

5

Address:

■ This private fund affiliate meets the exemption criteria stated on page
2, Part II. B. (Answer to Part II. B has to be ‘Yes’.)

0
2

2

■ This affiliate was liquidated, seized, or the U.S. Reporter’s direct and

indirect ownership interest in the affiliate otherwise fell below 10 percent
as of

Affiliate ID:
1

Page 4

2

3

3

____/____/_______ .

■ This affiliate was sold on

3

____/____/_______ . If it was sold to another
U.S. entity, provide name and contact information for the new owner:

4

Name:

5

Address:

FORM BE-10 Claim for Not Filing (REV. 01/2020)