Form 1650-02 Redline

Federal Deposit Insurance Corporation

FOREIGN NATIONAL VISITOR NOTIFICATION

OMB Number: 3064-0222

Expiration Date: 06/30/2028

INSTRUCTIONS: The FDIC host sends this form to foreign nationals (and their staff, if applicable) visiting the FDIC for any reason. The visitor completes Sections I-II of the form. The FDIC host completes section III and submits completed form to the FDIC, Intelligence and Threat Sharing Unit (ITSU) for review.

SECTION I - FOREIGN NATIONAL VISITOR INFORMATION

1. Surname/Family Name/Last Name	2. Given Name/First Name						3. Middle Name
4. Aliases (List All)							5. Date of Birth
6. City and Country of Birth				7. City and Country of Residence
8. Passport Country/Jurisdiction of Issue	9. Passport Number						10. Expiration Date
11. Email				12. Telephone
SECTION II - EMPLOYER INFORMATION
13. Current Employer (Business/Organization Name)
14. Type of Business/Organization				15.	Position Title
SECTION III - FDIC HOST INFORMATION
16. Event Host or Cognizant Point-of-Contact (Federal Employee)
Name:		Title:				Email:
17. Hosting Division/Office
18. Type of Visit Meeting or Event Purpose
19. Date(s) of Visit Meeting or Event Start and End Date(s)
SECTION IV - ITSU REVIEW
20. Is a briefing for the sponsoring office required?: Yes No
Explain.

FDIC 1650/02 (10-25) Page 1 of 1