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Statement Of Purpose For An Extension Of Credit Secured By Margin Stock Form. This is a Official Federal Forms form and can be use in Securities And Exchange Act Federal Reserve System.
Tags: Statement Of Purpose For An Extension Of Credit Secured By Margin Stock, FR U-1, Official Federal Forms Federal Reserve System, Securities And Exchange Act
FR U-1 OMB Number 7100-0011 Approval expires June 30, 2021 Page 1 of 2Board of Governors of the Federal Reserve System Statement of Purpose for an Extension of Credit Secured by Margin Stock227FR U-1 Name of BankThis form is required by law (15 U.S.C. 247247 78g and 78w; 12 C.F.R. 247221).The Federal Reserve may not conduct or sponsor, and an organi-zation (or a person) is not required to respond to, a collection of information unless it displays a currently valid OMB control number.To be completed by borrower(s)1. What is the amount of the credit being extended? 2. Will any part of this credit be used to purchase or carry margin stock?If the answer is "No," describe the specific purpose of the credit.I (We) have read this form and certify that to the best of my (our) knowledge and belief the information given is true, accurate, and com-plete, and that the margin stock and any other securities collateralizing this credit are authentic, genuine, unaltered, and not stolen, forged, or counterfeit.Signed: Print or Type NameSigned: Print or Type Name Borrower's Signature Date Borrower's Signature Date Yes NoPart I The term 223margin stock224 is defined in Regulation U (12 C.F.R. 247 221) and 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.Public reporting burden for this collection of information is estimated to average 10 minutes 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. 06/2018Please print or type (if space is inadequate, attach separate sheet).A borrower who falsely certifies the purpose of a credit on this form or otherwise willfully or intentionally evades the provisions of Regulation U will also violate Federal Reserve Regulation X, 223Borrowers of Securities Credit.224This form should not be signed if blank.This form must be completed when a bank extends credit in excess of $100,000 secured directly or indirectly, in whole or in part, by any margin stock. American LegalNet, Inc. www.FormsWorkFlow.com FR U-1 Page 2 of 2Part IITo be completed by bank only if the purpose of the credit is to purchase or carry margin securities (Part I (2) answered "yes").1.List the margin stock securing this credit; do not include debt securities convertible into margin stock. The maximum loan value ofmargin stock is 50 percent of its current market value under the current Supplement to Regulation U.2.List the debt securities convertible into margin stock securing this credit. The maximum loan value of such debt securities is 50percent of the current market value under the current Supplement to Regulation U.3.List other collateral including nonmargin stock securing this credit. No. of Shares Issue Market Price Per Share Date and Source of Valuation1 Total Market Value Per Issue Principal Amount Issue Market Price Date and Source of Valuation1 Total Market Value Per Issue Describe Briefly Market Price Date and Source of Valuation1 Good Faith Loan Value 06/2018Part III I am a duly authorized representative of the bank and understand that this credit secured by margin stock may be subject to the credit restrictions of Regulation U. I have read this form and any attachments, and I have accepted the customer222s statement in Part I in good faith as required by Regulation U2; and I certify that to the best of my knowledge and belief, all the information given is true, accurate, and complete. I also certify that if any securities that directly secure the credit are not or will not be registered in the name of the borrower or its nominee, I have or will cause to have examined the written consent of the registered owner to pledge such securities. I further certify that any securities that have been or will be physically delivered to the bank in connection with this credit have been or will be examined, that all validation procedures required by bank policy and the Securities Exchange Act of 1934 (section 17(f), as amended) have been or will be performed, and that I am satisfied to the best of my knowledge and belief that such securities are genuine and not stolen or forged and their faces have not been altered.To be signed by a bank officer in all instances. Signed: Bank Officer's Signature Date Print or Type Name Title1.Bank need not complete fields for Date and source of valuation if the market value was obtained from regularly published information in either ajournal of general circulation or an automated quotation system.2.To accept the customer222s statement in good faith, the duly authorized representative of the creditor must be alert to the circumstances surrounding thecredit and, if in possession of any information that would cause a prudent person not to accept the statement without inquiry, must have investigatedand be satisfied that the statement is truthful. Among the facts which would require such investigation are receipt of the statement through the mail orfrom a third party. This form must be retained by the lender for three years after the credit is extinguished. American LegalNet, Inc. www.FormsWorkFlow.com