Fillable Registration Statement Pursuant to the Foreign Agents Registration

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Registration Statement Pursuant to the Foreign Agents Registration

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OMB No. 1124-0001; Expires May 31, 2020
U.S. Department of Justice
Registration Statement
Washington, DC 20530
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.
Attachments. Inserts and riders of less than full page size shall not be used. Whenever insufficient space is provided for
response to any item, reference shall be made in such space to a full insert page or pages on which the item number and
inquiry shall be restated and a complete answer given.
5. Filing.
The completed statement, including all exhibits, shall be filed in electronic form with the Registration Unit,
Counterintelligence and Export Control Section, National Security Division, U.S. Department of Justice at
. The statement must be filed in accordance with 28 U.S.C. § 1746. A copy should be retained by the
registrant.
https://www.fara.gov
6. 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).
7. 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
Registration Unit in Washington, DC. Statements are also available online at the Registration 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
.
8. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average 1.375 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, Registration 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 05/17
U.S. Department of Justice
Washington, DC 20530
I--REGISTRANT
1. Name of Registrant
2. Registration No. (To Be Assigned By the FARA Registration Unit)
3. Principal Business Address
4. If the registrant is an individual, furnish the following information:
(a) Residence address(es)
(b) Other business address(es), if any
(c) Nationality
(d) Year of birth
(e) Present citizenship
(f) If present citizenship not acquired by birth, state when, where and how acquired
(g) Occupation
5. If the registrant is not an individual, furnish the following information:
(a) Type of organization: Committee
□
Association
□
Partnership
□
Voluntary group
□
Corporation
□
Other (specify) ______________________
(b) Date and place of organization
(c) Address of principal office
(d) Name of person in charge
(e) Locations of branch or local offices
(f) If a membership organization, give number of members
Revised 05/17
FORM NSD-1
OMB No. 1124-0001; Expires May 31, 2020
Registration Statement
Pursuant to the Foreign Agents Registration Act of
1938, as amended
(PAGE 2)
(g) List all partners, officers, directors or persons performing the functions of an officer or director of the registrant.
Name
Residence Address(es)
Position Nationality
(h) Which of the above named persons renders services directly in furtherance of the interests of any of the foreign principals?
(i) Describe the nature of the registrant's regular business or activity.
(j) Give a complete statement of the ownership and control of the registrant.
6. List all employees who render services to the registrant directly in furtherance of the interests of any of the foreign principals in
other than a clerical, secretarial, or in a related or similar capacity.
Name
Residence Address(es)
Nature of Services
(PAGE 3)
II--FOREIGN PRINCIPAL
7. List every foreign principal
1
for whom the registrant is acting or has agreed to act.
Foreign Principal
Principal Address(es)
III--ACTIVITIES
8. In addition to the activities described in any Exhibit B to this statement, will you engage or are you engaging now in activity on
your own behalf which benefits any or all of your foreign principals? Yes
□
No
□
If yes, describe fully
.
IV--FINANCIAL INFORMATION
9. (a) RECEIPTS-MONIES
During the period beginning 60 days prior to the date of your obligation to register
2
to the time of filing this statement,
did you receive from any foreign principal named in Item 7 any contribution, 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
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 ten 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, moneys, 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)).
Date Received
(PAGE 4)
(b) RECEIPTS-THINGS OF VALUE
During the period beginning 60 days prior to the date of your obligation to register
4
to the time of filing this statement, did you
receive from any foreign principal named in Item 7 anything of value
5
other than money, either as compensation, or for
disbursement, or otherwise? Yes
□
No
□
If yes, furnish the following information:
Foreign Principal Date Received Thing of Value
Purpose
10. (a) DISBURSEMENT-MONIES
During the period beginning 60 days prior to the date of your obligation to register
6
to the time of filing this statement, did you
spend or disburse any money in furtherance of or in connection with your activities on behalf of any foreign principal named in
Item 7? 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.
Date To Whom
Purpose
Amount
(b) DISBURSEMENTS-THINGS OF VALUE
During the period beginning 60 days prior to the date of your obligation to register
7
to the time of filing this statement, did you
dispose of any thing of value
8
other than money in furtherance of or in connection with your activities on behalf of any foreign
principal named in Item 7? Yes
□
No
□
If yes, furnish the following information:
Date
Recipient
Foreign Principal
Thing of Value
Purpose
(c) DISBURSEMENTS-POLITICAL CONTRIBUTIONS
During the period beginning 60 days prior to the date of your obligation to register
9
to the time of filing this statement, did you,
the registrant, or any short form registrant, make any contribution of money or other thing of value from your own funds and on
your 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
Amount or Thing of Value
Location of Event
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.
Political Organization or Candidate
(PAGE 5)
V--INFORMATIONAL MATERIALS
10
11. Will the activities of the registrant on behalf of any foreign principal include the preparation or dissemination of informational
materials? Yes
□
No
□
IF YES, RESPOND TO THE REMAINING ITEMS IN THIS SECTION V.
12. Identify each such foreign principal.
13. Has a budget been established or specified sum of money allocated to finance your activities in preparing or disseminating
informational materials? Yes
□
No
□
If yes, identify each such foreign principal, specify amount and for what period of time.
14. Will any public relations firms or publicity agents participate in the preparation or dissemination of such informational materials?
Yes
□
No
□
If yes, furnish the names and addresses of such persons or firms.
15. Activities in preparing or disseminating informational materials will include the use of the following:
□
Radio or TV broadcasts
□
Magazine or newspaper
□
Motion picture films
□
Letters or telegrams
□
Advertising campaigns
□
Press releases
□
Pamphlets or other publications
□
Lectures or speeches
□
Other (specify)
_____________________________________________________________________________________________
Electronic Communications
□
Email
□
Website URL(s):
_____________________________________________________________________________________________
□
Social media website URL(s):
________________________________________________________________________________
□
Other (specify)
_______________________________________________________________________________________________
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 language to be used in the informational materials:
□
English
□
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, 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.
(PAGE 6)
VI--EXHIBITS AND ATTACHMENTS
18. (a) The following described exhibits shall be filed with an initial 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 7.
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, the undersigned swear(s) or affirm(s) under penalty of perjury that he/she has (they have) read
the information set forth in this registration statement and the attached exhibits and that he/she is (they are) familiar with the contents
thereof and that such contents are in their entirety true and accurate to the best of his/her (their) knowledge and belief, except that the
undersigned make(s) no representation as to truth or accuracy of the information contained in the attached Short Form Registration
Statement(s), if any, insofar as such information is not within his/her (their) personal knowledge.
(Date of signature)
(Print or type name under each signature or provide electronic signature
11
)
11 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.
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Registration Statement Pursuant to the Foreign Agents Registration

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Completed 22 October 2021

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