FR U-1
OMB Number 7100-0115
Approval expires July 31, 2018
Page 1 of 2
Board of Governors of the Federal Reserve System
Statement of Purpose for an Extension of Credit
Secured by Margin Stock—FR U-1
Name of Bank
T
his form is required by law (15 U.S.C. §§ 78g and 78w; 12 C.F.R.
§ 221).
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.
Instructions
1. 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.
2. The term “margin stock” is defined in Regulation U (12 C.F.R. § 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.
3. Please print or type (if space is inadequate, attach separate sheet).
Part I
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 Name
Signed:
Print or Type Name
Borrower's Signature DateBorrower's Signature Date
Yes No
This form should not be signed if blank.
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 (7100-0115), Washington, DC 20503.
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, “Borrowers of Securities Credit.”
01/2018