Form 3 PDF Details

Form 3 is a new form that was recently released by the IRS. This form is used to report certain information related to foreign financial assets and income. There are a number of changes in this year's form, so it's important to understand how to complete it correctly. In this blog post, we'll provide an overview of Form 3 and explain how to correctly fill out each section. We'll also highlight some key changes from last year's form. So, if you have any foreign financial assets or income, be sure to read this post!

QuestionAnswer
Form NameForm 3
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameswhat is form 3 of united states securities commission, you form 3 pdf, form sec 3 download, form 3 filing

Form Preview Example

You may not send a completed printout of this form to the SEC to satisfy a filing obligation. submitting the information required by this form to the SEC in electronic format online at

You can only satisfy an SEC filing obligation by https://www.onlineforms.edgarfiling.sec.gov.

FORM 3

(Print or Type Responses)

UNITEDSTATESSECURITIESANDEXCHANGECOMMISSION

Washington, D.C. 20549

Form 3

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL

OMB Number:

3235-0104

Expires:

March 31, 2015

Estimated

average

burden

hours per

response. . . . . . 0.5

1. Name and Address of Reporting Person*

 

 

2. Date of Event

 

3. Issuer Name and Ticker or Trading Symbol

 

 

 

 

 

 

Requiring Statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

 

 

 

 

 

 

(Last)

(First)

(Middle)

 

 

 

 

4. Relationship of Reporting Person(s) to Issuer

5.

If Amendment, Date

 

 

 

 

 

 

 

 

Original Filed (Month/Day/

 

 

 

 

 

 

 

 

 

 

 

(Check

all applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year)

 

 

 

 

 

 

 

 

 

Director

 

 

10% Owner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer (give

 

 

Other (specify

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Street)

 

 

 

 

 

6.

Individual or Joint/Group

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

title below)

below)

 

Filing (Check Applicable Line)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__Form filed by One Reporting Person

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__Form filed by More than One ReportingPerson

(City)

(State)

(Zip)

 

 

Table I — Non­Derivative Securities Beneficially Owned

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Title of Security

 

 

 

2.

Amount of Securities

 

3.

Ownership

4. Nature of Indirect Beneficial Ownership

(Instr. 4)

 

 

 

 

 

Beneficially Owned

 

 

Form: Direct

(Instr. 5)

 

 

 

 

 

 

 

 

(Instr. 4)

 

 

(D) or Indirect

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(I) (Instr. 5)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. * If the form is filed by more than one reporting person, SEE Instruction 5(b)(v).

Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

(Over) SEC 1473 (11-11)

FORM 3 (continued)

Table II — Derivative Securities Beneficially Owned ( E.G., puts, calls, warrants, options, convertible securities)

1.Title of Derivative Security (Instr. 4)

2. Date Exer-

3. Title and Amount of Securities Underlying

cisable and

Derivative Security

 

Expiration

(Instr. 4)

 

Date

 

 

 

(Month/Day/Year)

 

 

 

 

 

 

Date

Expira-

 

Amount

 

or

Exer-

tion

Title

Number

cisable

Date

 

of

 

 

 

 

 

 

Shares

 

 

 

 

 

 

 

 

4.Conver- sion or Exercise Price of Deri- vative Security

5.Owner- ship Form of Deriv- ative Security: Direct

(D)or

Indirect

(Instr. 5)

6.Nature of Indirect Beneficial Ownership (Instr. 5)

Explanation of Responses:

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations.

**Signature of Reporting Person

Date

SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

 

 

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,

 

 

SEE Instruction 6 for procedure.

 

 

Potential persons who are to respond to the collection of information contained in this form are not

 

 

required to respond unless the form displays a currently valid OMB Number.

 

 

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