Osfi-590 (2007 Short Form Version) (Report under subsection 11(2) of the




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PROTECTED WHEN COMPLETED AND FILED WITH OSFI

WHEN COMPLETED



OSFI-590 (2007 Short Form Version)

(Report under subsection 11(2) of the

Regulations Implementing the United Nations

Resolution on the Democratic People’s Republic of Korea or

of the Regulations Implementing the United Nations Resolution on Iran)


The Short Form version can be used by financial institutions to file a NIL Report only. To file a POSITIVE Report, please use the Long Form version of the OSFI-590.
This report must be filed with the Office of the Superintendent of Financial Institutions, Regulatory Information Division, 255 Albert Street, Ottawa Ontario K1A 0H2, or by fax at (613) 991-6248.

REPORTING MONTH:





Name of Financial Institution:


Type of Financial Institution (check one):

 Bank  Trust or Loan Company

 Insurance Company  Fraternal Benefit Society

 Cooperative Credit Assoc.  Foreign Bank Branch


Foreign Insurance Company


Filing Options (check one):

 FAX only 613-991-6248

MAIL only

 FAX and MAIL




If this is a joint Report, insert the names of the other Federally Regulated Financial Institutions (FRFI) included in this Report (see Instruction 12):

Name of other FRFI(s):





No The above financial institution(s) do not have an account in the name of a Designated Person*, or have a contract with a Designated Person, or possess or control property that is owned or controlled by or on behalf of a Designated Person.

Please complete the certificate below.

Definition:

  • Property” includes assets under administration (both discretionary and non-discretionary).

* Please refer to # 4 of the “Instructions OSFI-590 Report” for the definition of “Designated Person”.




Certificate

The Undersigned certifies that, to the best of his/her knowledge, and after having made reasonable enquiries, the information contained in this Report is correct.

Name



Signature

Title

Telephone

Date





Reminder: Section 12 of the Regulations Implementing the United Nations Resolution on the Democratic People’s of Korea or of the Regulations Implementing the United Nations Resolution on Iran requires every person in Canada and every Canadian outside Canada to disclose without delay to the Royal Canadian Mounted Police and the Canadian Security Intelligence Service (a) the existence of property in their possession or control that is owned or controlled by or on behalf of a Designated Person, and (b) information about a transaction or proposed transaction in respect of property in their possession or control that is owned or controlled by or on behalf of a Designated Person.




OSFI-590 – Short

2007 Version





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