Protected when completed and filed with osfi osfi-525




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PROTECTED WHEN COMPLETED AND FILED WITH OSFI

OSFI-525 (2006 Short Form Version)

(Report under section 83.11 of the Criminal Code and under section 7 of the

Regulations Implementing the United Nations Resolutions on the Suppression of Terrorism

and section 5.1 of the United Nations Al-Qaida and Taliban Regulations)





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-525
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-525 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:





OSFI-525 Short – 2006 Version


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