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The information contained
in this Certification is sought pursuant to Sections 5318(j)
and 5318(k) of Title 31 of the United States Code, as added
by sections 313 and 319(b) of the USA PATRIOT Act of 2001
(Public Law 107-56).
The information contained in this Certification
is sought pursuant to Sections 5318(j) and 5318(k) of Title
31 of the United States Code, as added by sections 313 and
319(b) of the USA PATRIOT Act of 2001 (Public Law 107-56).
This Certification should be completed by any foreign
bank that maintains a correspondent account with any U.S.
bank or U.S. broker-dealer in securities (a covered financial
institution as defined in 31 C.F.R. 103.175(f)). An entity
that is not a foreign bank is not required to complete
this Certification.
A foreign bank is a bank organized under foreign law
and located outside of the United States (see definition
at 31 C.F.R. 103.11(o)). A bank includes offices, branches,
and agencies of commercial banks or trust companies, private
banks, national banks, thrift institutions, credit unions,
and other organizations chartered under banking laws and
supervised by banking supervisors of any state (see definition
at 31 C.F.R. 103.11(c)). *
A Correspondent Account for a foreign bank is any account
to receive deposits from, make payments or other disbursements
on behalf of a foreign bank, or handle other financial
transactions related to the foreign bank.
Special instruction for foreign branches of U.S. banks:
A branch o r office of a U.S. bank outside the United
States is a foreign bank. Such a branch or office is not
required to complete this Certification with respect to
Correspondent Accounts with U.S. branches and offices
of the same U.S. bank.
Special instruction for covering multiple branches on
a single Certification: A foreign bank may complete one
Certification for its branches and offices outside the
United States. The Certification must list all of the
branches and offices that are covered and must include
the information required in Part C for each branch or
office that maintains a Correspondent Account with a Covered
Financial Institution. Use attachment sheets as necessary.
A.
B. |
The undersigned financial
institution, Laxmi Bank Limited ("Foreign Bank")
here by certifies as follows:
Correspondent Accounts Covered by this Certification: Check one box. |
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This
Certification applies to all accounts established
for Foreign Bank by Covered Financial Institutions.
This Certification applies to Correspondent Accounts
established by Laxmi Bank Limited (name of Covered
Financial Institution(s)) for Foreign Bank |
C. |
Physical Presence/Regulated Affiliate Status:
Check one box and complete the blanks. |
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Foreign Bank maintains a
physical presence in any country. That means: |
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Foreign
Bank has a place of business at the following street
address:
Adarsha Nagar P.O.Box : 61, Birgunj, Nepal, where
Foreign Bank employs one or more individuals on a
full-time basis and maintains operating records related
to its banking activities.
The above address is in Nepal, where
Foreign Bank is authorized to conduct banking activities.
Foreign Bank is subject to inspection by Nepal
Rastra Bank, the banking authority that licensed
Foreign Bank to conduct banking activities. |
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Foreign Bank does not have a physical presence in any
country, but Foreign Bank is a regulated affiliate.
That means: |
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Foreign Bank is
an affiliate of a depository institution, credit union,
or a foreign bank that maintains a physical presence
at the following street address: __________________________________,
where it employs one or more persons on a full-time
basis and maintains operating records related to its
banking activities.
The above address is in ______________________________
(insert country),
where the depository institution,
credit union, or foreign bank is authorized to conduct
banking activities.
Foreign Bank is subject to supervision by ____________________,
(insert Banking Authority), the same banking authority
that regulates the depository institution, credit
union, or foreign bank. |
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Foreign Bank does not have a physical
presence in a country and is not a
regulated affiliate. |
D. |
Indirect Use
of Correspondent Accounts: Check box to certify. |
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No Correspondent
Account maintained by a Covered Financial Institution
may be used to indirectly provide banking services
to certain foreign banks.
Foreign Bank hereby certifies that it does not use
any Correspondent Account with a Covered Financial
Institution to indirectly provide banking services
to any foreign bank that does not maintain a physical
presence in any country and that is not a regulated
affiliate. |
E. |
Ownership Information:
Check box 1 or 2 below, if applicable. |
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1.
2. |
Form FR
Y-7 is on file. Foreign Bank has filed with
the Federal Reserve Board a current Form FR Y-7 and
has disclosed its ownership information on Item 4
of Form FR Y-7.
Foreign Bank's shares are publicly traded.Publicly
traded means that the shares are traded on an exchange
or an organized over-the-counter market that is regulated
by a foreign securities authority as defined in section
3(a)(50) of the Securities Exchange Act o f 1934 (15
U.S.C. 78c(a)(50) ). |
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If neither
box 1 nor 2 of Part E are checked, complete item 3 below,
if applicable. |
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3. |
Foreign Bank has
no owner(s) except as set forth below.
For purposes of this
Certification, owner means any person
who, directly or indirectly, (a) owns, controls, or
has power to vote 25 percent or more of any class
of voting securities or other voting interests of
Foreign Bank; or (b) controls in any manner the election
of a majority of the directors (or individuals exercising
similar functions) of Foreign Bank. For purposes of
this Certification, (i) person means
any individual, bank, corporation, partnership, limited
liability company or any other legal entity; (ii)
voting securities or other voting interests
means securities or other interests that entitle the
holder to vote for or select directors (or individuals
exercising similar functions); and (iii) members of
the same family* shall be considered one person.
| Name |
Address |
Financial Institution 9.02%
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| Private Promoters 55.42% |
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| General Public 35.56% |
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F.
G. |
Process Agent: complete the following.
The following individual or entity: CT Corporation
System is a resident of the United States at the
following street address:
111 Eighth Avenue, 13th Floor-CT, New York, NY 10011,
and is authorized to accept service of legal process
on behalf of Foreign Bank from the_________________________________
* The same family means parents, spouses, children,
siblings, uncles, aunts, grandparents, grandchildren,
first cousins, stepchildren, stepsiblings, parents-in-law
and spouses of any of the foregoing. In determining
the ownership interests of the same family, any voting
interest of any family member shall be taken into
account.
Secretary of the Treasury or the Attorney General
of the United States pursuant to Section 5318(k) of
title 31, United States Code.
General
Foreign Bank hereby agrees to notify
in writing each Covered Financial Institution at which
it maintains any Correspondent Account of any change
in facts or circumstances reported in this Certification.
Notification shall be given within 30 calendar days
of such change.
Foreign Bank understands that each Covered Financial
Institution at which it maintains a Correspondent
Account may provide a copy of this Certification to
the Secretary of the Treasury and the Attorney General
of the United States. Foreign Bank further understands
that the statements contained in this Certification
may be transmitted to one or more departments or agencies
of the United States of America for the purpose of
fulfilling such departments' and agencies' governmental
functions.
I, Bhubal Rai
(name of signatory), certify that I have read and
understand this Certification, that the statements
made in this Certification are complete and correct,
and that I am authorized to execute this Certification
on behalf of Foreign Bank.
Laxmi Bank Limited
[Name of Foreign Bank}
____________________
[Signature]
____________________
[Printed Name]
Bhubal Rai / Head Operational
Risk
[Title]
Executed on this 24
day of October, 2008
Received and reviewed by:
Name: ________________________________
Title: ________________________________
For: _________________________________
[Name of Covered Financial Institution]
Date: _______________________ |
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