2018 OSFI 590 POS FINAL January 2018 E

OSFI-590 (2018 Long Form Version)[1]

The Long Form version can be used by financial institutions to file a POSITIVE Report only. To file a NIL Report, please use the Short Form version of the OSFI-590.
This report must be filed with the Office of the Superintendent of Financial Institutions, Regulatory Data ManagementDivision via the Regulatory Reporting System (RRS). / 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:
RRS – OSFI-590 Long Form
If this is a joint Report, insert the names of the other Federally Regulated Financial Institutions (FRFI) included in this Report (see Instruction 14): /

Name of other FRFI(s):

Yes The above financial institution(s) have an account in the name of a Designatedor Listed Person or foreign national* (Designated Person)[2], or have a contract with a Designated Person, or possess or control property that is owned or controlled by or on behalf of a DesignatedPerson.
Please complete the table below and the certificate at the end of this form.
Definitions:

“No.” means “number”, and refers to the number of accounts, policies or contracts associated with a DesignatedPerson.
“Property” includes assets under administration (both discretionary and non-discretionary).
“SRO” means Self Regulatory Organization.
“Federally Regulated Financial Institution” means a Financial Institution that is regulated by OSFI.

* Please refer to # 4, 5, and 6 of the “Instructions OSFI-590 Report” for the definition of “Designated Person”,“Listed Person”, and“foreign national”.

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Type of Dealing with Designated Person /

Total Value of Dealing and Type of Entity Involved

Total

Federally Regulated Financial Institution / Regulated Canadian Financial Institution Supervised by Another Canadian Regulator or SRO / Non-regulated Canadian Entity / Regulated Foreign Financial Institution Supervised by a Foreign Regulator or SRO / Non-regulated Foreign Entity
No. / $ / No. / $ / No. / $ / No. / $ / No. / $ / No. / $
Property
Cash, cash equivalents, demand and term deposits
Letters of credit, letters of guaranty or similar obligations
Securities (bonds, debentures, commercial paper, treasury bills, mutual fund units, common and preferred shares, and derivatives)
Life insurance and annuity products with cash surrender value (cash surrender value)
Other property, including real estate
Totals
Loans
Mortgages, overdrafts, credit card balances, term loans, lines of credit balances, other indebtedness
Insurance
Life insurance policies with no cash surrender value (face value)
Annuity products with no cash surrender value (monthly income)
Property & casualty insurance policies (policy limit)
Group Benefit plans such as medical or dental plans (policy limit for Listed Person or Listed Entity)

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, any property summarized in this Report has been frozen, and the relevant account details have been reported to the Royal Canadian Mounted Police or the Canadian Security Intelligence Service and, in respect of any foreign operations, to foreign law enforcement officials, as appropriate.

Name / Title / Telephone / Date
Reminder: Subsection 12(1) of the Regulations Implementing the United Nations Resolution on the Democratic People’s of Korea and subsection 9(1) of the Regulations Implementing the United Nations Resolution on Iran and subsection 7(1) of the Special Economic Measures (Venezuela) Regulations and subsection 7(2) of the Justice for Victims of Corrupt Foreign Officials Act requires every person in Canada and every Canadian outside Canada to disclose without delay to the Royal Canadian Mounted Police or 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.

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[1] This Report is made under subsection 11(2) of the Regulations Implementing the United Nations Resolution on the Democratic People’s Republic of Korea or subsection 8(2) of the Regulations Implementing the United Nations Resolution on Iran or subsection 6(2) of the Special Economic Measures (Venezuela) Regulations) or subsection 7(1) of the Justice for Victims of Corrupt Foreign Officials Act.

[2]For the purposes of this form, the term “Designated Person” shall equate to “Designated Person”, “Listed Person” and “foreign national”, as defined in the applicable regulations or legislation.