5 CFR Part 2634, Appendix B to Part 2634 - Certificate of Compliance (Form Approved: OMB Control No. 3209-0007)

View PDF at GPO Pt. 2634, App. B
Appendix B to Part 2634—Certificate of Compliance (Form Approved: OMB Control No. 3209-0007)
The Certificate of Compliance required by § 2634.408(d)(4) shall be executed as follows:
Certificate of Compliance
With respect to the qualified blind trust (qualified diversified trust) of___ (Settlor), the undersigned, the approved [Trustee] [___] of such trust, pursuant to 5 CFR 2634.405, has served in such fiduciary capacity during the calendar year [or for the period beginning___ and ending___] and is eligible to continue in such capacity by virtue of the following:
FIRST: The undersigned (and any director, officer, or employee) has not knowingly or negligently, and will not—
(A) disclose any information to an interested party with respect to the trust that may not be disclosed pursuant to title I of the Act, the implementing regulations (including 5 CFR 2634.408(d)(1)(i)), or the trust instrument;
(B) acquire any holding the ownership of which is prohibited by, or not in accordance with, applicable statute, regulation, or the terms of the trust instrument;
(C) solicit advice from any interested party with respect to such trust, which solicitation is prohibited by title I of the Act, the implementing regulations (including 5 CFR 2634.408(d)(1)(iii)), or the trust instrument;
(D) fail to file any document required by title I of the Act, the implementing regulations (5 CFR 2634.408), or the trust instrument; or
(E) violate or fail to comply with any provision or requirement of title I of the Act, the implementing regulations, or the trust instrument.
SECOND: The undersigned (and any director, officer, or employee) will not knowingly or negligently engage in the above-mentioned activities.
THIRD: The undersigned certifies that the statements contained herein are true, complete and correct to the best of such undersigned's knowledge and belief.
Date___
(firm)___
By:___
(title)___
Note:
See appendix C of this part for Privacy Act and Paperwork Reduction Act notices.
[57 FR 11830, Apr. 7, 1992; 57 FR 21855, May 22, 1992, as amended at 77 FR 39150, July 2, 2012]

Title 5 published on 2014-01-01

no entries appear in the Federal Register after this date.