Item 11. Ownership or holdings by the trustee of any securities of a person owning 50 percent or more of the voting
securities of the obligor.
If the trustee owns beneficially or holds as collateral security for obligations in default any securities of a person who, to the
knowledge of the trustee, owns 50 percent or more of the voting securities of the obligor, furnish the following information as to
each class of securities of such person an of which are so owned or held by the trustee:
As of _______________________(Insert date within 31 days).
Col. A
Col. B
Col. C
Col. D
Amount Owned
Beneficially or Hold as
Collateral Security for
Percentage of Class
Title of Issuer
Obligations in Default
Represented by Amount
And Title of Class
Amount Outstanding
by Trustee
Given in Col. C
Instructions 1,2, and 4 to Item 8 shall be applicable to this item.
Item 12. Indebtedness of the Obligor to the Trustee.
Except as noted in the instructions, if the obligor is indebted to the trustee, furnish the following information:
As of _______________________________(Insert date within 31 days).
Col. A
Col. B
Col. C
Nature of Indebtedness
Amount Outstanding
Date Due
Instructions.
1. No information need be provided as to: (a) the ownership of securities issued under any indenture, or any security or
securities having a maturity of more than one year at the time of acquisition by the indenture trustee; (b) disbursements made
in the ordinary course of business in the capacity of trustee of an indenture, transfer agent, registrant, custodian, paying
agent, fiscal agent or despositary, or other similar capacity; (c) Indebtedness created as a result of services rendered or
premises rented; or indebtedness created as a result of goods or securities sole in a cash transaction; (d) the ownership of
stock or of other securities of a corporation organized under Section 25(a) of the federal Reserve Act, as amended, which is
directly or indirectly a creditor of an obligor upon the indenture securities; (e) the ownership of any drafts, bills of exchange,
acceptances, or obligations which fall within the classification of self-liquidating paper.
2. Information should be given as to the general type of indebtedness, such as lines of credit, commercial paper, long-term
notes, mortgages, etc.
Item 13. Defaults by the Obligor.
(a) State whether there is or has been a default with respect to the securities under this indenture. Explain the nature of any
such default.
(b) If the trustee is a trustee under another indenture under which any other securities, or certificates of interest or participaton
in any other securities, of the obligor are outstanding, or is trustee for more than one outstanding series of securities
under the indenture, state whether there has been a default under any such indenture or series, identify the indenture or
series affected, and explain the nature of any such default.
Item 14. Affiliations with the Underwriters.
If any underwriter is an affiliate of the trustee, describe each such affiliation.
Instruction.
1. The term “affiliate” as defined in Rule o-2 of the General Rules and Regulations under the Act. Attention is directed to Rule
7a-26.
2. Include the name of each such affiliate and the names of all intermediate affiliates, if any. Indicate the respective percentage
of voting securities or other bases of control giving rise to the affiliation.
Item 15. Foreign Trustee.
Identify the order or rule pursuant to which the foreign trustee is authorized to act as sole trustee under indentures qualified
under the Act.