[For management investment companies only]----------------------------------------------------------------------------------------------------------------
Col. A Col. B Col. C Col. D Col. E----------------------------------------------------------------------------------------------------------------Name of issuer and title of Number of shares-- Amount of equity Amount of Value of each item
issue or nature of indebtedness principal amount in net profit and dividends or at close of
\1\ of bonds, notes loss for the interest \2 5\ period \2 3 4 5\
and other period \2 6\
indebtedness held
at close of
period
--------------------
(1) Credited to
income.
--------------------
(2) Other.........----------------------------------------------------------------------------------------------------------------\1\ (a) List each issue separately and group (1) Investments in majority-owned subsidiaries, segregating
subsidiaries consolidated; (2) other controlled companies; and (3) other affiliates. (b) If during the period
there has been any increase or decrease in the amount of investment in and advance to any affiliate, state in
a footnote (or if there have been changes to numerous affiliates, in a supplementary schedule) (1) name of
each issuer and title of issue or nature of indebtedness; (2) balance at beginning of period; (3) gross
additions; (4) gross reductions; (5) balance at close of period as shown in Column E. Include in the footnote
or schedule comparable information as to affiliates in which there was an investment at any time during the
period even though there was no investment at the close of the period of report.\2\ Give totals for each group. If operations of any controlled companies are different in character from those
of the company, group such affiliates (1) within divisions and (2) by type of activities.\3\ Columns C, D and E shall be totaled. The totals of Column E shall agree with the correlative amount shown on
the related balance sheet.\4\ (a) indicate by an appropriate symbol each issue of restricted securities. The information required by
instruction 5 of Sec. 210.12-12 shall be given in a footnote. (b) Indicate by an appropriate symbol each
issue of securities subject to option. The information required by instruction 5 of Sec. 210.12-13 shall be
given in a footnote.\5\ (a) include in Column D (1) as to each issue held at the close of the period, the dividends or interest
included in caption 1 of the statement of operations. In addition, show as the final item in column D (1) the
aggregate of dividends and interest included in the statement of operations in respect of investments in
affiliates not held at the close of the period. The total of this column shall agree with the correlative
amount shown on the related statement of operations.(b) Include in Column D (2) all other dividends and interest. Explain in an appropriate footnote the treatment
accorded each item.(c) Indicate by an appropriate symbol all non-cash dividends and explain the circumstances in a footnote.(d) Indicate by an appropriate symbol each issue of securities which is non-income producing.
\6\ The information required by column C shall be furnished only as to controlled companies. [47 FR 56844, Dec. 21, 1982]