Federal
Financial
Institutions
Examination
Council |
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Information
Technology Examination
of
MDPS (Multi-regional Data Processing Servicer)
or TSP (Technology Service Provider)
or Financial Institution
|
(SERVICER
NAME)
(CITY, STATE)
As of (Date of Exam)
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THIS
REPORT OF EXAMINATION IS STRICTLY CONFIDENTIAL
This
copy of the examination report is the joint property of the
FFIEC Member Agencies, and it is furnished for the confidential
use of the examined entity. The information contained in this
document is based upon the records and books of the entity,
upon statements made by directors, officers, and employees,
and upon information obtained from other sources believed
to be reliable and correct.
This
examination is not an audit and should not be construed as
such. It is emphasized that this examination does not replace,
nor relieve the management of its responsibility for making
or providing for adequate audits of the examined entity.
Under
no circumstances shall any recipient of this report, or any
of its directors, officers, employees, outside auditor or
legal counsel disclose or make public this report or any portion
thereof. Unauthorized disclosure of any of the contents of
this report is subject to the penalties in 18 U.S.C. 641.
The agency that transmitted this report must be notified immediately
if the examined entity receives a subpoena or other legal
process calling for the production of this report.
|
FFIEC
Information Technology
Report of Examination |
Data
Center: |
_______________________________________________________________________________________
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City: |
________________________ |
County: |
____________________________ |
State: |
____________ |
Zip: |
____________ |
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Date
of examination: |
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_________________________________
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Participating
Agencies |
Agency |
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Region/District |
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Number |
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_______________________________ |
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_______________________ |
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| _______________________________ |
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_______________________ |
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| _______________________________ |
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_______________________________ |
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_______________________ |
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| _______________________________ |
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_______________________________ |
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_______________________ |
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EIC: |
__________________________________ |
Examiner: |
__________________________________ |
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Examiner: |
__________________________________ |
Examiner: |
____________________________________ |
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____________________________________ |
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ID/Charter
No. |
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| TABLE
OF CONTENTS |
Examiner’s
Conclusions………………………………………………………………………………C-1
Violations
of Law and Regulations…….………………………………………..……………………C-1
Supporting
Comments………………………………………………………………………………...C-1
Directors’
Signature Page…………………………………………………………………………….C-1
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ID/Charter
No. |
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| EXAMINER'S
CONCLUSIONS |
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Start
text here ... |
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ID/Charter
No. |
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| VIOLATIONS
of LAW and REGULATIONS |
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Start
text here ... |
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ID/Charter
No. |
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| SUPPORTING
COMMENTS |
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Start
text here ... |
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ID/Charter
No. |
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| DIRECTORS’
SIGNATURE PAGE |
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We,
the undersigned directors of the [Name of MDPS/TSP/Financial
Institution], [City], [State and ZIP], have personally reviewed
the contents of the report of examination dated [Date of Exam]. |
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NAMES |
SIGNATURES |
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DATES |
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Type
first name here |
_____________________________________________________ |
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_______________________ |
Second
name here |
_____________________________________________________ |
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_______________________ |
Third
name here |
_____________________________________________________ |
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_______________________ |
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_____________________________________________________ |
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_______________________ |
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_____________________________________________________ |
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_______________________ |
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_____________________________________________________ |
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_______________________ |
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_____________________________________________________ |
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_______________________ |
NOTE:
This form should remain attached to the report of examination
and be retained in the institution’s file for review
during subsequent examinations. The signature of committee
members will suffice only if the committee includes outside
directors and a resolution has been passed by the full board
delegating the review to such committee. |
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ID/Charter
No. |
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| ADMINISTRATIVE
SECTION |
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| Region/District |
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[District/Region] |
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ID/Charter
Number |
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[######] |
| Name & Location of MDPS/TSP/Financial Institution |
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[Name of
MDPS/TSP/Financial Institution]
[Street]
[City],
[ State and ZIP] |
| Examination Opened |
Examination Closed |
Type of Examination-Agency |
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[Date of Exam] |
[Close Date of Exam] |
[Exam Type] |
| Prior Exams |
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Date: |
Rating: |
Agency: |
Date: |
Rating: |
Agency: |
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Working Hours |
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In House |
Outside |
| [Name of EIC], Examiner-in-Charge |
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| Examiner 2 |
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| Examiner 3 |
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| Examiner 4 |
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TOTAL |
0 |
0 |
GRAND
TOTAL (Less Training)
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ID/Charter
No. |
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| ADMINISTRATIVE
SECTION |
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Applications
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Code |
Application |
Batch |
On-line |
Real Time |
| 1 |
Demand
Deposits |
X, M |
I |
F |
| 2 |
Savings
Accounts |
X, M |
I |
F |
| 3 |
Loans |
X |
I |
F |
| 4 |
General
Ledger |
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I |
X |
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X = All Processing
M = Memo Post
I = Inquiry
Only
F = File Maintenance
Serviced
Financial Institutions
Name &
Location Application (By Code)
National Banks
First National
Bank of Anytown
1,2,3,4,5,6,7,8,9,10,11,12,13,14
Anytown,
Illinois
State Member Banks
Anytown State
Bank
1,2,3,4,5,6,7,8,9,10,11,12,13,14
Anytown,
Illinois
State Non-Member Banks
The State
Bank
Anytown,
Illinois
1,2,3,4,5,6,7,8,9,10,11,12,13,14
Savings Associations
Anytown Savings
Bank
1,2,3,4,5,6,7,8,9,10,11,12,13,14
Anytown,
Illinois
Credit Unions
Anytown Credit
Union 1,2,3,4,5,6,7,8,9,10,11,12,13,14
Anytown,
Illinois
| 1
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The
EIC is responsible for ensuring this information is
in the above format. |
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ID/Charter
No. |
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| ADMINISTRATIVE
SECTION |
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RECAP:
Totals
for all Institution Types:
Total
National Banks:
Total State Member Banks:
Total State Non-Member Banks:
Total Thrifts:
Total Credit Unions:
____
Total All Institutions:
====
OTHER
SERVICING:
# of
Customers:
Applications
Processed:
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ID/Charter
No. |
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| ADMINISTRATIVE
SECTION |
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System
Description
(Mission Critical Systems Only) |
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Hardware:
Operating System: |
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Software:
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Networks: |
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Organizational
Structure
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Staff Size: |
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S&D |
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D&A |
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Total |
0 |
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Examination
Contact:
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Officers/Managers:
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If financial
institution, give total assets: |
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Total deposits: |
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Ownership:
Directors:
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ID/Charter
No. |
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| FINANCIAL
INFORMATION |
Part 5 - Condensed Balance Sheet
and Income Statement for Nonfinancial Institution Servicer
CONDENSED BALANCE SHEET As of December 31
200X 200X 19XX 19XX
| ASSETS |
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| Cash |
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| Accounts Receivable |
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| Prepaid Expenses |
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| Other Current Assets |
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| CURRENT ASSETS |
0
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0
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0
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0
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| Real Estate |
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| Furniture & Fixtures |
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| Software |
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| Software Amortization |
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| Hardware |
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| Hardware Depreciation |
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| Other Assets |
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| Goodwill & Other Intangible Assets |
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| TOTAL ASSETS |
0
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0
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0
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0
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| LIABILITIES AND CAPITAL |
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| Notes Payable Banks |
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| Notes Payable Others |
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| Accounts Payable |
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| Accrued Expenses |
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| Taxes |
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| Other Current Liabilities |
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| CURRENT LIABILITIES |
0
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0
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0
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0
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| Term Debt |
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| Other Debt |
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| Subordinated Debt |
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| Long Term Capital Leases |
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| TOTAL LIABILITIES |
0
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0
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0
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0
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| EQUITY CAPITAL |
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| TOTAL LIABILITIES & EQUITY |
0
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0
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0
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0
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ID/Charter
No. |
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| FINANCIAL
INFORMATION |
CONDENSED
INCOME STATEMENT As of December 31
200X 200X 199X 199X
| OPERATING INCOME |
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| Data Processing Servicing Income |
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| Other Income |
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| TOTAL OPERATING INCOME |
0
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0
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0
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0
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| OPERATING EXPENSES |
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| Mainframe Hardware and Software |
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| Lease and Rental |
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| Depreciation |
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| Repairs and Maintenance |
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| Contract Programming |
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| License Fees and Amortization |
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| Other |
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| Other Operating Expenses |
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| Compensation |
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| Data Communication |
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| Occupancy Expense |
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| Benefits and Travel |
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| Public Relations & Advertising |
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| Other Operating Expenses |
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| TOTAL OPERATING EXPENSES |
0
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0
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0
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0
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| NON-OPERATING |
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| Non-operating Income |
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| Interest Income |
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| Other Non-operating Income |
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| Non-operating Expenses |
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| Interest Expense |
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| Other Non-operating Expenses |
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| NET NON-OPERATING INCOME |
0
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0
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0
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0
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| INCOME BEFORE TAXES |
0
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0
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0
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0
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| Income Tax |
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| NI BEFORE EXTRAORDINARY ITEMS |
0
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0
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0
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0
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| Extraordinary Losses |
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| Extraordinary Gains |
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| NET INCOME |
0
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0
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0
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0
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ID/Charter
No. |
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| FINANCIAL
INFORMATION |
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Statement
of Cashflow
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200X |
200X |
199X |
199X |
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Cash provided by operations |
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Net Income |
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Adjustments not requiring outlay of cash |
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Cumulative
effect of accounting changes |
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Depreciation
and amortization of property,
plant and equipment |
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Amortization
of goodwill and other intangibles |
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Deferred income
taxes |
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Changes in working capital and other accounts |
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Account receivables |
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Inventory |
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Account payables |
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Other |
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Net cash provided from operating activities |
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Cash flows from Investing Activities |
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Capital expenditures |
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Disposition of property, plant and equipment |
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All other investing activities |
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Cash flow from financing activities |
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Proceeds from borrowings |
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Retirement of debt |
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All other financing activities |
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