FORM 3

n
SPECIAL REPORT

Registered public accounting firms must provide any required special report and any amendments thereto to the PCAOB by completing
and submitting this Form according to the instructions to Form 3.

sio
It is important to refer to the instructions when completing each item of the Form. The Firm is responsible for completing each item
according to those instructions, and should not merely rely on the Firm's own interpretation of the item descriptions appearing in this
Form.

Terms that appear in italics have specific defined meanings that the Firm must apply in completing this Form. The definitions are
found in PCAOB Rule 1001.

Note: If the Firm is filing this Form 3 to report that the Firm's legal name has changed, the name entered in Item 1.1.a should be the
Firm's legal name before the name change that is being reported. The Firm's new name should be included in the
response to Item 1.1.c.

PART I - IDENTITY OF THE FIRM

ITEM 1.1 NAME OF THE FIRM
a. State the legal name of the Firm

er
b. Other names
used in audit
reports

c. If the Firm is filing this Form 3 to report that the Firm's legal name has changed, state the new legal name of the Firm
V
Note: The name provided in Item 1.1.c will be the name under which the Firm is registered with the Board if this Form is filed in accordance with
Rule 2203.

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART II - REASON FOR FILING THIS REPORT CHECK ALL THAT APPLY
Indicate, by checking the relevant box(es) from among Items 2.1 through 2.18 below, the event(s) being reported on this Form. More than one
event may be reported in the same Form 3 filing. For each event indicated below, proceed to the Parts and Items of this Form indicated
parenthetically for the specific event being reported and provide the information therein described. Provide responses only to those Parts and
Items of the Form specifically indicated for the event or events that the Firm identifies in this Part II as an event being reported on this Form. (For
le
example, if the Form is being filed solely to report that the Firm has changed its name, check the box for Item 2.17 in this Part of the Form, and
complete only Item 7.1 and Part VIII of the Form.) If the Firm is filing this Form to amend a previous filing, the Firm also should complete Item 2.19.

Note: In Items 2.4 through 2.11 and Item 2.15, the reportable event is described in terms of whether the Firm "has become aware" of certain facts.
For these purposes, the Firm is deemed to have become aware of the relevant facts on the date that any partner, shareholder, principal, owner,
or member of the Firm first becomes aware of the facts.
AUDIT REPORTS
2.1 The Firm has withdrawn an audit report on an issuer's financial statements, or withdrawn its consent to the use of its name in a
mp

report, document, or written communication containing an issuer's financial statements, and the issuer has failed to comply with
a Commission requirement to make a report concerning the matter pursuant to Item 4.02 of Commission Form 8-K. (Complete
c
d
e
f
g
Item 3.1 and Part VIII.)

2.1-C The Firm has resigned, declined to stand for re-appointment, or been dismissed from an audit engagement as principal auditor (or
an auditor upon whom the issuer's principal auditor expressed reliance in its report regarding a significant subsidiary), and the
issuer has failed to comply with a Commission requirement to make a report concerning the matter pursuant to Item 4.01 of
c
d
e
f
g
Commission Form 8-K. (Complete Item 3.2 and Part VIII.)

2.2 The Firm has issued audit reports with respect to more than 100 issuers in a calendar year immediately following a calendar
year in which the Firm did not issue audit reports with respect to more than 100 issuers. (Complete Part VIII.) c
d
e
f
g

2.3 The Firm has issued audit reports with respect to 100 or fewer issuers in a completed calendar year immediately following a
calendar year in which the Firm issued audit reports with respect to more than 100 issuers. (Complete Part VIII.) c
d
e
f
g
CERTAIN LEGAL PROCEEDINGS
The Firm has become aware that the Firm has become a defendant in a criminal proceeding prosecuted by a governmental
Sa

2.4
criminal law enforcement authority. (Complete Item 4.1 and Part VIII.) c
d
e
f
g

2.5 The Firm has become aware that, in a matter arising out of his or her conduct in the course of providing audit services or other
accounting services to an issuer, broker, dealer, a partner, shareholder, principal, owner, member, or audit manager of the Firm g
c
d
e
f
has become a defendant in a criminal proceeding prosecuted by a governmental criminal law enforcement authority. (Complete
Item 4.1 and Part VIII.)

2.6 The Firm has become aware that a partner, shareholder, principal, owner, member, or audit manager of the Firm who
provided at least ten hours of audit services for any issuer, broker, or dealer during the Firm's current fiscal year or its most
recently completed fiscal year has become a defendant in a criminal proceeding prosecuted by a governmental criminal law
enforcement authority and is charged with fraud, embezzlement, forgery, extortion, bribery, obstruction of justice, perjury, or c
d
e
f
g
false statements; or charged with any crime arising out of alleged conduct relating to accounting, auditing, securities, banking,
commodities, taxation, consumer protection, or insurance. (Complete Item 4.1 and Part VIII.)

2.7 The Firm has become aware that, in a matter arising out of the Firm's conduct in the course of providing professional services
for a client, the Firm has become a defendant or respondent in a civil or alternative dispute resolution proceeding initiated by a
governmental entity or in an administrative or disciplinary proceeding other than a Board disciplinary proceeding. (Complete
Test Firm: Special Report Item 4.1 and Part VIII.) PCAOB g
c
d
e
f
Form 3 (v. 2.00) Page 1 / 14

2.8 The Firm has become aware that, in a matter arising out of his or her conduct in the course of providing audit services or
other accounting services to an issuer, broker, dealer, a partner, shareholder, principal, owner, member, or audit manager of
the Firm has become a defendant or respondent in a civil or alternative dispute resolution proceeding initiated by a
 Note: The name provided in Item 1.1.c will be the name under which the Firm is registered with the Board if this Form is filed in accordance with
Rule 2203.

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART II - REASON FOR FILING THIS REPORT CHECK ALL THAT APPLY
Indicate, by checking the relevant box(es) from among Items 2.1 through 2.18 below, the event(s) being reported on this Form. More than one
event may be reported in the same Form 3 filing. For each event indicated below, proceed to the Parts and Items of this Form indicated
parenthetically for the specific event being reported and provide the information therein described. Provide responses only to those Parts and
Items of the Form specifically indicated for the event or events that the Firm identifies in this Part II as an event being reported on this Form. (For
example, if the Form is being filed solely to report that the Firm has changed its name, check the box for Item 2.17 in this Part of the Form, and

n
complete only Item 7.1 and Part VIII of the Form.) If the Firm is filing this Form to amend a previous filing, the Firm also should complete Item 2.19.

Note: In Items 2.4 through 2.11 and Item 2.15, the reportable event is described in terms of whether the Firm "has become aware" of certain facts.
For these purposes, the Firm is deemed to have become aware of the relevant facts on the date that any partner, shareholder, principal, owner,
or member of the Firm first becomes aware of the facts.
AUDIT REPORTS

sio
2.1 The Firm has withdrawn an audit report on an issuer's financial statements, or withdrawn its consent to the use of its name in a
report, document, or written communication containing an issuer's financial statements, and the issuer has failed to comply with
a Commission requirement to make a report concerning the matter pursuant to Item 4.02 of Commission Form 8-K. (Complete
c
d
e
f
g
Item 3.1 and Part VIII.)

2.1-C The Firm has resigned, declined to stand for re-appointment, or been dismissed from an audit engagement as principal auditor (or
an auditor upon whom the issuer's principal auditor expressed reliance in its report regarding a significant subsidiary), and the
issuer has failed to comply with a Commission requirement to make a report concerning the matter pursuant to Item 4.01 of
c
d
e
f
g
Commission Form 8-K. (Complete Item 3.2 and Part VIII.)

2.2 The Firm has issued audit reports with respect to more than 100 issuers in a calendar year immediately following a calendar
year in which the Firm did not issue audit reports with respect to more than 100 issuers. (Complete Part VIII.) c
d
e
f
g

2.3 The Firm has issued audit reports with respect to 100 or fewer issuers in a completed calendar year immediately following a
calendar year in which the Firm issued audit reports with respect to more than 100 issuers. (Complete Part VIII.) c
d
e
f
g

er
CERTAIN LEGAL PROCEEDINGS
2.4 The Firm has become aware that the Firm has become a defendant in a criminal proceeding prosecuted by a governmental
criminal law enforcement authority. (Complete Item 4.1 and Part VIII.) c
d
e
f
g

2.5 The Firm has become aware that, in a matter arising out of his or her conduct in the course of providing audit services or other
accounting services to an issuer, broker, dealer, a partner, shareholder, principal, owner, member, or audit manager of the Firm g
c
d
e
f
has become a defendant in a criminal proceeding prosecuted by a governmental criminal law enforcement authority. (Complete
Item 4.1 and Part VIII.)

2.6 The Firm has become aware that a partner, shareholder, principal, owner, member, or audit manager of the Firm who
V
provided at least ten hours of audit services for any issuer, broker, or dealer during the Firm's current fiscal year or its most
recently completed fiscal year has become a defendant in a criminal proceeding prosecuted by a governmental criminal law
enforcement authority and is charged with fraud, embezzlement, forgery, extortion, bribery, obstruction of justice, perjury, or
false statements; or charged with any crime arising out of alleged conduct relating to accounting, auditing, securities, banking,
c
d
e
f
g

commodities, taxation, consumer protection, or insurance. (Complete Item 4.1 and Part VIII.)

2.7 The Firm has become aware that, in a matter arising out of the Firm's conduct in the course of providing professional services
for a client, the Firm has become a defendant or respondent in a civil or alternative dispute resolution proceeding initiated by a
governmental entity or in an administrative or disciplinary proceeding other than a Board disciplinary proceeding. (Complete
Item 4.1 and Part VIII.)
c
d
e
f
g

2.8 The Firm has become aware that, in a matter arising out of his or her conduct in the course of providing audit services or
le
other accounting services to an issuer, broker, dealer, a partner, shareholder, principal, owner, member, or audit manager of
the Firm has become a defendant or respondent in a civil or alternative dispute resolution proceeding initiated by a
governmental entity or in an administrative or disciplinary proceeding other than a Board disciplinary proceeding. (Complete c
d
e
f
g
Item 4.1 and Part VIII.)

2.9 The Firm has become aware that, in a matter arising out of his or her conduct in the course of providing professional services
for a client, a partner, shareholder, principal, owner, member, or audit manager of the Firm who provided at least ten hours of
audit services for any issuer, broker, or dealer during the Firm's current fiscal year or its most recently completed fiscal year
has become a defendant or respondent in a civil or alternative dispute resolution proceeding initiated by a governmental entity c
d
e
f
g
or in an administrative or disciplinary proceeding other than a Board disciplinary proceeding. (Complete Item 4.1 and Part VIII.)
mp

2.10 The Firm has become aware that a proceeding meeting the criteria described in Items 2.4, 2.5, 2.6, 2.7, 2.8, or 2.9 above has
been concluded as to the Firm or a partner, shareholder, principal, owner, member, or audit manager of the Firm (whether by
dismissal, acceptance of pleas, through consents or settlement agreements, the entry of a final judgment, or otherwise).
(Complete Item 4.2 and Part VIII.) c
d
e
f
g

2.11 The Firm has become aware that the Firm, or the parent or a subsidiary of the Firm, has become the subject of a petition filed
in a bankruptcy court, or has otherwise become the subject of a proceeding in which a court or governmental agency (or, in a
non- U.S. jurisdiction, a person or entity performing a comparable function) has assumed jurisdiction over substantially all of
the assets or business of the Firm or its parent or a subsidiary. (Complete Item 4.3 and Part VIII.) c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
CERTAIN RELATIONSHIPS
2.12 The Firm has taken on as an employee, partner, shareholder, principal, or member, or has otherwise become owned or partly
owned by, a person who is currently the subject of (a) a Board disciplinary sanction suspending or barring the person from
being an associated person of a registered public accounting firm, (b) a Commission order suspending or denying the
privilege of appearing or practicing before the Commission, or (c) a court-ordered injunction prohibiting appearance or practice
Sa

before the Commission. (Complete Item 5.1 and Part VIII.) c

d
e
f
g

2.13 The Firm has become owned or partly owned by an entity that is currently the subject of (a) a Board disciplinary sanction
suspending or revoking that entity's registration or disapproving that entity's application for registration, (b) a
Commission order suspending or denying the privilege of appearing or practicing before the Commission, or (c) a court-
ordered injunction prohibiting appearance or practice before the Commission. (Complete Item 5.2 and Part VIII.) c
d
e
f
g

2.14 The Firm has entered into a contractual or other arrangement to receive consulting or other professional services from a person or
entity meeting any of the criteria described in Items 2.12 or 2.13 above. (Complete Item 5.3 and Part VIII.) c
d
e
f
g
LICENSES AND CERTIFICATIONS
2.15 The Firm has become aware that its authorization to engage in the business of auditing or accounting in a particular jurisdiction
has ceased to be effective or has become subject to conditions or contingencies other than conditions or contingencies
imposed on all firms engaged in the business of auditing or accounting in the jurisdiction. (Complete Item 6.1 and Part VIII.) c
d
e
f
g

2.16 The Firm has obtained a license or certification authorizing the Firm to engage in the business of auditing or accounting and which
Test Firm: Special Report has not been identified on any Form 1 or Form 3 previously filed by the Firm, or there has been a change in a license or certification
PCAOB Form 3 (v. 2.00) Page 2 / 14
number identified on a Form 1 or Form 3 previously filed by the Firm. (Complete Item 6.2 and Part VIII.) c
d
e
f
g

CHANGES IN THE FIRM OR THE FIRM'S BOARD CONTACT PERSON

 non- U.S. jurisdiction, a person or entity performing a comparable function) has assumed jurisdiction over substantially all of
the assets or business of the Firm or its parent or a subsidiary. (Complete Item 4.3 and Part VIII.) c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
CERTAIN RELATIONSHIPS
2.12 The Firm has taken on as an employee, partner, shareholder, principal, or member, or has otherwise become owned or partly
owned by, a person who is currently the subject of (a) a Board disciplinary sanction suspending or barring the person from
being an associated person of a registered public accounting firm, (b) a Commission order suspending or denying the
privilege of appearing or practicing before the Commission, or (c) a court-ordered injunction prohibiting appearance or practice
before the Commission. (Complete Item 5.1 and Part VIII.) c
d
e
f
g

n
2.13 The Firm has become owned or partly owned by an entity that is currently the subject of (a) a Board disciplinary sanction
suspending or revoking that entity's registration or disapproving that entity's application for registration, (b) a
Commission order suspending or denying the privilege of appearing or practicing before the Commission, or (c) a court-
ordered injunction prohibiting appearance or practice before the Commission. (Complete Item 5.2 and Part VIII.) c
d
e
f
g

2.14 The Firm has entered into a contractual or other arrangement to receive consulting or other professional services from a person or
entity meeting any of the criteria described in Items 2.12 or 2.13 above. (Complete Item 5.3 and Part VIII.) c
d
e
f
g

sio
LICENSES AND CERTIFICATIONS
2.15 The Firm has become aware that its authorization to engage in the business of auditing or accounting in a particular jurisdiction
has ceased to be effective or has become subject to conditions or contingencies other than conditions or contingencies
imposed on all firms engaged in the business of auditing or accounting in the jurisdiction. (Complete Item 6.1 and Part VIII.) c
d
e
f
g

2.16 The Firm has obtained a license or certification authorizing the Firm to engage in the business of auditing or accounting and which
has not been identified on any Form 1 or Form 3 previously filed by the Firm, or there has been a change in a license or certification
number identified on a Form 1 or Form 3 previously filed by the Firm. (Complete Item 6.2 and Part VIII.) c
d
e
f
g

CHANGES IN THE FIRM OR THE FIRM'S BOARD CONTACT PERSON

2.17 The Firm has changed its legal name while otherwise remaining the same legal entity that it was before the name change. c
d
e
f
g
(Complete Item 7.1 and Part VIII.)

2.18 There has been a change in the business mailing address, business telephone number, business facsimile number, or business e-
mail of the person most recently designated by the Firm (on Form 2, Form 3, or Form 4) as the Firm's primary contact with the

er
Board, or the Firm is designating a new person to serve as the primary contact. (Complete Item 7.2 and Part VIII.) c
d
e
f
g
AMENDMENT
2.19 If this is an amendment to a report previously filed with the Board -

a. Indicate, by checking the box corresponding to this item, that this is an amendment. c
d
e
f
g

b. Identify the specific Item numbers of this Form (other than this Item 2.19) as to which the Firm's response has changed from that provided
in the most recent Form 3 or amended Form 3 filed by the Firm with respect to the events reported on this Form.

e
f
g
V
c Part I Identity of the Firm
d
l Part III Withdrawn Audit Reports and Issuer Auditor Changes
c Item 3.1 Withdrawn Issuer Audit Reports and Consents
d
e
f
g
c Item 3.2 Issuer Auditor Changes
d
e
f
g
c Incomplete Responses Due to Asserted Non-U.S. Legal Restrictions
d
e
f
g
l Part IV Certain Proceedings
c Item 4.1 Criminal, Governmental, Administrative, or Disciplinary Proceedings
d
e
f
g
le
c Item 4.2 Concluded Criminal, Governmental, Administrative, or Disciplinary Proceedings
d
e
f
g
c Item 4.3 Bankruptcy or Receivership
d
e
f
g
c Incomplete Responses Due to Asserted Non-U.S. Legal Restrictions
d
e
f
g
l Part V Certain Relationships
c Item 5.1 New Relationship with Person Subject to Bar or Suspension
d
e
f
g
c Item 5.2 New Ownership Interest by Firm Subject to Bar or Suspension
d
e
f
g
mp

c Item 5.3 Certain Arrangements to Receive Consulting or Other Professional Services

d
e
f
g
c Incomplete Responses Due to Asserted Non-U.S. Legal Restrictions
d
e
f
g
l Part VI License and Certifications
c Item 6.1 Loss of, or Limitations Imposed on, Authorization to Engage in the Business of Auditing or Accounting
d
e
f
g
c Item 6.2 New License or Certification
d
e
f
g
c Incomplete Responses Due to Asserted Non-U.S. Legal Restrictions
d
e
f
g
l Part VII Changes in the Firm or the Firm's Board Contact Person
c Item 7.1.a – 7.1.c
d
e
f
g
c Item 7.1.d Brief Description of the Reason(s) for the Change
d
e
f
g
c Item 7.2 Change in Contact Information
d
e
f
g
c Incomplete Responses Due to Asserted Non-U.S. Legal Restrictions
d
e
f
g
Sa

l Part IX Exhibits
c Exhibit 99.1 Request for Confidential Treatment
d
e
f
g
c Exhibit 99.3 Materials Required by Rule 2207(c)(2)-(4)
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART III - WITHDRAWN AUDIT REPORTS ANDISSUER AUDITOR CHANGES
ITEM 3.1 WITHDRAWN ISSUER AUDIT REPORTS AND CONSENTS
If the Firm has withdrawn an audit report on an issuer's financial statements, or withdrawn its consent to the use of its name in a report,
document, or written communication containing an issuer's financial statements, and the issuer has failed to comply with a Commission
requirement to make a report concerning the matter pursuant to Item 4.02 of Commission Form 8-K, provide -

Test Firm: Special Report a. Issuer name Issuer CIK (Central Index Key) number, if any PCAOB Form 3 (v. 2.00) Page 3 / 14
Check here, if none g
c
d
e
f
b. Date(s) of the audit report(s) that the Firm has withdrawn, or to which the Firm's withdrawal of consent relates (mm/dd/yyyy)
 c Exhibit 99.3 Materials Required by Rule 2207(c)(2)-(4)
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART III - WITHDRAWN AUDIT REPORTS ANDISSUER AUDITOR CHANGES
ITEM 3.1 WITHDRAWN ISSUER AUDIT REPORTS AND CONSENTS
If the Firm has withdrawn an audit report on an issuer's financial statements, or withdrawn its consent to the use of its name in a report,
document, or written communication containing an issuer's financial statements, and the issuer has failed to comply with a Commission
requirement to make a report concerning the matter pursuant to Item 4.02 of Commission Form 8-K, provide -

n
a. Issuer name Issuer CIK (Central Index Key) number, if any
Check here, if none g
c
d
e
f
b. Date(s) of the audit report(s) that the Firm has withdrawn, or to which the Firm's withdrawal of consent relates (mm/dd/yyyy)

sio
c. A description of the reason(s) the Firm has withdrawn the audit report(s) or the consent
CA CR
c
d
e
f
g c
d
e
f
g

V er
le
ITEM 3.2 ISSUER AUDITOR CHANGES

If the Firm has resigned, declined to stand for re-appointment, or been dismissed from an audit engagement as principal auditor
(or an auditor upon whom the issuer's principal auditor expressed reliance in its report regarding a significant subsidiary) and the
issuer has failed to comply with a Commission requirement to make a report concerning the matter pursuant to Item 4.01 of
Commission Form 8-K, provide –
mp

a. Issuer Name Issuer CIK (Central Index Key) number, if any

Check here, if none g

c
d
e
f
b. 1. Indicate whether the firm resigned, declined to 2. Date of Action
stand for re-appointment, or was dismissed.

Note: The 30-day period in which the Firm must report the event does not begin to run unless and until the issuer fails to report on Form 8-K
within the time required by the Commission's rules. The Firm must then report the event on Form 3 within 30 days of the expiration of the
required Form 8-K filing deadline, unless, within that 30-day period, the issuer reports on a late-filed Form 8-K.

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

Sa

If the Firm is a foreign registered public accounting firm that, in responding to Item 3.1.c, has either withheld information, or declined to request
certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3 without
violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that the Firm
has actually withheld or declined to request.

c 3.1.a
d
e
f
g c 3.1.b
d
e
f
g c 3.1.c
d
e
f
g

c 3.2.a
d
e
f
g c 3.2.b1
d
e
f
g c 3.2.b2
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IV - CERTAIN PROCEEDINGS
Test Firm: Special Report ITEM 4.1 CRIMINAL, GOVERNMENTAL, ADMINISTRATIVE, OR DISCIPLINARY PROCEEDINGS PCAOB Form 3 (v. 2.00) Page 4 / 14

If the Firm has indicated in this Form 3 that any of the events described in Items 2.4, 2.5, 2.6, 2.7, 2.8 or 2.9 has occurred, provide the following
information with respect to each such event -
 ITEM 3.2 ISSUER AUDITOR CHANGES

If the Firm has resigned, declined to stand for re-appointment, or been dismissed from an audit engagement as principal auditor
(or an auditor upon whom the issuer's principal auditor expressed reliance in its report regarding a significant subsidiary) and the
issuer has failed to comply with a Commission requirement to make a report concerning the matter pursuant to Item 4.01 of
Commission Form 8-K, provide –

a. Issuer Name Issuer CIK (Central Index Key) number, if any

n
Check here, if none g
c
d
e
f
b. 1. Indicate whether the firm resigned, declined to 2. Date of Action
stand for re-appointment, or was dismissed.

sio
Note: The 30-day period in which the Firm must report the event does not begin to run unless and until the issuer fails to report on Form 8-K
within the time required by the Commission's rules. The Firm must then report the event on Form 3 within 30 days of the expiration of the
required Form 8-K filing deadline, unless, within that 30-day period, the issuer reports on a late-filed Form 8-K.

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

If the Firm is a foreign registered public accounting firm that, in responding to Item 3.1.c, has either withheld information, or declined to request
certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3 without
violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that the Firm
has actually withheld or declined to request.

c 3.1.a
d
e
f
g c 3.1.b
d
e
f
g c 3.1.c
d
e
f
g

er
c 3.2.a
d
e
f
g c 3.2.b1
d
e
f
g c 3.2.b2
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IV - CERTAIN PROCEEDINGS
ITEM 4.1 CRIMINAL, GOVERNMENTAL, ADMINISTRATIVE, OR DISCIPLINARY PROCEEDINGS
V
If the Firm has indicated in this Form 3 that any of the events described in Items 2.4, 2.5, 2.6, 2.7, 2.8 or 2.9 has occurred, provide the following
information with respect to each such event -

a. Name, filing date, and case or docket number of the proceeding, and the nature of the proceeding CA CR

c g
d
e
f
g c
d
e
f
Name of the proceeding
le
Filing date of proceeding (mm/dd/yyyy) Case or docket number
Check here, if none g
c
d
e
f
Nature of proceeding

b. Name of the court, tribunal, or body in or before which the proceeding was filed CA CR

c g
d
e
f
g c
d
e
f
mp

c. Indicate (by checking yes or no) whether the Firm itself is a defendant or respondent in the proceeding. If
j Yes
k
l
m
n CA CR
the Firm is a defendant or a respondent, identify the statutes, rules, or legal duties that the Firm is alleged
to have violated, and a brief description of the firm's alleged conduct in violation of those statutes, rules, or c g
d
e
f
g c
d
e
f
legal duties. j No
k
l
m
n

d. The names of every defendant or respondent who is a partner, shareholder, principal, owner, member, or audit manager of the Firm, or
Sa

who was such either at the time the Firm received notice of the proceeding or at the time of the alleged conduct on which any claim or
charge is based, and who provided at least ten hours of audit services for any issuer, broker, or dealer during the Firm's current fiscal
year or its most recent fiscal year; and, as to each such defendant or respondent, the statutes, rules, or legal duties that he or she is
alleged to have violated, and a brief description of his or her alleged conduct in violation of those statutes, rules, or legal duties.

CA CR

Name c
d
e
f
g c
d
e
f
g
Family name (last name) Given name (first name)

The statutes, rules, or legal duties that he or she is alleged to have violated, and a brief description of his or her alleged conduct in
violation of those statutes, rules, or legal duties

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 5 / 14

 Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IV - CERTAIN PROCEEDINGS
ITEM 4.1 CRIMINAL, GOVERNMENTAL, ADMINISTRATIVE, OR DISCIPLINARY PROCEEDINGS
If the Firm has indicated in this Form 3 that any of the events described in Items 2.4, 2.5, 2.6, 2.7, 2.8 or 2.9 has occurred, provide the following
information with respect to each such event -

n
a. Name, filing date, and case or docket number of the proceeding, and the nature of the proceeding CA CR

c g
d
e
f
g c
d
e
f
Name of the proceeding

sio
Filing date of proceeding (mm/dd/yyyy) Case or docket number
Check here, if none g
c
d
e
f
Nature of proceeding

b. Name of the court, tribunal, or body in or before which the proceeding was filed CA CR

c g
d
e
f
g c
d
e
f
c. Indicate (by checking yes or no) whether the Firm itself is a defendant or respondent in the proceeding. If
j Yes
k
l
m
n CA CR
the Firm is a defendant or a respondent, identify the statutes, rules, or legal duties that the Firm is alleged
to have violated, and a brief description of the firm's alleged conduct in violation of those statutes, rules, or c g
d
e
f
g c
d
e
f
legal duties. j No
k
l
m
n

Name
V
Family name (last name)
er
d. The names of every defendant or respondent who is a partner, shareholder, principal, owner, member, or audit manager of the Firm, or
who was such either at the time the Firm received notice of the proceeding or at the time of the alleged conduct on which any claim or
charge is based, and who provided at least ten hours of audit services for any issuer, broker, or dealer during the Firm's current fiscal
year or its most recent fiscal year; and, as to each such defendant or respondent, the statutes, rules, or legal duties that he or she is
alleged to have violated, and a brief description of his or her alleged conduct in violation of those statutes, rules, or legal duties.

Given name (first name)

CA

c
d
e
f
g
CR

c
d
e
f
g
le
The statutes, rules, or legal duties that he or she is alleged to have violated, and a brief description of his or her alleged conduct in
violation of those statutes, rules, or legal duties
mp

e. Name of any client that was the recipient of the professional services to which any claim or charge in the proceeding relates.
CA CR
c g
d
e
f
g c
d
e
f

Note: For the purpose of this Part, administrative or disciplinary proceedings include those of the Commission; any other federal, state,
or non-U.S. agency, board, or administrative or licensing authority; and any professional association or body. Investigations that have
not resulted in the commencement of a proceeding need not be included.

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
ITEM 4.2 CONCLUDED CRIMINAL, GOVERNMENTAL, ADMINISTRATIVE, OR DISCIPLINARY PROCEEDINGS
Sa

If any proceeding meeting the criteria described in Items 2.4, 2.5, 2.6, 2.7, 2.8, or 2.9, including any proceeding reported in Item 4.1, has been
concluded as to the Firm or a partner, shareholder, principal, owner, member, or audit manager of the Firm (whether by dismissal, acceptance
of pleas, through consents or settlement agreements, the entry of a final judgment, or otherwise), provide -

Proceeding

a. Name, filing date, and case or docket number of the proceeding, and the nature of the proceeding CA CR

c
d
e
f
g c
d
e
f
g
Name of proceeding

Filing date of proceeding (mm/dd/yyyy) Case or docket number

Check here, if none g
c
d
e
f
Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 6 / 14
Nature of proceeding
 not resulted in the commencement of a proceeding need not be included.

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
ITEM 4.2 CONCLUDED CRIMINAL, GOVERNMENTAL, ADMINISTRATIVE, OR DISCIPLINARY PROCEEDINGS
If any proceeding meeting the criteria described in Items 2.4, 2.5, 2.6, 2.7, 2.8, or 2.9, including any proceeding reported in Item 4.1, has been
concluded as to the Firm or a partner, shareholder, principal, owner, member, or audit manager of the Firm (whether by dismissal, acceptance
of pleas, through consents or settlement agreements, the entry of a final judgment, or otherwise), provide -

Proceeding

n
a. Name, filing date, and case or docket number of the proceeding, and the nature of the proceeding CA CR

c
d
e
f
g c
d
e
f
g
Name of proceeding

sio
Filing date of proceeding (mm/dd/yyyy) Case or docket number
Check here, if none g
c
d
e
f

Nature of proceeding

b. Name of the court, tribunal, or body in or before which the proceeding was filed CA CR

c
d
e
f
g c
d
e
f
g
c. A brief description of the terms of the conclusion of the proceeding as to the Firm or partner, shareholder, principal, CA CR
owner, member, or audit manager c
d
e
f
g c
d
e
f
g

a. Name of the proceeding

V
b. Name of the court or governmental body
er
ITEM 4.3 BANKRUPTCY OR RECEIVERSHIP
If the Firm, or the parent or a subsidiary thereof, has become the subject of a petition filed in a bankruptcy court, or has otherwise become the
subject of a proceeding in which a court or governmental agency (or, in a non-U.S. jurisdiction, a person or entity performing a comparable
function) has assumed jurisdiction over substantially all of the assets or business of the Firm or its parent or a subsidiary, provide -

CA CR

c g
d
e
f
g

e
f
g
c
d
e
f
CA CR

c g
d c
d
e
f
c. Date of filing or the assumption of jurisdiction (mm/dd/yyyy) CA CR
le
c g
d
e
f
g c
d
e
f
d. Identity of the receiver, fiscal agent, or similar officer CA CR

c g
d
e
f
g c
d
e
f
Date the receiver, fiscal agent, or similar officer was appointed (mm/dd/yyyy) CA CR

c g
d
e
f
g c
d
e
f
mp

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

If the Firm is a foreign registered public accounting firm that, in responding to Part IV, has either withheld certain information, or declined to
request certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3
without violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that
the Firm has actually withheld or declined to request.

c 4.1.a
d
e
f
g c 4.1.b
d
e
f
g c 4.1.c
d
e
f
g c 4.1.d
d
e
f
g c 4.1.e
d
e
f
g c 4.2.a
d
e
f
g

c 4.2.b
d
e
f
g c 4.2.c
d
e
f
g c 4.3.a
d
e
f
g c 4.3.b
d
e
f
g c 4.3.c
d
e
f
g c 4.3.d
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART V - CERTAIN RELATIONSHIPS
ITEM 5.1 NEW RELATIONSHIP WITH PERSON SUBJECT TO BAR OR SUSPENSION
Sa

If the Firm has taken on as an employee, partner, shareholder, principal, or member, or has otherwise become owned or partly owned by a
person who is currently the subject of (a) a Board disciplinary sanction suspending or barring the person from being an associated person of
a registered public accounting firm, ( b ) a Commission order suspending or denying the privilege of appearing or practicing before the
Commission, or (c) a court-ordered injunction prohibiting appearance or practice before the Commission, provide -

a. Person's name CA CR
Family name (last name) Given name (first name)
c g
d
e
f
g c
d
e
f

b. Nature of the person's relationship with the Firm CA CR

c g
d
e
f
g c
d
e
f

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 7 / 14

 c 4.2.b
d
e
f
g c 4.2.c
d
e
f
g c 4.3.a
d
e
f
g c 4.3.b
d
e
f
g c 4.3.c
d
e
f
g c 4.3.d
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART V - CERTAIN RELATIONSHIPS
ITEM 5.1 NEW RELATIONSHIP WITH PERSON SUBJECT TO BAR OR SUSPENSION
If the Firm has taken on as an employee, partner, shareholder, principal, or member, or has otherwise become owned or partly owned by a
person who is currently the subject of (a) a Board disciplinary sanction suspending or barring the person from being an associated person of
a registered public accounting firm, ( b ) a Commission order suspending or denying the privilege of appearing or practicing before the
Commission, or (c) a court-ordered injunction prohibiting appearance or practice before the Commission, provide -

n
a. Person's name CA CR
Family name (last name) Given name (first name)
c g
d
e
f
g c
d
e
f

b. Nature of the person's relationship with the Firm CA CR

sio
c g
d
e
f
g c
d
e
f

c. Date the relationship with the Firm began (mm/dd/yyyy) CA CR

c g
d
e
f
g c
d
e
f

ITEM 5.2 NEW OWNERSHIP INTEREST BY FIRM SUBJECT TO BAR OR SUSPENSION

er
If the Firm has become owned or partly owned by an entity that is currently the subject of (a) a Board disciplinary sanction suspending or
revoking that entity's registration or disapproving that entity's application for registration, (b) a Commission order suspending or denying
the privilege of appearing or practicing before the Commission, or (c) a court-ordered injunction prohibiting appearance or practice before
the Commission, provide -

a. Name of the entity that has obtained an ownership interest in the Firm CA CR

c g
d
e
f
g c
d
e
f
b. Nature and extent of the ownership interest CA CR

c g
d
e
f
g c
d
e
f
V
c. Date the ownership interest was obtained (mm/dd/yyyy) CA CR

c g
d
e
f
g c
d
e
f
le
ITEM 5.3 CERTAIN ARRANGEMENTS TO RECEIVE CONSULTING OR OTHER PROFESSIONAL SERVICES
If the Firm has entered into a contractual or other arrangement to receive consulting or other professional services from a person or entity meeting
any of the criteria described in Items 2.12 or 2.13 above, provide -

a. Name of the person or entity CA CR

c g
d
e
f
g c
d
e
f
mp

b. Date that the Firm entered into the contract or other arrangement (mm/dd/yyyy) CA CR

c g
d
e
f
g c
d
e
f
c. Description of the services to be provided to the Firm by the person or entity CA CR

c g
d
e
f
g c
d
e
f
Sa

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS
If the Firm is a foreign registered public accounting firm that, in responding to Part V, has either withheld certain information, or declined to
request certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3
without violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that
the Firm has actually withheld or declined to request.

c 5.1.a
d
e
f
g c 5.1.b
d
e
f
g c 5.1.c
d
e
f
g c 5.2.a
d
e
f
g c 5.2.b
d
e
f
g
5.2.c 5.3.a 5.3.b 5.3.c
c
d
e
f
g c
d
e
f
g c
d
e
f
g c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VI - LICENSES AND CERTIFICATIONS
Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 8 / 14
ITEM 6.1 LOSS OF, OR LIMITATIONS IMPOSED ON, AUTHORIZATION TO ENGAGE IN THE BUSINESS OF AUDITING OR ACCOUNTING
If the Firm's authorization to engage in the business of auditing or accounting in a particular jurisdiction has ceased to be effective or has become
subject to conditions or contingencies other than conditions or contingencies imposed on all firms engaged in the business of auditing or
accounting in the jurisdiction, provide -
 Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS
If the Firm is a foreign registered public accounting firm that, in responding to Part V, has either withheld certain information, or declined to
request certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3
without violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that
the Firm has actually withheld or declined to request.

c 5.1.a
d
e
f
g c 5.1.b
d
e
f
g c 5.1.c
d
e
f
g c 5.2.a
d
e
f
g c 5.2.b
d
e
f
g

n
5.2.c 5.3.a 5.3.b 5.3.c
c
d
e
f
g c
d
e
f
g c
d
e
f
g c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VI - LICENSES AND CERTIFICATIONS

sio
ITEM 6.1 LOSS OF, OR LIMITATIONS IMPOSED ON, AUTHORIZATION TO ENGAGE IN THE BUSINESS OF AUDITING OR ACCOUNTING
If the Firm's authorization to engage in the business of auditing or accounting in a particular jurisdiction has ceased to be effective or has become
subject to conditions or contingencies other than conditions or contingencies imposed on all firms engaged in the business of auditing or
accounting in the jurisdiction, provide -

a. Name of the state, agency, board or other authority that had issued the license or certification related to such authorization

b. Number of the license or certification

Check here, if none g
c
d
e
f
c. Date that the authorization ceased to become effective or became subject to conditions or contingencies

er
d. A brief description of the reason(s) for such action, including a description of the conditions or contingencies, if any CA CR

c g
d
e
f
g c
d
e
f

V
ITEM 6.2 NEW LICENSE OR CERTIFICATION
If the Firm has obtained any license or certification authorizing the Firm to engage in the business of auditing or accounting, and which has not
been identified on any Form 1 or Form 3 previously filed by the Firm, or there has been a change in any license or certification number identified on
a Form 1 or Form 3 previously filed by the Firm, provide -

a. Name of the issuing state, agency, board or other authority

le
b. Number of the license or certification
Check here, if none g
c
d
e
f
c. Date the license or certification took effect (mm/dd/yyyy)

d. If the license or certification replaces another license or certification issued by the same authority, the number of the replaced license or
mp

certification

Note: If the Firm is filing a Form 4 to report a change in its form of organization, change in jurisdiction, or a business combination, the Firm
should report on Form 4, rather than Form 3, any related license change that takes effect before the submission of the Form 4.

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

If the Firm is a foreign registered public accounting firm that, in responding to Part VI, has either withheld certain information, or declined to
request certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3
without violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that
the Firm has actually withheld or declined to request.

c 6.1.a
d
e
f
g c 6.1.b
d
e
f
g c 6.1.c
d
e
f
g c 6.1.d
d
e
f
g c 6.2.a
d
e
f
g

c 6.2.b
d
e
f
g c 6.2.c
d
e
f
g c 6.2.d
d
e
f
g
Sa

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VII - CHANGES IN THE FIRM OR THE FIRM'S BOARD CONTACT PERSON
ITEM 7.1 CHANGE IN NAME OF FIRM
If the Firm is reporting a change in its legal name provide -

a. New legal name of Firm

b. Legal name of the Firm immediately preceding new legal name

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 9 / 14

c. Effective date of name change (mm/dd/yyyy)

 5.2.c 5.3.a 5.3.b 5.3.c
c
d
e
f
g c
d
e
f
g c
d
e
f
g c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VI - LICENSES AND CERTIFICATIONS
ITEM 6.1 LOSS OF, OR LIMITATIONS IMPOSED ON, AUTHORIZATION TO ENGAGE IN THE BUSINESS OF AUDITING OR ACCOUNTING
If the Firm's authorization to engage in the business of auditing or accounting in a particular jurisdiction has ceased to be effective or has become
subject to conditions or contingencies other than conditions or contingencies imposed on all firms engaged in the business of auditing or
accounting in the jurisdiction, provide -

n
a. Name of the state, agency, board or other authority that had issued the license or certification related to such authorization

b. Number of the license or certification

Check here, if none g
c
d
e
f

sio
c. Date that the authorization ceased to become effective or became subject to conditions or contingencies

d. A brief description of the reason(s) for such action, including a description of the conditions or contingencies, if any CA CR

c g
d
e
f
g c
d
e
f

er
ITEM 6.2 NEW LICENSE OR CERTIFICATION
If the Firm has obtained any license or certification authorizing the Firm to engage in the business of auditing or accounting, and which has not
been identified on any Form 1 or Form 3 previously filed by the Firm, or there has been a change in any license or certification number identified on
a Form 1 or Form 3 previously filed by the Firm, provide -

a. Name of the issuing state, agency, board or other authority

V
b. Number of the license or certification
Check here, if none g
c
d
e
f
c. Date the license or certification took effect (mm/dd/yyyy)

d. If the license or certification replaces another license or certification issued by the same authority, the number of the replaced license or
certification
le
Note: If the Firm is filing a Form 4 to report a change in its form of organization, change in jurisdiction, or a business combination, the Firm
should report on Form 4, rather than Form 3, any related license change that takes effect before the submission of the Form 4.

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

If the Firm is a foreign registered public accounting firm that, in responding to Part VI, has either withheld certain information, or declined to
request certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3
without violating non-U.S. law, the Firm must identify here all items -- and only those items -- with respect to which there is any information that
the Firm has actually withheld or declined to request.
mp

g 6.1.a
c
d
e
f g 6.1.b
c
d
e
f g 6.1.c
c
d
e
f g 6.1.d
c
d
e
f g 6.2.a
c
d
e
f

c 6.2.b
d
e
f
g c 6.2.c
d
e
f
g c 6.2.d
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VII - CHANGES IN THE FIRM OR THE FIRM'S BOARD CONTACT PERSON
ITEM 7.1 CHANGE IN NAME OF FIRM
If the Firm is reporting a change in its legal name provide -

a. New legal name of Firm

Sa

b. Legal name of the Firm immediately preceding new legal name

c. Effective date of name change (mm/dd/yyyy)

d. Brief description of the reason(s) for the change CA CR

c g
d
e
f
g c
d
e
f

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 10 / 14

 c 6.2.b
d
e
f
g c 6.2.c
d
e
f
g c 6.2.d
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VII - CHANGES IN THE FIRM OR THE FIRM'S BOARD CONTACT PERSON
ITEM 7.1 CHANGE IN NAME OF FIRM
If the Firm is reporting a change in its legal name provide -

a. New legal name of Firm

n
b. Legal name of the Firm immediately preceding new legal name

sio
c. Effective date of name change (mm/dd/yyyy)

d. Brief description of the reason(s) for the change CA CR

c g
d
e
f
g c
d
e
f

er
e. Affirm, by checking the box corresponding to this Item, that, other than the name change, the Firm is the same legal entity that it was c
d
e
f
g
before the name change.

Note: If, other than the name change, the Firm is not the same legal entity that it was before the name change, whether because
of a change in the Firm's legal form of organization or because of other transactions, the registration status of the predecessor
firm does not automatically attach to the Firm, and the Firm cannot report the event as a name change. If the Firm cannot make
the affirmation required by Item 7.1.e, the Firm cannot execute the certification in Part VIII as to Item 7.1, and this Form cannot be
deemed filed under Rule 2206.
V
In that event, the Firm should consider whether, pursuant to the provisions of Rule 2108, the Firm can make the representations
required in a Form 4 filing to enable the predecessor firm's registration to attach to the Firm. If the Firm cannot or does not file
with the Board a Form 4 making all necessary representations, the predecessor firm's registration does not attach to the Firm.
In those circumstances, the Firm may not lawfully prepare or issue an audit report without first filing an application for
registration on Form 1 and having that application approved by the Board.

Note: If the Firm is filing a Form 4 to report a change in its form of organization, change in jurisdiction, or a business combination,
the Firm should report any related name change on Form 4 and not on Form 3.
ITEM 7.2 CHANGE IN CONTACT INFORMATION
If there has been a change in the business mailing address, business telephone number, business facsimile number, or business e-mail
address of the person most recently designated by the Firm (on Form 2, Form 3, or Form 4) as the Firm's primary contact with the Board, or if
le
the Firm is designating a new person to serve as the primary contact, provide -

Primary contact name

Family name (last name) Given name (first name)

Business mailing address

Country City
mp

Street address 1 State/Province

Street address 2 Non-U.S. State/Province

Zip/Postal code
Sa

Business telephone number (incl. country and area code)

Business facsimile number (incl. country and area code)

Business e-mail address

INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS

If the Firm is a foreign registered public accounting firm that, in responding to Item 7.1.d, has either withheld information, or declined to request
Test Firm: Special Report certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this FormPCAOB 3 without
Form 3 (v. 2.00) Page 11 / 14
violating non-U.S. law, the Firm must indicate that by checking here.

c 7.1.d
d
e
f
g
 INCOMPLETE RESPONSES DUE TO ASSERTED NON-U.S. LEGAL RESTRICTIONS
If the Firm is a foreign registered public accounting firm that, in responding to Item 7.1.d, has either withheld information, or declined to request
certain information from relevant third parties, on the ground that the Firm cannot provide the information to the Board on this Form 3 without
violating non-U.S. law, the Firm must indicate that by checking here.

c 7.1.d
d
e
f
g

n
Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VIII - CERTIFICATION OF THE FIRM
ITEM 8.1 SIGNATURE OF PARTNER OR AUTHORIZED OFFICER

sio
This Form must be signed on behalf of the Firm by an authorized partner or officer of the Firm including, in accordance with Rule 2204, both a
signature that appears in typed form within the electronic submission and a corresponding manual signature retained by the Firm.

I, the undersigned, certify that -

a. I am a partner or an officer of the Firm and I am authorized to sign this Form on behalf of the Firm;
b. I have reviewed this Form;
c. based on my knowledge, this Form does not contain any untrue statement of a material fact or omit to state a material
fact necessary to make the statements made, in light of the circumstances under which such statements were made,
not misleading and

d. either - 1. Based on my knowledge, the Firm has not failed to include in this Form any information or
j
k
l
m
n affirmation that is required by the instructions to this Form, with respect to the event or
events being reported on this Form, or

er
2. based on my knowledge -
j
k
l
m
n
(A) the Firm is a foreign registered public accounting firm and has not failed to include in this
Form any information or affirmation that is required by the instructions to this Form, with
respect to the event or events being reported on this Form, except for information or
affirmations that the Firm asserts it cannot provide to the Board on this Form 3 without
violating non-U.S. law;
(B) with respect to any such withheld information or affirmation, the Firm has made the efforts
required by PCAOB Rule 2207(b) and has in its possession the materials required by
PCAOB Rule 2207(c); and
(C) the Firm has indicated, in accordance with the instructions to this Form, each Item of this
V Form with respect to which the Firm has withheld any required information.

Typed signature (to be submitted electronically):

Given name (first name) Family name (last name)

Manual signature (to be retained in accordance

with PCAOB Rule 2204):

Date of typed and manual signatures

le
(mm/dd/yyyy):

Business Title:

Capacity in which signed: Partner n

j
k
l
m Officer n
j
k
l
m
Business mailing address
Country City
mp

Street address 1 State/Province

Street address 2 Non-US State/Province

Zip/Postal code

Business telephone number (incl. country and area codes)

Business facsimile number (incl. country and area codes)

Business e-mail address

Sa

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IX - EXHIBITS
EXHIBIT 99.1 - REQUEST FOR CONFIDENTIAL TREATMENT
If the Firm has identified, in accordance with the instructions to this Form, any information for which the Firm requests confidential treatment, the
Firm must include as Exhibit 99.1 an exhibit that includes the representations and information required by Rule 2300(c)(2).

Unless the Firm requests otherwise by checking the box below, any such Exhibit 99.1 will be afforded confidential treatment without the need
for a request for confidential treatment.

Check here to indicate if you do not want confidential treatment for Exhibit 99.1
Test Firm: Special Report c 3 (v. 2.00) Page 12 / 14
d
e
f
g
PCAOB Form

EXHIBIT 99.3 - MATERIALS REQUIRED BY RULE 2207(c)(2)-(4)

If the Firm is responding to a request pursuant to Rule 2207(d) for any of the materials described in Rule 2207(c)(2)-(4), submit the CA CR
 c
d
e
f
g

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART VIII - CERTIFICATION OF THE FIRM
ITEM 8.1 SIGNATURE OF PARTNER OR AUTHORIZED OFFICER
This Form must be signed on behalf of the Firm by an authorized partner or officer of the Firm including, in accordance with Rule 2204, both a
signature that appears in typed form within the electronic submission and a corresponding manual signature retained by the Firm.

n
I, the undersigned, certify that -
a. I am a partner or an officer of the Firm and I am authorized to sign this Form on behalf of the Firm;
b. I have reviewed this Form;
c. based on my knowledge, this Form does not contain any untrue statement of a material fact or omit to state a material
fact necessary to make the statements made, in light of the circumstances under which such statements were made,

sio
not misleading and

d. either - 1. Based on my knowledge, the Firm has not failed to include in this Form any information or
j
k
l
m
n affirmation that is required by the instructions to this Form, with respect to the event or
events being reported on this Form, or
2. based on my knowledge -
j
k
l
m
n
(A) the Firm is a foreign registered public accounting firm and has not failed to include in this
Form any information or affirmation that is required by the instructions to this Form, with
respect to the event or events being reported on this Form, except for information or
affirmations that the Firm asserts it cannot provide to the Board on this Form 3 without
violating non-U.S. law;
(B) with respect to any such withheld information or affirmation, the Firm has made the efforts
required by PCAOB Rule 2207(b) and has in its possession the materials required by
PCAOB Rule 2207(c); and

er
(C) the Firm has indicated, in accordance with the instructions to this Form, each Item of this
Form with respect to which the Firm has withheld any required information.

Typed signature (to be submitted electronically):

Given name (first name) Family name (last name)

Manual signature (to be retained in accordance

with PCAOB Rule 2204):
V Date of typed and manual signatures
(mm/dd/yyyy):

Business Title:

Capacity in which signed: Partner n

j
k
l
m Officer n
j
k
l
m
Business mailing address
Country City
le
Street address 1 State/Province

Street address 2 Non-US State/Province

Zip/Postal code
mp

Business telephone number (incl. country and area codes)

Business facsimile number (incl. country and area codes)

Business e-mail address

Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IX - EXHIBITS
EXHIBIT 99.1 - REQUEST FOR CONFIDENTIAL TREATMENT
If the Firm has identified, in accordance with the instructions to this Form, any information for which the Firm requests confidential treatment, the
Sa

Firm must include as Exhibit 99.1 an exhibit that includes the representations and information required by Rule 2300(c)(2).

Unless the Firm requests otherwise by checking the box below, any such Exhibit 99.1 will be afforded confidential treatment without the need
for a request for confidential treatment.

Check here to indicate if you do not want confidential treatment for Exhibit 99.1
c
d
e
f
g

EXHIBIT 99.3 - MATERIALS REQUIRED BY RULE 2207(c)(2)-(4)

If the Firm is responding to a request pursuant to Rule 2207(d) for any of the materials described in Rule 2207(c)(2)-(4), submit the CA CR
requested materials as Exhibit 99.3 to an amended Form 3.
c g
d
e
f
g c
d
e
f
If the Firm seeks confidential treatment for any such materials submitted, check the CR box in this section and also provide Exhibit 99.1
in accordance with the instructions.

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 13 / 14

 Italicized terms are defined in PCAOB Rule 1001. The Firm must apply those definitions in completing this Form.
PART IX - EXHIBITS
EXHIBIT 99.1 - REQUEST FOR CONFIDENTIAL TREATMENT
If the Firm has identified, in accordance with the instructions to this Form, any information for which the Firm requests confidential treatment, the
Firm must include as Exhibit 99.1 an exhibit that includes the representations and information required by Rule 2300(c)(2).

Unless the Firm requests otherwise by checking the box below, any such Exhibit 99.1 will be afforded confidential treatment without the need

n
for a request for confidential treatment.

Check here to indicate if you do not want confidential treatment for Exhibit 99.1
c
d
e
f
g

EXHIBIT 99.3 - MATERIALS REQUIRED BY RULE 2207(c)(2)-(4)

sio
If the Firm is responding to a request pursuant to Rule 2207(d) for any of the materials described in Rule 2207(c)(2)-(4), submit the CA CR
requested materials as Exhibit 99.3 to an amended Form 3.
c g
d
e
f
g c
d
e
f
If the Firm seeks confidential treatment for any such materials submitted, check the CR box in this section and also provide Exhibit 99.1
in accordance with the instructions.

V er
le
mp
Sa

Test Firm: Special Report PCAOB Form 3 (v. 2.00) Page 14 / 14