OFAC Sanctions License Application

OFAC SPECIFIC LICENSE APPLICATION

Office of Foreign Assets Control

U.S. Department of the Treasury

SECTION 1: APPLICANT INFORMATION

A. Applicant Details

Full Legal Name:
[________________________________]

Type of Entity:
☐ Individual
☐ Corporation
☐ Limited Liability Company
☐ Partnership
☐ Financial Institution
☐ Government Entity
☐ Non-Profit Organization
☐ Other: [____________________]

Tax Identification Number (EIN/SSN):
[________________________________]

DUNS Number (if applicable):
[________________________________]

B. Contact Information

Address:
[________________________________]
[________________________________]

City: [____________________] State: [____] ZIP: [__________]

Country: [____________________]

Telephone: [____________________]

Email: [________________________________]

C. Primary Contact for This Application

Name: [________________________________]

Title: [________________________________]

Telephone: [____________________]

Email: [________________________________]

SECTION 2: REPRESENTATIVE INFORMATION (IF APPLICABLE)

Is this application being filed by an agent or attorney?
☐ Yes ☐ No

If Yes:

Representative Name: [________________________________]

Firm Name: [________________________________]

Address: [________________________________]

Telephone: [____________________]

Email: [________________________________]

Relationship to Applicant: [________________________________]

☐ Power of Attorney attached

SECTION 3: SANCTIONS PROGRAM IDENTIFICATION

A. Applicable Sanctions Program(s)

Select all applicable programs:

☐ Belarus Sanctions
☐ Central African Republic Sanctions
☐ Counter-Narcotics Sanctions
☐ Counter-Terrorism Sanctions
☐ Cuba Sanctions
☐ Cyber-Related Sanctions
☐ Democratic Republic of the Congo Sanctions
☐ Ethiopia Sanctions
☐ Foreign Interference in U.S. Elections Sanctions
☐ Global Magnitsky Sanctions
☐ Hong Kong-Related Sanctions
☐ Iran Sanctions
☐ Iraq Sanctions
☐ Lebanon Sanctions
☐ Libya Sanctions
☐ Mali Sanctions
☐ Nicaragua Sanctions
☐ North Korea Sanctions
☐ Russia/Ukraine-Related Sanctions
☐ Somalia Sanctions
☐ South Sudan Sanctions
☐ Sudan Sanctions
☐ Syria Sanctions
☐ Transnational Criminal Organizations Sanctions
☐ Venezuela Sanctions
☐ Western Balkans Sanctions
☐ Yemen Sanctions
☐ Zimbabwe Sanctions
☐ Other: [____________________]

B. Basis for License Request

Why is a license required?

☐ Transaction involves Specially Designated National (SDN)
☐ Transaction involves blocked property
☐ Transaction involves comprehensively sanctioned country/region
☐ Transaction involves sectoral sanctions
☐ Transaction involves secondary sanctions risk
☐ Other: [________________________________]

SECTION 4: TRANSACTION DETAILS

A. Type of License Requested

☐ One-Time License: For a single, specific transaction

☐ Specific License: For ongoing or multiple transactions of a defined nature

☐ Release of Blocked Funds: To unblock previously blocked property

B. Transaction Description

Provide a complete description of the proposed activity:
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

C. Transaction Value

Total Value of Transaction: $[____________________]

Currency: [____________________]

Breakdown of Transaction Value:
| Item/Category | Amount |
|--------------|--------|
| [__________] | $[__________] |
| [__________] | $[__________] |
| [__________] | $[__________] |
| Total | $[__________] |

D. Timing

Proposed Start Date: [__/__/____]

Proposed End Date: [__/__/____] or ☐ Ongoing

Is this transaction already completed or pending?
☐ Completed ☐ Pending ☐ Not Yet Initiated

SECTION 5: PARTIES TO THE TRANSACTION

A. Originator (if applicable)

Name: [________________________________]

Address: [________________________________]

Country: [____________________]

Relationship to Applicant: [________________________________]

B. Beneficiary/Recipient

Name: [________________________________]

Address: [________________________________]

Country: [____________________]

Is Beneficiary an SDN or Located in Sanctioned Country?
☐ Yes ☐ No

If Yes, provide SDN List Entry or explain:
[________________________________]

C. Intermediary Parties (if any)

SECTION 6: SDN/BLOCKED PERSONS INFORMATION

A. SDN Identification (if applicable)

SDN Name as Listed: [________________________________]

SDN Type:
☐ Individual
☐ Entity
☐ Vessel
☐ Aircraft

SDN Program(s): [________________________________]

Date Added to SDN List: [__/__/____]

OFAC ID Number: [____________________]

B. Blocked Property Information (if applicable)

Description of Blocked Property:
[________________________________]
[________________________________]

Date Property Was Blocked: [__/__/____]

Location of Blocked Property: [________________________________]

Blocking Institution (if applicable):
Name: [________________________________]
Contact: [________________________________]

OFAC Reporting System (ORS) Reference Numbers (if available):
Transaction ID: [____________________]
Submission ID: [____________________]

SECTION 7: JUSTIFICATION FOR LICENSE

A. Purpose of Transaction

Explain why the transaction is necessary:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

B. Humanitarian Considerations (if applicable)

☐ Medical supplies/services
☐ Food and agricultural commodities
☐ Information materials
☐ Humanitarian aid
☐ Personal remittances
☐ Other humanitarian purpose: [____________________]

Describe humanitarian justification:
[________________________________]
[________________________________]

C. Legal Obligations

Are there legal obligations requiring this transaction?
☐ Yes ☐ No

If Yes, describe:
[________________________________]
[________________________________]

D. General License Analysis

Have you determined that no general license authorizes this activity?
☐ Yes ☐ No

General licenses considered and reasons they do not apply:
[________________________________]
[________________________________]
[________________________________]

SECTION 8: COMPLIANCE PROGRAM INFORMATION

A. Sanctions Compliance Program

Does applicant have a sanctions compliance program?
☐ Yes ☐ No

If Yes, describe key elements:
[________________________________]
[________________________________]

B. Screening Practices

Describe screening procedures used:
☐ Screen against OFAC SDN List
☐ Screen against Consolidated Sanctions List
☐ Use commercial screening software
☐ Manual review process
☐ Other: [____________________]

C. Prior OFAC History

Has applicant previously applied for an OFAC license?
☐ Yes ☐ No

If Yes:
Previous License Number: [____________________]
Date: [__/__/____]
Outcome: ☐ Granted ☐ Denied ☐ Withdrawn

Has applicant been subject to OFAC enforcement action?
☐ Yes ☐ No

If Yes, describe: [________________________________]

SECTION 9: SUPPORTING DOCUMENTATION

A. Required Documents Checklist

☐ Copy of government-issued ID (for individuals)
☐ Corporate formation documents (for entities)
☐ Power of Attorney (if filing through representative)
☐ Contract or agreement for underlying transaction
☐ Invoices or receipts
☐ Bank statements showing blocked funds
☐ OFAC blocking report (if applicable)
☐ Correspondence with financial institution
☐ Supporting letters or affidavits
☐ Other: [____________________]

B. Confidential Information

Does this application contain confidential business information?
☐ Yes ☐ No

If Yes, identify confidential portions:
[________________________________]

SECTION 10: CERTIFICATIONS

I, the undersigned, hereby certify that:

☐ All information provided in this application is true, accurate, and complete to the best of my knowledge and belief.

☐ I understand that false statements or misrepresentations may result in denial of this application and may subject me to criminal penalties under 18 U.S.C. § 1001.

☐ I am authorized to submit this application on behalf of the applicant.

☐ I have reviewed applicable general licenses and determined that the proposed activity is not authorized by a general license.

☐ I will comply with all conditions of any license that may be issued.

☐ I will notify OFAC of any material changes in the information provided.

☐ I understand that any license issued is specific to the facts and circumstances described in this application.

☐ I understand that a license may be revoked or modified at any time.

Signature: ________________________________

Printed Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

SECTION 11: SUBMISSION INSTRUCTIONS

A. Electronic Filing (Preferred)

OFAC Licensing Portal:
https://licensing.ofac.treas.gov

Steps:
1. Create account at licensing portal
2. Complete online application form
3. Upload supporting documents
4. Submit application
5. Monitor status through portal

B. Mail Filing (If Electronic Not Available)

Address:
Office of Foreign Assets Control
Licensing Division
U.S. Department of the Treasury
1500 Pennsylvania Avenue NW
Freedman's Bank Building
Washington, DC 20220

C. Processing Time

Standard Processing: 90-180 days (varies by program and complexity)

Expedited Review: May be available for humanitarian cases

Status Inquiries:
- Check online portal for electronic submissions
- Email: [email protected]
- Hotline: 1-800-540-6322

SECTION 12: CONDITIONS AND LIMITATIONS

A. Standard License Conditions

Licenses typically include conditions such as:

☐ Reporting requirements
☐ Record-keeping obligations (5 years minimum)
☐ Restrictions on use of funds
☐ Notification requirements
☐ Time limitations
☐ Amount limitations
☐ Specific authorized activities only

B. Compliance Obligations

If License is Granted:

☐ Maintain records of all transactions for 5 years
☐ Comply with all license conditions
☐ Report any deviations to OFAC
☐ Be prepared for audit
☐ Renew license before expiration if needed

SECTION 13: DENIAL AND RECONSIDERATION

A. If License is Denied

Options:
☐ Request reconsideration with additional information
☐ File new application with modified terms
☐ Seek legal counsel regarding alternatives

B. Reconsideration Request

If seeking reconsideration, provide:
- Original application reference number
- Explanation of changed circumstances
- Additional supporting documentation
- Revised proposed terms (if applicable)

SOURCES AND REFERENCES

• OFAC Website: https://ofac.treasury.gov
• OFAC Licensing Portal: https://licensing.ofac.treas.gov
• Sanctions Programs: https://ofac.treasury.gov/sanctions-programs-and-country-information
• SDN List Search: https://sanctionssearch.ofac.treas.gov
• OFAC FAQs: https://ofac.treasury.gov/faqs
• 31 CFR Chapter V: https://www.ecfr.gov/current/title-31/subtitle-B/chapter-V
• General Licenses: Available on program-specific pages

PENALTIES FOR VIOLATIONS

Civil Penalties:
- Up to $356,579 per violation (2026 inflation-adjusted)
- Or twice the transaction value, whichever is greater

Criminal Penalties:
- Up to $1,000,000 fine
- Up to 20 years imprisonment
- Both may apply

LEGAL NOTICES

License Specificity: A specific license authorizes only the transactions described in the license. It does not authorize related or similar transactions not specifically described.

Non-Transferability: Licenses are not transferable to other parties.

No Precedent: Issuance of a license does not constitute precedent for future applications.

Revocation: OFAC may revoke or modify any license at any time at its discretion.

This template is provided for educational and informational purposes only. OFAC sanctions are complex and violations carry severe penalties. Consult with a qualified sanctions attorney before filing any application or engaging in any activity that may implicate U.S. sanctions.