OMB NO. 3038-0023 May 1, 2006
COMMODITY FUTURES TRADING COMMISSION NATIONAL FUTURES ASSOCIATION NOTICE FORM 7-R LIMITED PURPOSE FUTURES COMMISSION MERCHANT
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Broker-Dealer Name and Business Address
NAME ADDRESS
CITY, STATE, ZIP CODE FAX CRD# (Required) NFA ID#
TELEPHONE
(Will be assigned when application processed)
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Individual to whom all correspondence should be directed:
NAME TITLE ADDRESS
CITY, STATE, ZIP CODE FAX EMAIL
TELEPHONE
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Representations Limited Purpose Futures Commission Merchant hereby represents that: 1) it is required to register because it effects transactions in Total Return Asset ContractsSM or TRAKRSSM only with customers who are not either “qualified institutional buyers” as defined in Rule 144A, 17 C.F.R. §230.144A, or Chicago Mercantile Exchange members registered with the Commodity Futures Trading Commission (“CFTC”) as floor brokers or floor traders; 2) it is registered with the Securities and Exchange Commission as a broker-dealer and will notify National Futures Association (“NFA”) immediately if it becomes subject to a statutory disqualification under Sections 8a(2) or 8a(3) of the Commodity Exchange Act (“Act”), 17 U.S.C. §§12a(2) and 12a(3), or a disqualification under NFA Bylaw 301(c); 3) it will notify NFA immediately if any information on this form, including the representations, changes; and 4) it understands that it is subject to the imposition of criminal penalties under Section 9(a) of the Act and 18 U.S.C. §1001 for any false statements or omissions made in the Notice Form 7-R. NFA Membership Agreement Limited Purpose Futures Commission Merchant hereby: 1) applies to become a Member of NFA; 2) represents that it is a member of the Financial Industry Regulatory Authority (FINRA) and its FINRA membership is not suspended, revoked, expelled, terminated or lapsed and will notify NFA immediately if its FINRA membership is suspended, revoked, expelled, terminated or lapsed; 3) agrees that it and its employees, now and in the future, will be subject to the rules and enforcement authority of CFTC and NFA and shall become and remain bound by all applicable NFA requirements, including without limitation all applicable NFA Bylaws, Compliance Rules, Financial Requirements, Registration Rules, Code of Arbitration and Member Arbitration Rules, as then and thereafter in effect; and 4) certifies that it has authorized the person filing this application for NFA membership to file the application on its behalf. By Officer, General Partner or Sole Proprietor: Authorized Signature Print Authorized Signature (See reverse for instructions and notices.) Title Date
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CFTC NFA
NOTICE FORM 7-R
(05-06)
INSTRUCTIONS
Registration as a Limited Purpose Futures Commission Merchant will be effective upon receipt by NFA of a properly completed Notice Form 7-R. Mail this form and $750.00 annual NFA membership dues to: National Futures Association Registration Department 300 S. Riverside Plaza Suite 1800 Chicago, IL 60606-6615 Written confirmation of registration will be mailed to the contact person listed on this form.
PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
The information on CFTC Notice Form 7-R is being collected pursuant to authority granted in Sections 4f, 4n, 8a and 19 of the Commodity Exchange Act [7 U.S.C. §§ 6f, 6n, 12a and 23]. Under Section 4d of the Commodity Exchange Act [7 U.S.C. §6d], it is unlawful for anyone to act as a futures commission merchant or introducing broker without being registered in that capacity under the Act. The information requested in Notice Form 7-R is designed to assist NFA and the CFTC, as appropriate, in determining whether the application for registration should be granted or denied and to maintain the accuracy of registration files. All information requested on Notice Form 7-R must be furnished before the form will be processed. The failure by an applicant or registrant to timely file a properly completed Notice Form 7-R may result in the denial of an application for registration or withdrawal thereof. This Notice Form 7-R is considered by the CFTC to be a public record and will be available for inspection by any interested person. Copies will be maintained by National Futures Association, Registration Department, Suite 1800, 300 S. Riverside Plaza, Chicago, IL 60606-6615. Forms which have not been prepared and executed in compliance with applicable requirements may be returned as not acceptable for filing. Acceptance of this form shall not constitute any finding that it has been filed as required or that the information is true, current or complete. Misstatements or omissions of fact may constitute federal criminal violations [7 U.S.C. §13 and 18 U.S.C. §1001] or grounds for disqualification from registration. You are not required to provide the information requested on a form subject to the Paperwork Reduction Act unless the form displays a valid OMB Control Number. The time needed to complete and file Notice Form 7-R may vary depending upon individual circumstances. The estimated average time is 5 minutes.
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