Short Form Stock Purchase

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					                                                                                           CBOE REIMBURSEMENT REQUEST
                                                                                             STRATEGIES REBATE FORM

CBOE Trading Permit Holder or TPH Organization Name:                                                                             Clearing Trading Permit Holder Name:

CBOE Trading Permit Holder or TPH Organization Acronym:                                                                          Clearing Trading Permit Holder #:

TPH Organization Affiliation, if applicable:

                        A                      B          C            D            E              F                G                  H              I (G + H)       J         K (I x J)        L        M (K - L)
                                                      Columns A - H to be completed by requestor                                                                   Columns J - M to be completed by CBOE Accounting
                Type of Strategy &
                                                                                                                                                                   Rate per
                   Description:
                                                                                                                                                                   Contract
                 C - Conversion
                   D - Dividend                                                                                                                                   (Standard
                   J - Jelly Roll                                                                                                                                    Rate
                    M - Merger                                                                                 Buy #         Sell #                    Total      Subject to     Total     $1,000 Cap
                  R - Reversals                                        Root        Option                   Contracts       Contracts                Contracts     Volume     Transaction   Per Day,     Net Rebate
                 S - Short Stock       Ex-Date      Trade Date        Symbol       Symbol Div Rate (1) Per Strategy Per Strategy                     Per Side     Discounts) Fees Assessed Per Class      Request
             Please note: The information on the first three lines below is provided as an example for completing the form.
Buy Side      D - CYQ Apr 10 Call        4/6/2011      4/5/2011    CSCO AB        CYQ          $1.00                 5,000                                5,000
Sell Side    D - CYQ Apr 12.5 Call       4/6/2011      4/5/2011    CSCO AV        CYQ          $1.00                                    5,000             5,000
       Total                                                                                                                                             10,000
Buy Side                                                                                                                                                      0
Sell Side                                                                                                                                                     0
       Total                                                                                                                                                  0
Buy Side                                                                                                                                                      0
Sell Side                                                                                                                                                     0
       Total                                                                                                                                                  0
Buy Side                                                                                                                                                      0
Sell Side                                                                                                                                                     0
       Total                                                                                                                                                  0
Buy Side                                                                                                                                                      0
Sell Side                                                                                                                                                     0
       Total                                                                                                                                                  0
                                                                                           (1) Dividend rate only applies to Dividend Strategies.
                                                                                                                                                                                   Less License Fees (              )
             CERTIFICATION                                                                                                                                                                                      $0.00
             I certify that the transactions identified above and by way of this electronic submission represent options trades executed
             under a "conversion", "dividend", "jelly roll", "merger", "reversals" or "short stock interest" strategy and are eligible for the
             rebate as defined in CBOE rules and CBOE fees schedule. I understand that, as CBOE Trading Permit Holders or TPH
             organizations executing strategies eligible for the rebate, I must provide supporting documentation such as trade confirmations
             and exercise notices, with this request, identifying the transactions subject to the reimbursement. I understand this reimbursement
             request is subject to examination, review, and verification by CBOE staff and is only valid if filed with CBOE staff and with the
             CBOE Help Desk within 3 business days of the transaction date.



             Trading Permit Holder (Individual) Name                                       Date                                                     Phone #



             E-mail address




           a0127fc1-3569-422c-b3f1-fea512ef57bd.xls
           Revised and Effective 5/2/11
                                                                              CBOE REIMBURSEMENT REQUEST
                                                                                STRATEGIES REBATE FORM

 INSTRUCTIONS
 Complete a separate form for each day's strategy.                            B.   Ex date of stock                                      J. Standard rate per contract per Fees Schedule
    Please include in the e-mail subject line                                 C.   Date of execution; must be day prior to "B"              as of 6/21/10, subject to sliding scale
    the type of rebate being requested and the transaction                    D.   Root symbol                                              - Market Maker/DPM - $0.20
    date. For example "Merger Rebate Request - Trans                          E.   Option symbol, if different from root symbol             - Broker Dealer - Manual (Equity, SPDR, Credit Default,
    date 4/5/11". Submit completed form and support                           F.   Rate of dividend                                             Other Indexes, ETFs & HOLDR, & QQQQ) - $0.25
    to CBOE at helpdesk@cboe.com.                                             G.   Number of "Buy" contracts per strategy                   - Broker Dealer - Electronic (Equity, SPDR, Credit Default,
 Columns A - H to be completed by the requestor.                              H.   Number of "Sell" contracts per strategy                      Other Indexes, ETFs & HOLDR, & QQQQ) - $0.45
 Columns J - M to be completed by CBOE Acctg.                                 I.   Total of "Buy & Sell" contracts (G + H)                  - Broker Dealer - OEX, XEO, SPX, S&P 500 Dividend Index,
 A. Type of strategy and description:                                                                                                           and Volatility Indexes - $0.40
    C - Conversion                                                                                                                          - Broker Dealer - AIM Executions - $0.20
    D - Dividend                                                                                                                            - Clearing Trading Permit Holder Proprietary - $0.20
    J - Jelly Roll                                                                                                                       K. Total contracts multiplied by rate (I x J)
    M - Merger                                                                                                                           L. Capped Fee Amount
    R - Reversals                                                                                                                        M. If Assessed Fees > than Cap, then
    S - Short stock interest                                                                                                                difference (K - L)


 PROGRAM DESCRIPTION - Revised & Effective May 2, 2011
 Market-maker, Clearing Trading Permit Holder and broker-dealer transaction fees are capped at $1,000 for all (i) dividend, (ii) merger and (iii) short stock interest strategies executed
 on the same trading day in the same options class. Market-maker and broker-dealer transaction fees are capped at $1,000 for all reversals, conversions and jelly roll
 strategies executed on the same trading day, excluding any option class on which the Exchange charges the surcharge fee under footnote 14 of the CBOE Fees
 Schedule. Such transaction fees for these strategies are further capped at $25,000 per month per initiating Trading Permit Holder or TPH organization. Surcharge fees will be
 passed through to trading participants on these strategies on a pro-rata basis. Surcharge fees will not be included in the calculation of the $1,000 per day class fee cap or the
 $25,000 per month fee cap. Floor brokerage fees assessed on any of these strategies are eligible for a full rebate (see below).

 A conversion strategy is defined as transactions that employ calls, puts and the underlying security to lock in a nearly risk free profit. Conversions employ long positions in the
 underlying security that accompany long puts and short calls sharing the same strike and expiration.

 A dividend strategy is defined as transactions done to achieve a dividend arbitrage involving the purchase, sale and exercise of in-the-money options of the same class, executed
 prior to the date on which the underlying stock goes ex-dividend.

 A jelly roll strategy is defined as a long calendar call spread combined with the same short calendar put spread, or vice versa. This option strategy aims to profit from a time
 value spread through the purchase and sale of two call and two put options, each with different expiration dates. A jelly roll is created by entering into two separate positions
 simultaneously. One position involves buying a put and selling a call with the same strike price and expiration. The second position involves selling a put and buying a call, with
 the same strike price, but a different expiration from the first position.

 A merger strategy is defined as transactions done to achieve a merger arbitrage involving the purchase, sale and exercise of options of the same class and expiration date, each
 executed prior to the date on which shareholders of record are required to elect their respective form of consideration, i.e., cash or stock.

 A reversal strategy is defined as transactions that employ calls, puts and the underlying security to lock in a nearly risk free profit. Reversals are established by combining a
 short security position with a short put and a long call position that shares the same strike and expiration.

 A short stock interest strategy is defined as transactions done to achieve a short stock interest arbitrage involving the purchase, sale and exercise of in-the-money options of
 the same class.

 To qualify transactions for the cap and floor brokerage fees rebate, a completed rebate request form with supporting documentation must be submitted electronically to the
 CBOE Help Desk at helpdesk@cboe.com within 3 business days of the transaction. Please contact Cheryl Ahrens at 312-786-7450 or ahrens@cboe.com or Don Patton
 at 312-786-7026 or patton@cboe.com with any questions. Rebates will be issued to the Trading Permit Holder via electronic payments to the Clearing Trading Permit Holder
 as soon as practical.



a0127fc1-3569-422c-b3f1-fea512ef57bd.xls
Revised and Effective 5/2/11

				
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Description: Short Form Stock Purchase document sample