Form Ca-1 Application For Registration Or For Exemption From Registration (Page 3 of 7) in pdf

FORM CA-1

FORM FOR REGISTRATION OR FOR EXEMPTION FROM REGISTRATION

AS A CLEARING AGENCY AND FOR AMENDMENT TO REGISTRATION

AS A CLEARING AGENCY PURSUANT TO THE SECURITIES EXCHANGE ACT OF 1934

GENERAL

Form CA-1 is to be used to apply for registration or for exemption from registration as a clearing agency and to amend

registration as a clearing agency with the Securities and Exchange Commission pursuant to Section 17A of the Securities and

Exchange Act of 1934. Read all instructions before preparing the Form. Please type or print all responses.

____________________________________________________________________________________________________________________

(Exact name of registrant as specified in charter)

____________________________________________________________________________________________________________________

(Address of registrant’s principal place of business)

† a registration

This Form is filed as:

† a request for exemption from registration

† an amendment

If filed as a registration, does registrant request the Commission to consider granting registration in accordance with paragraph

(c)(1) of Rule 17Ab2-1 under the Act?......................................................................................................................†Yes †No

EXECUTION

The Registrant submitting this Form, its schedules, its exhibits and its attachments and the person by whom it is executed

represent hereby that all information contained herein is true, current and complete. Submission of any amendment after registration

has become effective represents that items 1-3 and any schedules, exhibits and attachments related to items 1-3 remain true, current

and complete as previously submitted.

Registrant agrees and consents that the notice of any proceedings under Sections 17A or 19 of the Act involving registrant may

be given by sending such notice by registered or certified mail or confirmed telegram to the person named, and at the address given,

in response to item 2.

Dated the ___________ day of __________________________, ______

___________________________________________________________________________________________________________

(Name of clearing agency)

___________________________________________________________________________________________________________

(Manual signature of Principal Officer or duly authorized Principal)

___________________________________________________________________________________________________________

(Title)

ATTENTION: Intentional misstatements or omissions of fact constitute Federal Criminal Violations

(See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a))

GENERAL INFORMATION

Exact name, principal business address, mailing address (if different) and telephone number of registrant:

Name of registrant: __________________________________ IRS Employee Identification No.__________________________________

Name under which clearing agency activities are conducted, if different: __________________________________________________

If name of registrant is hereby amended, state name under which registered previously: ____________________________________

Form Ca-1 Application For Registration Or For Exemption From Registration Page 3

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