Form X-17a-5 - Focus Report (United States Securities And Exchange Commission)
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30OMB APPROVAL
UNITED STATES
OMB Number:
3235-0498
SECURITIES AND EXCHANGE COMMISSION
Expires:
January 31, 2019
Washington, D.C. 20549
Estimated average burden
hours per response. . . . . . . .
20
FORM X-17A-5
FOCUS REPORT
(Financial and Operational Combined Uniform Single Report)
PART IIB
11
OTC DERIVATIVES DEALER
(PLEASE READ INSTRUCTIONS BEFORE PREPARING FORM.)
THIS REPORT IS BEING FILED PURSUANT TO (Check Applicable Block(s)):
1) Rule 17a-12
16
2) Rule 17a-11
18
3) Other
26
___________________________________________________________________________ 13
______________________________________________14
(Name of Dealer)
(SEC File No.)
________________________________________________________________________ ____ 20
______________________________________________15
(Address of Principal Place of Business (DO NOT USE P.O. Box No.))
(Firm I.D. No.)
________________________________21_______________22___________________ _____ 23
______________________________________________24
(City)
(State)
(Zip Code)
(For Period Beginning (MM/DD/YYYY))
______________________________________________25
(For Period Ending (MM/DD/YYYY))
NAME AND TELEPHONE NO. OF PERSON TO CONTACT IN REGARD TO THIS REPORT:
___________________________________________________________________________ 30
______________________________________________31
(Name)
((Area Code) - (Telephone No.)
NAME(s) OF SUBSIDIARIES OR AFFILIATES CONSOLIDATED IN THIS REPORT:
OFFICIAL USE
________________________________________________________________________ ____ 32
______________________________________________33
________________________________________________________________________ ____ 34
______________________________________________35
________________________________________________________________________ ____ 36
______________________________________________37
________________________________________________________________________ ____ 38
______________________________________________39
[Does respondent carry its own customer accou
nts?]
Yes
40
N0
41
Check here if respondent is filing an audited re
port:
42
EXECUTION:
The registrant/dealer submitting this Form and its attachments and the person(s) by whom it is executed
represent hereby that all information contained therein is true, correct and complete. It is understood that
all required items, statements, and schedules are considered integral parts of this Form and that the
submission of any amendment represents that all unamended items, statements and schedules remain
true, correct and complete as previously submitted.
Dated the ________________ day of ______________________________, ________
MANUAL SIGNATURES OF:
1) _________________________________________________________________________
(Principal Executive Officer or Managing Partner)
2) _________________________________________________________________________
(Principal Financial Officer or Partner)
3) _________________________________________________________________________
(Principal Operations Officer or Partner)
ATTENTION — Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
(See 18 U.S.C. 1001 and 15 U.S.C. 78:f(a))
SEC 2430 (2-02) Page 1 of 28
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