Electronic Filing Of Transfer Agent Forms - Securities And Exchange Commission Page 47
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100City
State or County
Zip
State of Incorporation
Fiscal Year End (mm/yy)
PART III — CONTACT INFORMATION (To be completed by all applicants)
Person to receive EDGAR Information, Inquiries and Access Codes
Telephone Number (Include Area and, if foreign, Country Code) ( )
Mailing Address or Post Office Box No. (if different from applicant's mailing address)
City
State or Country
Zip
E-Mail Address
PART IV — ACCOUNT INFORMATION (To be completed by filers and filing agents
only)
Person to receive SEC Account Information
Telephone Number (Include Area and, if
and Billing Invoices
Foreign, Country Code) (
)
Mailing Address or Post Office Box No. (if different from applicant's mailing address)
City
State or Country
Zip
PART V — SIGNATURE (To be Completed by all Applicants)
Signature:
Type or Print Name:
Position or Title:
Date:
Intentional misstatements or omissions of facts constitute federal criminal violations.
See 18 U.S.C. 1001.
Section 19(a) of the Securities Act of 1933 (15 U.S.C. 77s(a)), sections 13(a) and 23(a) of the
Securities Exchange Act of 1934 (15 U.S.C. 78m(a) and 78w(a)), section 319 of the Trust
Indenture Act of 1939 (15 U.S.C. 77sss), and sections 30 and 38 of the Investment Company
47
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