Form 8-R - Individual Application Template (Page 18 of 38) in pdf

Form 8-R - Individual Application Template Page 18

TEMPLATE: DO NOT SEND TO NFA

INDIVIDUAL APPLICATION (FORM 8-R)

COMMODITY FUTURES TRADING COMMISSION

NATIONAL FUTURES ASSOCIATION

Disciplinary Information – Criminal Disclosures (cont.)

Question A.*

(1) Have you personally or

(2) has any entity of which you were a Principal at the time the activities occurred

ever pled guilty or nolo contendere (“no contest”) to or been convicted or found guilty of any felony in any U.S.,

non-U.S. or military court?



Yes

Question B.*

(1) Have you personally or

(2) has any entity of which you were a Principal at the time the activities occurred

ever pled guilty to or been convicted or found guilty of any misdemeanor in any U.S., non-U.S. or military

court which involves:

• embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, brib-

ery, gambling, racketeering or misappropriation of funds, securities or property;

• violation of sections 7203, 7204, 7205 or 7207 of the Internal Revenue Code of 1986; or

• violation of sections 152, 1341, 1342, or 1343 or chapters 25, 47, 95 or 96 of the U.S. Criminal Code; or

• any transaction in or advice concerning futures, options, leverage transactions or securities?



Yes

Question C.*

(1) Are you personally or

(2) is any entity of which you were a Principal at the time the activities occurred

a party to any action, or is there a charge pending, the resolution of which could result in a “Yes” answer to the

above questions?



Yes

*Required to file application

Page 18 | OMB Numbers 3038-0023 (exp. November 30, 2018) & 3038-0072 (exp. July 31, 2018) | CFTC Form 8-R (April 2017)

Form 8-R - Individual Application Template Page 18