Form 8-R - Individual Application Template (Page 21 of 38) in pdf

Form 8-R - Individual Application Template Page 21

TEMPLATE: DO NOT SEND TO NFA

INDIVIDUAL APPLICATION (FORM 8-R)

COMMODITY FUTURES TRADING COMMISSION

NATIONAL FUTURES ASSOCIATION

Disciplinary Information – Regulatory Disclosures (cont.)

Question F.*

(1) Have you personally or

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

ever been debarred by any agency of the U. S. from contracting with the U. S.?



Yes

Question G.*

(1) Have you personally or

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

ever been the subject of any order issued by or a party to any agreement with a U.S. or non-U.S. regulatory au-

thority (other than the CFTC), including but not limited to a licensing authority, or self-regulatory organization

(other than NFA or a U.S. futures exchange) that prevented or restricted your ability to engage in any business in

the financial services industry?



Yes

Question H.*

Are any of the orders or other agreements described in Question G currently in effect against you personally?



Yes

Question I.

(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 21 | 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 21