Form 8-R - Individual Application Template (Page 23 of 38) in pdf

Form 8-R - Individual Application Template Page 23

TEMPLATE: DO NOT SEND TO NFA

INDIVIDUAL APPLICATION (FORM 8-R)

COMMODITY FUTURES TRADING COMMISSION

NATIONAL FUTURES ASSOCIATION

Disciplinary Information – Financial Disclosures

For additional assistance and information on completing this page refer to the Instructions and Definition of

Terms at the beginning of this document.

For each matter that requires a “Yes” answer to Questions J and K below, you must provide additional informa-

tion by filing a Financial DMP for each financial matter using NFA’s DMP Filing system that requests:

• who was involved;

• when it occurred;

• what the allegations were;

• what the final determination was, if any;

• the date of the determination; and

• a summary of the circumstances surrounding the financial matter.

For actions filed with bodies other than NFA or the CFTC, you must also provide documents regarding each

financial matter requiring a “Yes” answer that show

• the allegations; and

• the final disposition.

You may provide these documents electronically using the upload function in the DMP Filing System or sending

them to NFA (See Instruction).

Answer the following questions.

Question J.*

Have you failed to pay any arbitration awards involving CFTC-regulated products, CFTC civil monetary penal-

ties, CFTC restitution amounts, CFTC disgorgement amounts, or CFTC reparation amounts?



Yes

Question K.*

(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 an

adversary action brought by a U.S. bankruptcy trustee?



Yes

*Required to file application

Page 23 | 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 23