Form 8-R - Individual Application Template (Page 34 of 38) in pdf

TEMPLATE: DO NOT SEND TO NFA

INDIVIDUAL APPLICATION (FORM 8-R)

COMMODITY FUTURES TRADING COMMISSION

NATIONAL FUTURES ASSOCIATION

Sponsor Agreement (cont.)

the applicant has been hired or is employed by the Sponsor or that it is the intention of the Sponsor to hire or

otherwise employ the applicant as an AP, Forex AP or Swap AP within 30 days after receipt of notification that

the applicant has received a temporary license or has been registered;

the applicant will not be permitted to act as an AP until the applicant has received a temporary license or has

been registered as an AP, to act as a Forex AP until the applicant has been approved as a Forex AP or to act as a

Swap AP until the applicant has been approved as a Swap AP;

if the Sponsor is a new sponsor filing an application for registration of the applicant as an AP pursuant to the

provisions of NFA Registration Rule 207(a), that the Sponsor has verified that the applicant is not subject to a

disqualification from registration under Section 8a(2) of the Commodity Exchange Act, 7 U.S.C. §12(a)(2), and

that the Sponsor meets the requirements set forth in NFA Registration Rule 509(b)(5);

if the applicant is applying for a temporary license pursuant to NFA Registration Rule 301(a)(2), that the Sponsor

has reviewed the information concerning the applicant in NFA’s BASIC system and has received a copy of the

notice of the institution of any proceeding in the BASIC system that is pending and was brought against the

applicant under Sections 6(c), 6(d), 6c, 6d, 8a or 9 of the Commodity Exchange Act, 7 U.S.C. §§ 9, 13b, 13a-1,

13a-2, 12a, and 13, CFTC regulations 3.55 or 3.60 or NFA or exchange rules or that was instituted in accordance

with the procedures provided in CFTC regulation 3.51 or Part 500 of the NFA Registration Rules and, within the

prior 12 months, resulted in the Commission or NFA permitting the withdrawal of such person’s application for

registration in any capacity;

if the applicant is subject to any current NFA or Commission order imposing conditions on the registration of

the applicant, that the Sponsor meets the requirements set forth in NFA Registration Rule 509(b)(5) to sponsor

a conditioned registrant, that it has reviewed the conditions contained in any current NFA or Commission order

imposing conditions on the registration of the applicant and that the Sponsor will supervise the applicant in

accordance with the conditions contained in the order; and

the Sponsor has taken, and will take, such measures as are necessary to prevent the unwarranted dissemination

of any of the information contained in the Form 8-R and the records and documents retained in support of the

Form 8-R.

Sponsor acknowledges that:

the Sponsor is subject to the imposition of criminal penalties under Section 9(a) of the Commodity Exchange

Act, 7 U.S.C. §13(a), and 18 U.S.C. §1001 for any false statements or omissions Sponsor made in the Form 8-R;

while the individual is an AP, Forex AP or Swap AP sponsored by or a principal of the Sponsor or is responsible

for entering orders on behalf of the Floor Trader’s own account, the Sponsor is responsible for maintaining the

information in the Form 8-R in a complete, accurate and current manner by electronically filing updates to the

information contained therein;

Page 34 | 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 34