Form Id - Uniform Application For Access Codes To File On Edgar Form

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U.S. Securities and Exchange Commission
OMB APPROVAL
Washington, DC 20549
OMB Number:
3235-0328
Expires:
May 31, 2019
Estimated average burden
hours per response:
0.15
Form ID
UNIForm APPLICATIoN For ACCESS CoDES To FILE oN EDGAr
PART I—APPLICATION FOR ACCESS CODES TO FILE ON EDGAR
Name of applicant (Applicant’s name as specified in its charter, except, if individual, last name, first name, middle name,
suffix [e.g., “Jr.”]) _____________________________________________________________________________
Mailing Address or Post Office Box No. __________________________________________________________
City _________________________ State or Country ________________________ Zip __________________
Telephone number (include Area and, if Foreign, Country Code) _______________________________________
Applicant is (see definitions in the General Instructions):
Individual (if you check this box, you must also check another box that appropriately describes you)
Clearing Agency
Filer
Filing Agent
Institutional Investment Manager (Form 13F Filer)
Investment Company, Business Development Company or Insurance Company Separate Account
Large Trader
Municipal Advisor
Municipal Securities Dealer
Nationally Recognized Statistical Rating Organization
Non-Investment Company Applicant under the Investment Company Act of 1940
Security-Based Swap Data Repository
Security-Based Swap Dealer and Major Security-Based Swap Participant
Security-Based Swap Execution Facility
Training Agent
Transfer Agent
PART II—FILER INFORMATION (To be completed only by filers that are not individuals)
Filer’s Tax or Federal Identification Number (do not enter Social Security Number) ________________________
Doing Business As ___________________________________________________________________________
Foreign Name (if Foreign Issuer Filer and applicable) ________________________________________________
Primary Business Address or Post Office Box No. (if different from mailing address)
___________________________________________________________________________________________
City _________________________ State or Country ________________________ Zip __________________
State of Incorporation __________________________________Fiscal Year End (mm/dd) __________________
Persons who respond to the collection of information contained in this form are not required to respond
unless the form displays a current valid OMB control number.
1
SEC 2084 (1-13)

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