Form Id - Uniform Application For Access Codes To File On Edgar Form Page 2
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5PART III—CONTACT INFORMATION (To be completed by all applicants)
Person to receive EDGAR Information, Inquiries and Access Codes ___________________________________
Telephone Number (Include Area and, if Foreign, Country Code) ______________________________________
Mailing Address or Post Office Box No. (if different from applicant’s mailing address)
___________________________________________________________________________________________
City _________________________ State or Country ________________________ Zip __________________
E-Mail Address
____________________________________________________________________________
PART IV—ACCOUNT INFORMATION (To be completed by filers and filing agents only)
Person to receive SEC Account Information and Billing Invoices _______________________________________
Telephone Number (Include Area and, if Foreign, Country Code) ______________________________________
Mailing Address or Post Office Box No. (if different from applicant’s mailing address)
___________________________________________________________________________________________
City _________________________ State or Country ________________________ Zip __________________
PART V—SIGNATURE (To be completed by all applicants)
Signature ___________________________________________________________________________________
Type or Print Name __________________________________________________________________________
Position or Title _____________________________________________________________________________
Date _______________________________________
Intentional misstatements or omissions of facts constitute federal criminal violations. See 18 U.S.C. 1001.
Section 19(a) of the Securities Act of 1933 (15 U.S.C. 77s(a)), sections 13(a) and 23(a) of the Securities Exchange Act of 1934
(15 U.S.C. 78m(a) and 78w(a)), section 319 of the Trust Indenture Act of 1939 (15 U.S.C. 77sss), and sections 30 and 38 of
the Investment Company Act of 1940 (15 U.S.C. 80a-29 and 80a-37) authorize solicitation of this information. We will use this
information to assign system identification to filers, filing agents, and training agents. This will allow the Commission to identify
persons sending electronic submissions and grant secure access to the EDGAR system.
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