Is Applicant actively engaged in a futures business? No Yes Is Applicant registered with NFA?

Similar documents
NASDAQ FUTURES. A. Applicant Information Full legal name of Applicant ( Applicant ) (must be an organization): B. Qualification

Instructions for Part 2B of Form ADV: Preparing a Brochure Supplement

NASDAQ ISE, LLC Membership Application Form

Educational Background and Business Experience. Form ADV Part 2B Brochure Supplement. Brochure Updated: April 27, 2016

North Carolina Department of Insurance

Kathleen S. Parks Knoxville, TN. Apella Capital, LLC 151 National Drive Glastonbury, CT FORM ADV PART 2B BROCHURE SUPPLEMENT

Regulatory Notice 11-06

BATS Exchange, Inc. Options Member Application and Agreements

CHARTIS. Name of Insurance Company to which Application is made (herein called the Insurer ) HEDGE FUND INSURANCE APPLICATION

Application for Corporate Membership CME Qualified Affiliate / Qualified Subsidiary Member Firm Agreement for Membership

Application for Consumer Finance License

PLEASE SUBMIT CHECKLIST AND ALL OTHER PAPERWORK VIA FAX: OR

Form ADV Part 2B: Brochure Supplement

Sign and date the Application For Appointment: Recruiter s signature is required. Read, sign and date the Authorization for Release of Information.

Application for Clearing Privileges

Application for Latin American Fund Manager Incentive Program ( FMIP" or the Program ) Agreement for FMIP Participation

Form ADV. Part 2B Supplemental Brochure for Lee Frush 2018

Form ADV Part 2A CHECKLIST

ICE Futures U.S., Inc. MEMBERSHIP RULES

CHICAGO MERCANTILE EXCHANGE INC. ( CME ) BOARD OF TRADE OF THE CITY OF CHICAGO, INC. ( CBOT ) NEW YORK MERCANTILE EXCHANGE, INC

NAME: Full Name (Last, First, Middle)

CORPORATE MEMBERSHIP APPLICATION FORM NON-HEDGE FUND

FORM ADV. Primary Business Name: EXCELSIOR OPPORTUNITY ADVISORS LLC CRD Number: Other-Than-Annual Amendment - All Sections Rev.

Producer Background Questionnaire and Data Sheet

Sunlife Financial Contracting Instructions

CME GROUP INTERNATIONAL INCENTIVE PROGRAMS - APPLICATION FORM

NMLS COMPANY FORM * ALL FORMS ARE COMPLETED ELECTRONICALLY THROUGH NMLS THIS FORM IS FOR INSTRUCTIONAL PURPOSES ONLY *

State of New Jersey. Long Form Renewal Registration Statement CRI-300R

Referred to Committee on Commerce and Labor. SUMMARY Makes various changes relating to insurance adjusters. (BDR )

OneAmerica Producer Contracting

LOAN ORIGINATOR APPLICATION INSTRUCTIONS

SPECIMEN. Sign and date the Application For Appointment: Recruiter s signature is required.

Version date: 2012 main ed.

Application for Oregon Worker Leasing License Please refer to Oregon Administrative Rules (OAR) and through

Assembly Bill No. 12 Committee on Commerce and Labor

NC General Statutes - Chapter 14 Article 19B 1

Independent Agent Appointment Agreement (Registered Representative)

LIMITED POWER OF ATTORNEY

AMENDMENT (To amend, circle or identify item(s) being amended.) SURRENDER. State License # State License # State License #

Florida Senate SB 1106

REQUEST FOR PROPOSALS FOR SERVICES OF FUND ATTORNEY /REGULATORY COMPLIANCE & LEGISLATIVE SERVICES

DRAWINGS: SPECIFICATIONS: ADDENDA: IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first written above.

STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES OFFICE OF INSURANCE REGULATION TALLAHASSEE, FLORIDA BIOGRAPHICAL STATEMENT AND AFFIDAVIT

FORM ADV UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT BY EXEMPT REPORTING ADVISERS

IC Chapter 4. Broker-Dealers, Agents, Investment Advisers, Investment Adviser Representatives, and Federal Covered Investment Advisers

AP Wealth Management, LLC FORM ADV PART 2A BROCHURE

RETAIL DISCLOSURE SHEET 26 TH FLOOR, CORNING TOWER, EMPIRE STATE PLAZA ALBANY, NEW YORK PROJECT NO: DATE: FEDERAL I.D. NO.

D. Type of work or services performed:

STATE OF NORTH CAROLINA DEPARTMENT OF INSURANCE BIOGRAPHICAL AFFIDAVIT FOR ADMINISTRATORS

STATE OF WISCONSIN Department of Financial Institutions

SEACAP ADVISORS, LLC ITEM 1 COVER PAGE ADV PART 2 A

4530 Disclosure Event Form Instructions

CORPORATE GOVERNANCE AND RELATED PARTY TRANSACTION COMMITTEE CHARTER

NC General Statutes - Chapter 78D Article 1 1

December 13, Dear Vendors: Reference: RFQ No. FY Subject: Annual Shipping Services

SECTION I. Appointment, Activities, Authority and Status of REPRESENTATIVE

New York Stock Exchange LLC ( NYSE ) and/or NYSE American LLC ( NYSE American )

REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS OR QUOTERS

(No., Street) Present Crime Insurance Program: (Include primary AND excess, if applicable) If not applicable, please check here:

Patrick A. Sweeny David E. Connelly Jr. Dana D Auria

Demographic Information. 17 Business Web Site Address 18 Business Address ( ) -

1. A Securities Company may not be controlled, either directly or indirectly by an individual who:

Uniform Application for Business Entity Adjuster License/Registration (Please Print or Type)

Sign and date the Application For Appointment: Recruiter s signature is required. Read, sign and date the Authorization for Release of Information.

Social Security #: Gender: Resident State Insurance License #: Resident Insurance State: Last Name: First Name: Middle: Title:

IARD - All Sections [User Name: arosenfield1, OrgID: ] FORM ADV

STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

REQUIRED SIGNATURE PAGE FOR PROPOSALS. Disaster Restoration and Recovery Services

Demographic Information. Is the business entity affiliated with a financial institution/bank? Yes No

EXPERIENCE AND QUALIFICATION STATEMENT OF

FORM ADV UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT BY EXEMPT REPORTING ADVISERS

Certification Program Application CFA Challenge

Certificate of Fraternal Society

TABLE OF CONTENTS. Appendix A Application for Registration as an NFLPA Registered Individual Player Financial Advisor

FORM ADV (Paper Version) UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION

Global View Capital Advisors

Contract Checklist for General Agent (Corporation w/special Agent)

NYSE American Options. American Trading Permit Application

PRODUCER APPOINTMENT INFORMATION FORM (PIF)

LOS ANGELES WORLD AIRPORTS CONTRACTOR RESPONSIBILITY PROGRAM QUESTIONNAIRE

Life Investors Insurance Company

Kansas Credit Services Organization Instructions for Application of Registration

Florida Department of Agriculture and Consumer Services Division of Consumer Services CHARITABLE ORGANIZATIONS / SPONSORS REGISTRATION APPLICATION

FORM ADV (Paper Version)

GILMAN HILL ASSET MANAGEMENT, LLC. 156 King s Highway North Westport, CT (203) January 24, 2017

New York Stock Exchange LLC ( NYSE ) and/or NYSE American LLC ( NYSE American )

Chapter I - Definitions

CITY OF FERNANDINA BEACH, FLORIDA INVITATION TO BID

Form 7-C2016 Merchant Application/Agreement

Patrick A. Sweeny David E. Connelly Jr. Dana M. D Auria Philip R. McDonald

Interactive Brokers Consolidated Account Clearing Agreement

Application for High Velocity CTA/Hedge Fund Pilot Program*

Beaumont Independent School District

Contract Information and Signature Form

CHARITABLE ORGANIZATIONS APPLICATION

MODEL CONSUMER DEBT MANAGEMENT SERVICES ACT February 2004

Transamerica. Pre-Appointment states: AL, CO, CT, DE, GA, KY, LA, MT, NJ, NC, OH, OK, PA, TX, UT, VT, WA

Contracting Information and Signature Form

Producer Set-Up Packet

PRODUCER AGREEMENT PACKAGE

Transcription:

A. Applicant Information Full legal name of NFX Futures Applicant ( Applicant ) (must be an organization): Main office address: Contact (for questions concerning this application): B. Qualifications Is Applicant actively engaged in a futures business? No Yes Is Applicant registered with NFA? Is Applicant registered with FINRA? No Yes No Yes NFA registration # (NOTE: Applicants handling US customer business are required to be registered with NFA as a Futures Commission Merchant ( FCM )). CRD registration # Select the exchange(s) for which Applicant has been granted membership or at which Applicant is currently pending membership: CBOT Chicago Board of Trade CEI Commodity Exchange, Inc. CFE CBOE Futures Exchange LLC CME Chicago Mercantile Exchange ICE ICE Futures US Inc. KCBT Kansas City Board of Trade MGE Minneapolis Grain Exchange NYME New York Mercantile Exchange C. Clearing Information Provide name of Applicant s Designated Self-Regulatory Organization ( DSRO ): Is Applicant a direct member of The Options Clearing Corporation ( OCC )? Yes Provide OCC clearing account number(s): No, Provide clearing information below. Please also complete the clearing guarantee attached as Appendix A. Clearing Member organization: Clearing contact: OCC clearing account numbers: Please note that NFX requires all Futures Participants to provide an account number with OCC for purposes of direct debit pursuant to Exchange Rules. Please provide the OCC account number which can be utilized for purposes of direct debit: OCC direct debit account number: 1

D. Market Maker Does Applicant desire to apply to become a Market Maker on NFX? No Yes E. Executive Representative Futures Participants are required to appoint and certify to the Membership Department one Executive Representative who shall represent and act for the Futures Participant in all the affairs of the Exchange. A Futures Participant may change its Executive Representative or appoint a substitute for its Executive Representative upon notification to the Membership Department as provided in Exchange Rules. An Executive Representative of NFX shall be authorized to act on behalf of the Futures Participant. Each Executive Representative shall maintain an Internet electronic mail account for communication with the Exchange and shall update contact information as prescribed by the Exchange. Executive Representative: F. s Futures Participants are required to maintain a current list of all s of the Futures Participant with Exchange s Membership Department. The Exchange s Membership Department must be immediately notified of the addition, termination or resignation of an. List all s, including the name, title, phone number and email address, in Appendix B. G. Compliance Contact Enter the individual to whom all compliance inquiries are to be directed: H. Emergency Contact(s) Please list at least one emergency contact: Emergency contact: Emergency contact: I. Disclosures (Chapter II, Sec. 4 and Sections 8a(2), (3), (4) and (11) of the Commodity Exchange Act) IF YOU RESPONDED YES TO ANY QUESTION 1 THROUGH 9, PLEASE PROVIDE SUPPORTING DOCUMENTATION. For purposes of responding to these questions, the term person associated with when applied to any person shall mean, as applicable, any general partner, officer, or director of such person, any holder or beneficial owner of ten percent or more of the outstanding shares of any class of stock of such person, any person who has contributed ten percent or more of the capital of such person or any person directly or indirectly controlling such person. 1. Has the organization or any person affiliated with the organization had a registration suspended or revoked? 2

2. In any case brought by a domestic or foreign governmental body, has the organization or any person affiliated with the organization ever been permanently or temporarily enjoined, either after a hearing or in a settlement, from engaging in or continuing any activity involving: (i) any transaction in or advice concerning futures, options on futures, leverage transactions or securities; or (ii) embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property? 3. Has the organization or any person affiliated with the organization ever pled guilty or nolo contendere ( no contest ) to or been convicted or found guilty of any felony in any domestic, foreign or military court? 4. Has the organization or any person affiliated with the organization ever pled guilty to or been convicted or found guilty of any misdemeanor in any domestic, foreign or military court which involves: (i) embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property; (ii) violation of sections 7203, 7204, 7205 or 7207 of the Internal Revenue Code of 1986; (iii) violation of sections 152, 1341, 1342 or 1343 or chapters 25, 47, 95 or 96 of the United States Criminal Code; or (iv) any transaction in or advice concerning futures, options on futures, leverage transactions or securities? 5. In any proceeding brought by a domestic or foreign governmental body, has the organization or any person affiliated with the organization ever been found, either after a hearing or in a settlement, to: (i) have violated any provision of an investment-related statute or regulation; or (ii) have violated any statute, rule, regulation or order which involves embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property; or (iii) have willfully aided, abetted, counseled, commanded, induced or procured such violation by any other person? 6. Has the organization or any person affiliated with the organization ever been debarred by an agency of the United States from contracting with the United States? 7. Has the organization or any person affiliated with the organization ever been the subject of any order issued by a domestic or foreign regulatory authority or self-regulatory organization that prevented or restricted the organization s ability to engage in any business in the financial services industry? 8. Are any of the orders described in Question 7 currently in effect against the organization or any person affiliated with the organization? 9. Is the organization or any person affiliated with the organization a party to any action, or is there a charge pending, the resolution of which could result in a Yes answer to the previous questions? J. Fees, Fines, Dues and Penalties Each Futures Participant shall be liable for such fees, fines, dues, penalties and other amounts imposed by NFX in connection with its permit and activities conducted in connection therewith by such Futures Participant, whether or not any such obligation was incurred on behalf or for the account of the Futures Participant or on behalf of or for the account of an associated Futures Participant. Billing contact: K. Signatures We hereby represent that, we have read and understand the above information and that the answers and attachments are, to the best of our knowledge and belief, true and correct. We hereby pledge ourselves to submit to and abide by the Governing documents, By-Laws, Rules and operating procedures of NFX, as now existing and as hereafter duly amended from time to time. 3

The organization authorizes any governmental agency, futures exchange, securities exchange, national securities association, national futures association or other entity to furnish to NFX, upon its request, any information they may have concerning the organization, and the organization hereby releases each such entity from any and all liability of whatsoever nature by reason of furnishing such information to NFX. The organization authorizes NFX to make available to any governmental agency, futures exchange, securities exchange, national securities association, national futures association or other entity (upon such entity s showing of proper authority and need) any information NFX may have concerning the organization, and the organization hereby releases NFX from any and all liability of whatsoever nature by reason of furnishing such information. Please note that Futures Participants are under a continuing obligation to inform the Exchange of any changes to the information provided herein as well as noncompliance with any of the registration requirements set forth above. (Futures Participant) certifies that the statements made herein and materials furnished to NFX are true, complete and accurate and executes as follows: Authorized Applicant signature: Print name: Date: L. Supplemental Material All applicants must provide the following documents: Executed Clearing Letter of Guarantee for each Contract that Applicant intends to submit orders or quotes for on NFX (Appendix A)(Chapter IV, Sec. 9 of NFX Rules) Form (Appendix B) Consent Form for each (Exhibit 1 of Appendix B) Consent Form for associated persons responsible for Automated Trading System (Exhibit 2 of Appendix B) Summary of Applicant s business plan A copy of Applicant s Written Supervisory Procedures with respect to its futures business activities Statement of financial condition as of a date not greater than 45 days from the date of application Provide a written explanation detailing the events for any matter that caused a Yes answer in Section I of this Application A complete set of applicable formation documents Corporation include the following: o Articles of Incorporation or Formation o By-Laws Partnership include the following: o Partnership Agreement Limited Liability Company include the following: o Operating Agreement o Articles of Organization or Certificate of Formation M. Submission Questions regarding this application may be directed to NASDAQ OMX Membership at 215.496.5322 or 215.496.5159. Completed applications and all required supplemental Material should be submitted by email to: membership@nasdaqomx.com. Amended 2/22/13 4

APPENDIX A To: From: NASDAQ OMX Futures Exchange, Inc. ( NFX ) Membership Department (NFX Futures Participant) (NFX Clearing Member) Re: NFX Clearing Letter of Guarantee The NFX Futures Participant noted above has represented to the undersigned Clearing Member, a member of The Options Clearing Corporation ( OCC ), that it is an approved member of NFX. Pursuant to Exchange Rules, Clearing Members must provide NFX with a copy of each written agreement ( Clearing Letter of Guarantee or Guarantee ) guaranteeing the performance of a Non-Clearing Member. This letter shall be deemed to be a Guarantee with respect to all transactions made by the above-referenced Non- Clearing Member through the undersigned Clearing Member on NFX. Pursuant to Exchange Rules, the Clearing Member affirms the following: Clearing Member guarantees and indemnifies the performance for the following Contracts executed on the Exchange by the Non-Clearing Member: XAU/USD Spot Gold Futures The Clearing Member permits the Exchange to debit any undisputed or final fees, fines, charges and/or other monetary sanctions or other monies due and owing to the Exchange that were incurred by the Non- Clearing Member. This Clearing Letter of Guarantee shall remain in effect until written notice of revocation has been filed with NFX s Membership Department. Any such revocation shall in no way relieve the undersigned Clearing Member of responsibility for transactions guaranteed prior to the effective date of the revocation or terminated pursuant to Exchange Rules. The Clearing Member must immediately notify the Exchange of termination of this Guarantee. Accepted and agreed to this date: Clearing Member Organization: Clearing Member OCC Number: Clearing Member Representative Signature: (Phone Number) (Print Name/Title) 5

APPENDIX B NFX Futures Participant Organization: AUTHORIZED TRADERS The undersigned authorized representative for the above-listed NFX Futures Participant acknowledges that each Authorized Trader is responsible for all business conducted by or through the Futures Participant's House Account by any Persons associated with that Futures Participant. Each Futures Participant ensures that all Orders and Quotes submitted through its Futures Participant House Account are submitted in good faith to execute bona fide trades and that the Orders and Quotes comply with all applicable provisions of the Act, Commission regulations and related requirements, all Rules, and all Exchange regulatory and operational orders and procedures. Further, the undersigned acknowledges that the below is a complete list of all s. Each and person responsible for an Automated Trading System listed below MUST execute the applicable Consent Form attached hereto as Exhibits 1 and 2. Officer Signature: Print Name/ Please note that the Futures Participant is under an obligation to immediately inform the Exchange of any change to this list or an s contact information. Further, the Futures Participant is required to provide NFX with a Trader ID for each. Automated Trading System Individual responsible for system: Automated Trading System Individual responsible for system: 6

EXHIBIT 1 AUTHORIZED TRADER CONSENT I, (name of ), an for (name of Futures Participant), consent to NASDAQ OMX Futures Exchange, Inc. s ( NFX ) jurisdiction and as such agree to be bound by NFX s governing documents, By-Laws, Rules, and regulatory and operational orders and procedures. In addition, I consent to the jurisdiction of the Commodity Futures Exchange Commission and agree to be bound by the Commodity Exchange Act, Commission Regulations and related requirements. Date: Signature of Name of 7

EXHIBIT 2 AUTHORIZED TRADER CONSENT FOR USE OF AN AUTOMATED TRADING SYSTEM I, (individual responsible for Future Participant s Automated Trading System), an associated person of (name of Futures Participant), consent to NASDAQ OMX Futures Exchange, Inc. s ( NFX ) jurisdiction and as such agree to be bound by NFX s governing documents, By- Laws, Rules, and regulatory and operational orders and procedures. In addition, I consent to the jurisdiction of the Commodity Futures Exchange Commission and agree to be bound by the Commodity Exchange Act, Commission Regulations and related requirements. Date: Signature of Associated Person Name of Associated Person 8