UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
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FORM TA-1
UNIFORM FORM FOR REGISTRATION AS A TRANSFER AGENT AND FOR AMENDMENT
TO REGISTRATION PURSUANT TO SECTION 17A OF THE
SECURITIES EXCHANGE ACT OF 1934
GENERAL:
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Form TA-1 is to be used to register or amend registration as a transfer agent with the Comptroller of the Currency, the Board of Governors of the Federal Reserve System, the Federal Deposit Insurance Corporation or the Securities and Exchange Commission pursuant to Section 17A of the Securities Exchange Act of 1934. Read all instructions before completing this form. Please print or type all responses.
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1(a). Filer CIK: 1(e). Form Type: 1(f). File Number:
TA-1 TA-1/A
1(g)(i). Contact Name:
1(g)(ii). Contact phone Number: 1(g)(iii). Contact E-mail Address:
3(a). Full Name of Registrant:
Previous name, if being amended:
3(b). Financial Industry Number Standard (FINS) number :
3(c). Address of principal office where transfer agent activities are,
or will be, performed :
Address1
Address2
City State Zip Code
3(d). Is Mailing address different from response to Question 3c?
Yes No
If yes, please list correct mailing address below:
Address1
Address2
City State Zip Code
3(e). Telephone Number
(Include Area Code)
4.
Does registrant conduct, or will it conduct, transfer agent
activities at any location other than that given in question 3c
above?
If "yes," provide address(es):
Yes No
Address1
Address2
City State Zip Code
5. Does registrant act, or will it act, as a transfer agent solely for its own securities and/or securities of an affiliate(s)?
Yes No
6. Has registrant, as a named transfer agent, engaged, or will it engage, a service company to perform any transfer agent functions?
Yes No
If "yes," provide the name(s) and address(es) of all service companies engaged, or that will be engaged, by the registrant to perform its transfer agent functions:
Name:
File Number:
Address1
Address2
City State Zip Code
7. Has registrant been engaged, or will it be engaged, as a service company by a named transfer agent to perform transfer agent functions?
Yes No
If "yes," provide the name(s) and File Number(s) of the named transfer agent(s) for which the registrant has been engaged, or will be engaged, as a service company to perform transfer agent functions:
Name: File Number:
List additional transfer agents on a separate page.
8. Is registrant a:
Corporation Partnership Sole Proprietorship Other
See Form Instructions to determine requirements for Reporting Additional Persons based on your entity type.
8(a)(i). Full Name
8(a)(ii). Relationship Start Date
8(a)(iii). Title or Status
Complete this question if applicant is a Corporation or Partnership:
8(a)(iv). Ownership Code
8(a)(v). Control Person
Complete this question if applicant is a Sole Proprietorship:
8(a)(vi) Description of Authority and Beneficial Interest
8(a)(vii). Relationship End Date
8(a)(i). Full Name
8(a)(ii). Relationship Start Date
8(a)(iii). Title or Status
Complete this question if applicant is a Corporation or Partnership:
8(a)(iv). Ownership Code
8(a)(v). Control Person
Complete this question if applicant is a Sole Proprietorship:
8(a)(vi) Description of Authority and Beneficial Interest
8(a)(vii). Relationship End Date
8(a)(i). Full Name
8(a)(ii). Relationship Start Date
8(a)(iii). Title or Status
Complete this question if applicant is a Corporation or Partnership:
8(a)(iv). Ownership Code
8(a)(v). Control Person
Complete this question if applicant is a Sole Proprietorship:
8(a)(vi). Description of Authority and Beneficial Interest
8(a)(vii). Relationship End Date
List additional entries on a separate page.
9. Does any person or entity not named in the question 8:
9(a). directly or indirectly, through agreement or otherwise exercise or have the power to exercise control over the management or policies of applicant; or . . . .
Yes No
If Yes, fill in information below:
Exact name of each person or entity
Description of the Agreement or other basis
Exact name of each person or entity
Description of the Agreement or other basis
List additional entries on a separate page.
9(b). wholly or partially finance the business of applicant, directly or indirectly, in any manner other than by a public offering of securities made pursuant to the Securities Act of 1933 or by credit extended in the ordinary course of business by suppliers, banks and others ? . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
If Yes, fill in information below:
Exact name of each person or entity
Description of the Agreement or other basis
Exact name of each person or entity
Description of the Agreement or other basis
List additional entries on a separate page.
10. Definitions:
Control affiliate
- An individual or firm that directly or indirectly controls, is under common control with, or is controlled by applicant. Included are any employees identified in 8(a), 8(b), 8(c) of this form as exercising control. Excluded are any employees who perform solely clerical, administrative support of similar functions, or who, regardless of title, perform no executive duties or have no senior policy making authority.
Investment or investment related
- Pertaining to securities, commodities, banking, insurance, or real estate (including, but not limited to, acting as or being associated with a broker-dealer, investment company, investment adviser, futures sponsor, bank, or savings and loan association).
Involved
- Doing an act of aiding, abetting, counseling, commanding, inducing, conspiring with or failing reasonably to supervise another in doing an act.
A. In the past ten years has the applicant or a control affiliate been convicted of or plead guilty or nolo contendre ("no contest") to:
(1) a felony or misdemeanor involving: investments or an investment-related business, fraud, false statements or omissions, wrongful taking of property, or bribery, forgery, counterfeiting or extortion? . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(2) any other felony? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
B. Has any court in the past ten years:
(1) enjoined the applicant or a control affiliate in connection with any investment-related activity? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(2) found that the applicant or a control affiliate was involved in a violation of investment-related statutes or regulations? . . . . .
Yes No
C. Has the U.S Securities and Exchange Commission or the Commodity Futures Trading Commission ever:
(1) found the applicant or a control affiliate to have made a false statement or omission? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(2) found the applicant or a control affiliate to have been involved in a violation of its regulations or statutes? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(3) found the applicant or a control affiliate to have been a cause of an investment-related business having its authorization to do business denied, suspended, revoked or restricted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(4) entered an order denying, suspending or revoking the applicant's or a control affiliate's registration or otherwise disciplined it by restricting its activities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
D. Has any other Federal regulatory agency or any state regulatory agency:
(1) ever found the applicant or a control affiliate to have made a false statement or omission or to have been dishonest, unfair, or unethical? . . . . . .
Yes No
(2) ever found the applicant or a control affiliate to have been involved in a violation of investment-related regulations or statutes? . . . . . . . . . . . . . . . . .
Yes No
(3) ever found the applicant or a control affiliate to have been a cause of an investment-related business having its authorization to do business denied, suspended, revoked, or restricted? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(4) in the past ten years entered an order against the applicant or a control affiliate in connection with investment-related activity? . . . . . . . . . . . . . . . .
Yes No
(5) ever denied, suspended, or revoked the applicant's or a control affiliate's registration or license, or prevented it from associating with an investment-related business, or otherwise disciplined it by restricting its activities? . . . . . .
Yes No
(6) ever revoked or suspended the applicant's or a control affiliate's license as an attorney or accountant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
E. Has any self-regulatory organization or commodities exchange ever:
(1) found the applicant or a control affiliate to have made a false statement or omission? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(2) found the applicant or a control affiliate to have been involved in a violation of its rules? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
(3) found the applicant or a control affiliate to have been the cause of an investment-related business losing its authorization to do business? . . . . . . . .
Yes No
(4) disciplined the applicant or a control affiliate by expelling or suspending it from membership, by barring or suspending its association with other members, or by otherwise restricting its activities? . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
F. Has any foreign government, court, regulatory agency, or exchange ever entered an order against the applicant or a control affiliate related to investments or fraud? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
G. Is the applicant or a control affiliate now the subject of any proceeding that could result in a yes answer to questions 10(a) - 10(F)?
Yes No
H. Has a bonding company denied, paid out on, or revoked a bond for the applicant or a control affiliate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
I. Does the applicant or a control affiliate have any unsatisfied judgments or liens against it? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
For each yes to Item 10, provide the following details:
(i). The individuals named in the Action
(ii). Title of Action
(iii). Date of Action
(iv). The Court or body taking the Action and its location.
(v). Description of the Action.
(vi). The disposition of the proceeding.
(i). The individuals named in the Action
(ii). Title of Action
(iii). Date of Action
(iv). The Court or body taking the Action and its location.
(v). Description of the Action.
(vi). The disposition of the proceeding.
List additional entries on a separate page.
ATTENTION: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACT
CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a)
SIGNATURE: The registrant submitting this form
and the executing official hereby represent that all the information contained herein is true, correct and complete.
Signature of Official responsible for Form:
Telephone number:
Title of Signing Officer:
Date signed (Month/Day/Year):
| File Type | application/msword |
| File Title | UNITED STATES |
| Last Modified By | martinsons |
| File Modified | 2006-10-24 |
| File Created | 2006-10-24 |