Form NOTICE7-R Notice Form 7-R

COMMODITY FUTURES TRADING COMMISSION
NATIONAL FUTURES ASSOCIATION
NOTICE FORM 7-R

OMB NO. 3038-0023
July 19, 2001

1

Broker-Dealer Name and Business Address
NAME
ADDRESS

CITY, STATE, ZIP CODE

2

TELEPHONE

CRD#

(Required)

NFA ID#

(Will be assigned when application processed)

Notice of Registration as (check one):
FUTURES COMMISSION MERCHANT
or
INTRODUCING BROKER

3

Individual to whom all correspondence should be directed:
NAME

TITLE

ADDRESS

CITY, STATE, ZIP CODE

4

TELEPHONE

Representation and Certification
Notice broker-dealer hereby represents that 1) it is required to register only because it effects transactions in security futures
products on a contract market or derivatives transaction execution facility and 2) it will notify NFA immediately if any
information on this form, including the representation and certification, changes. Notice broker-dealer certifies that it is
registered with the Securities and Exchange Commission as a broker-dealer, that its broker-dealer registration is not
suspended, and that it is a member of a national securities association registered pursuant to Section 15A(a) of the Securities
Exchange Act of 1934.
By Officer, General Partner or Sole Proprietor:
Authorized Signature
Print Authorized Signature

Title
Date

(See reverse for instructions and notices.)

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CFTC
NFA

NOTICE FORM 7-R
(07-01)

INSTRUCTIONS
Registration as a Futures Commission Merchant or Introducing Broker will be effective upon receipt by NFA of a properly
completed Notice Form 7-R.
Mail this form to:
National Futures Association
Registration Department
200 W. Madison Street
Chicago, IL 60606-3447
Written confirmation of registration will be mailed to the contact person listed on this form.

PRIVACY ACT AND PAPERWORK REDUCTION ACT NOTICE
The information on CFTC Notice Form 7-R is being collected pursuant to authority granted in Sections 4f, 4n, 8a and 19
of the Commodity Exchange Act [7 U.S.C. §§ 6f, 6n, 12a and 23]. Under Section 4d of the Commodity Exchange Act
[7 U.S.C. §6d], it is unlawful for anyone to act as a futures commission merchant or introducing broker without being
registered in that capacity under the Act.
The information requested in Notice Form 7-R is designed to assist NFA and the CFTC, as appropriate, in determining
whether the application for registration should be granted or denied and to maintain the accuracy of registration files.
All information requested on Notice Form 7-R must be furnished before the form will be processed. The failure by an applicant or registrant to timely file a properly completed Notice Form 7-R may result in the denial of an application for registration or withdrawal thereof.
This Notice Form 7-R is considered by the CFTC to be a public record and will be available for inspection by any interested
person. Copies will be maintained by National Futures Association, Registration Department, Suite 1400, 200 W. Madison
St., Chicago, IL 60606-3447.
Forms which have not been prepared and executed in compliance with applicable requirements may be returned as not
acceptable for filing. Acceptance of this form shall not constitute any finding that it has been filed as required or that the
information is true, current or complete. Misstatements or omissions of fact may constitute federal criminal violations
[7 U.S.C. §13 and 18 U.S.C. §1001] or grounds for disqualification from registration.
You are not required to provide the information requested on a form subject to the Paperwork Reduction Act unless the form
displays a valid OMB Control Number.
The time needed to complete and file Notice Form 7-R may vary depending upon individual circumstances. The estimated
average time is 5 minutes.

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