7-W Firm Withdrawal

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Instructions for Using the Firm Withdrawal Template
This document is not a Firm Withdrawal Request form. Do not send this document to NFA. It is a
template that you may use to assist in filing the electronic withdrawal request.
You may fill out the template online and save and/or print it when you are finished or you can download
the template and/or print it and fill it out later.
Not every section applies to every withdrawing firm. Certain sections apply depending on the reason
for withdrawal. The text above these sections explains who must complete the section. In the
electronic application, only the applicable sections will appear.
Additional Assistance
Additional information regarding registration requirements and specific topics can be found on the
Registration page of NFA’s web site at www.nfa.futures.org. NFA’s Information Center, (800-621-3570), is
also available to provide assistance. It’s normal hours are Monday through Friday, from 8:00 AM to 5:00
PM CT.

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TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Firm Name*
Firm NFA ID#*
Withdrawal Categories*
Check all categories for which withdrawal is requested.
Enter the last date that activities requiring registration will be or were performed. Leave blank
if never commenced.
Category
NFA MEMBER
FUTURES COMMISSION MERCHANT
INTRODUCING BROKER
COMMODITY POOL OPERATOR
COMMODITY TRADING ADVISOR
List Clearing Firm(s):

*Required to file withdrawal

Date Activities Ceased

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Location of Business Records
Enter the person having custody of the books and records of the registrant and the location
of the books and records of the registrant.
Books and Records Custodian
Name*
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number*
E-Mail Address
Books and Records Location
Office of*
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
*Required to file withdrawal
** Required to file withdrawal request for United States address

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Basis for Withdrawal
Check all that apply.
Basis for Withdrawal Request*
The registrant has not commenced engaging in activities requiring registration in such
capacity.
The registrant has ceased engaging in activities requiring registration in such capacity.
The registrant is exempt from registration in such capacity.
The registrant is excluded from the persons or any class of persons required to be
registered in such capacity.
The registrant will cease engaging in activities requiring registration in such capacity
when it becomes registered in another capacity for which it has applied for registration.
New registration capacity:
Futures Commission Merchant

Commodity Trading Advisor

Introducing Broker

Commodity Pool Operator

The registrant will cease engaging in activities requiring registration in such capacity
when it merges with another firm which is or will be registered.
Name of the firm to be merged with:

Requested Withdrawal Date
Enter a date if the registration needs to be withdrawn at a date other than 30 days from
NFA’s receipt of this request. If withdrawal is requested fewer than 30 days from NFA’s
receipt of the request, explain the reason for expediting the request.
Requested Date:
Reason:

*Required to file withdrawal

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Only firms that indicated that they are exempt or excluded from registration as the basis for their
withdrawal complete this section.

Basis for Exemption
Answer the following questions.
Indicate the section of the Act, regulations or other authority permitting exemption or exclusion.*

Indicate the circumstances which entitle the registrant to claim such exemption or exclusion.*

Additional Customer Information
Check all that apply.
All customer or option customer agreements have been terminated or transferred.
All positions have been closed or transferred.
All cash balances, securities or other property, including any interest and assets in any
commodity pool, have been returned, distributed, redeemed or transferred.
If customer agreements, positions or cash balances, securities or other property has been
transferred, list recipient:

All guarantee agreements have been terminated in accordance with the provisions of CFTC
Regulation 1.10(j).
There are no pending, anticipated or potential customer, option customer or commodity
pool participant claims against the registrant.

*Required to file withdrawal

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Privacy Act and Paperwork Reduction Act Notice
OMB# 3038-0023
Privacy Act and Paperwork Reduction Act Notice
The information in Forms 7-R, 7-W, 8-R and 8-T and on the fingerprint card is being collected pursuant to authority
granted in Sections 4f, 4k, 4n, 8a and 19 of the Commodity Exchange Act [7 U.S.C. §§ 6f, 6k, 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. Under Section 4m of the Commodity
Exchange Act [7 U.S.C. §6m], it is unlawful for a commodity trading advisor or commodity pool operator to make use of
the mails or any means or instrumentality of interstate commerce in connection with his business as a commodity
trading advisor or commodity pool operator without being registered in the appropriate capacity under the Act, except
that a commodity trading advisor who, during the course of the preceding 12 months, has not furnished commodity
trading advice to more than 15 persons and does not hold himself out generally to the public as a commodity trading
advisor, need not register. Under Section 19 of the Commodity Exchange Act [7 U.S.C. §23] and Section 31.5 of the CFTC’s
regulations, it is unlawful for anyone to act as a leverage transaction merchant without being registered in that capacity
under the Act.
The information requested in 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. The
information in Form 7-W is designed to assist NFA and the CFTC in determining whether it would be contrary to the
requirements of the Commodity Exchange Act, or any rule, regulation or order thereunder, or the public interest to
permit withdrawal from registration.
The information requested in Form 8-R and on the fingerprint card will be used by the CFTC or NFA, as appropriate, as a
basis for initiating an inquiry into the individual’s fitness to be an associated person, floor broker or floor trader or to be a
principal of a futures commission merchant, introducing broker, commodity trading advisor, commodity pool operator or
leverage transaction merchant. Portions of the information requested in Form 8-R will be used by the CFTC and, in
appropriate cases, by NFA, to confirm the registration of certain associated persons. The information requested in Form
8-T will be used by the CFTC, and, in appropriate cases, by NFA, to record the registration status of the individual and, in
appropriate cases, as a basis for further inquiry into the individual’s fitness to remain in business subject to the CFTC’s
jurisdiction.
With the exception of the social security number, all information in Forms 8-R and 8-T must be furnished. Disclosure of
the social security number is voluntary. Disclosure of the Federal employer identification number is voluntary. The Social
security number and the Federal employer identification number are sought pursuant to the Debt Collection
Improvement Act of 1996. Under the Debt Collection Improvement Act, a social security number or a taxpayer identifying
number furnished to the CFTC as part of the registration process can be used for purposes of collecting and reporting on
any debt owed to the U.S. Government, including civil monetary penalties. The furnishing of a social security number or
Federal employer identification number, however, assists the CFTC and NFA in identifying individuals and firms and
therefore expedites the processing of those forms.
The failure by an applicant, registrant or principal to timely file a properly completed Form 7-R and all other related
required filings may result in the denial of an application for registration or withdrawal thereof or, in the case of an
annual records maintenance fee, treating the registrant as having petitioned for withdrawal. Failure by an applicant,
registrant or principal to timely file or cause to be filed a properly completed Form 8-R or 8-T, any other required related
filings, or a fingerprint card may result in the lapse, denial, suspension or revocation of registration, withdrawal of the
application or other enforcement or disciplinary action by the CFTC or NFA.

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TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Privacy Act and Paperwork Reduction Act Notice
With the exception of the fingerprint card, any information contained in the Personal Information Section and any
information contained in Matter Information pages related to the Disciplinary Information Sections on Form 8-R and on
Form 8-T or Item 7 on Form 8-W, the Forms 7-R, 7-W, 8-R and 8-T are considered by the CFTC to be public records and
will be available for inspection by any person. Copies will be maintained by National Futures Association, Registration
Department, Suite 1400, 200 W. Madison St., Chicago, IL 60606-3447. Further, the CFTC or NFA may disclose the fingerprint
card and any other information described above to third parties pursuant to routine uses which the CFTC has published
in the Federal Register or as otherwise authorized under the Privacy Act, [5 U.S.C. §552a], and the Commodity Exchange
Act. Disclosure of such information may be made by the CFTC as follows: (1) in connection with administrative
proceedings or matters in litigation; (2) in connection with investigations; (3) where the information is furnished to
regulatory, self-regulatory and law enforcement or other governmental agencies to assist them in meeting
responsibilities assigned to them by law or made available to any member of Congress who is acting in his or her
capacity as a member of Congress; (4) where disclosure is required under the Freedom of Information Act [5 U.S.C. §552];
(5) in connection with an employer’s hiring or retention of an employee; (6) in connection with the verification of
information submitted for sponsorship purposes; (7) in other circumstances in which the withholding of such information
appears unwarranted; and (8) in connection with legally required or authorized reports. Disclosure may be made by NFA
in accordance with rules approved by the CFTC.
If an individual believes that the placing in the CFTC’s or NFA’s public files of any of the information contained in the
Personal Information Section or in Matter Information pages related to Disciplinary Information on Form 8-R and on
Form 8-T or Item 7 on Form 8-W, or on the fingerprint card would constitute a clearly unwarranted invasion of his
personal privacy, the individual may petition the CFTC, pursuant to 17 CFR 145.9, to treat such information as confidential
in response to requests under the Freedom of Information Act (FOIA) [5 U.S.C. §552]. The CFTC will make no
determination as to confidential treatment of information submitted unless and until the information is the subject of an
FOIA request. The filing of a petition for confidential treatment, however, does not guarantee that the information will be
treated confidentially in response to an FOIA request.
Forms which have not been prepared and executed in compliance with applicable requirements may not be acceptable
for filing. Acceptance of this form shall not constitute any finding 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.
This notice is provided in accordance with the requirements of the Privacy Act, [5 U.S.C. §552a(e)(3)] and summarizes
some of an individual’s rights under the Privacy Act [5 U.S.C. §552a] and the Freedom of Information Act [5 U.S.C. §552].
Individuals desiring further information should consult the CFTC’s regulations under the Privacy Act, 17 CFR Part 146, and
under the Freedom of Information Act, 17 CFR Part 145, and the CFTC’s annual notice, published in the Federal Register,
pursuant to the Privacy Act, of the existence and character of each system of records maintained by the CFTC.
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 Form 7-R, Form 3-R, Form 7-W, Form 8-R and Form 8-T and Form 8-W may vary
depending upon individual circumstances. The estimated average times are:

Form 7-R
FCM
IB
CPO
CTA

30 minutes
24 minutes
24 minutes
24 minutes

Form 3-R
Form 7-W
Form 8-R
Form 8-T
Form 8-W

3 minutes
3 minutes
20 minutes
6 minutes
3 minutes

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Withdrawal Agreement
BY FILING THIS FORM 7-W, THE REGISTRANT AGREES THAT SUCH FILING CONSTITUTES THE
REGISTRANT’S certification that the answers and the information provided in the Form 7-W are true,
complete and accurate and that in the light of the circumstances under which the registrant has given
them, the answers and statements in the Form 7-W are not misleading in any material respect;
certification that the person who electronically files the Form 7-W on behalf of the registrant is
authorized by the registrant to file the Form 7-W on its behalf and to make all required certifications and
acknowledgements; and acknowledgement that the registrant is subject to the imposition of criminal
penalties under Section 9(a) of the Act and 18 U.S.C. §1001 for any false statements or omissions made
in the Form 7-W.