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 or
312-781-1410), 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.
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

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TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
FIRM WITHDRAWAL
Privacy Act and Paperwork Reduction Act Notice
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 1800,
300 S. Riverside Plaza, Chicago, IL 60606-6615. 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.