3-R Supplemental Statement to Application for Request of ATM

COMMODITY FUTURES TRADING COMMISSION
NATIONAL FUTURES ASSOCIATION FORM 3-R

OMB NO. 3038-0048
NOVEMBER 1999

Supplemental statement to application for registration of an
Agricultural Trade Option Merchant and Associated Person or
Listed Individual of an Agricultural Trade Option Merchant and
reporting of additional sponsoring firms for the multiple association of an Associated Person of an Agricultural Trade Option
Merchant.

PART I: Changes and Corrections in Registration Information (Check where applicable)
1
2

Agricultural Trade Option Merchant

Associated Person

Listed Individual

Applicant or registrant to which changes apply
FIRM NAME
NFA ID#
OR
INDIVIDUAL NAME
NFA ID#
DATE AND PLACE OF BIRTH (IF ID NOT KNOWN)

3

INSTRUCTIONS FOR ITEM 3: Please indicate Form 7-R or 8-R as well as the item number (i.e., "7-R," "No. 4" or "8-R" "No. 5"). Use
Form 8-T, Notice of Termination, or NASD Form U-5 to report terminations of Associated Persons and Listed Individuals.
FORM 7-R
OR 8-R

4

ITEM
NO.

ADDITION

CHANGE

DELETE

CHANGES AND CORRECTIONS OF INFORMATION CONTAINED IN
APPLICATION FOR REGISTRATION OR SUPPLEMENTAL STATEMENT
(Attach a supplemental sheet if necessary)

EFFECTIVE
DATE
MM/DD/YY

TRANSFER OF REGISTRATION: If individual’s prior registration as an Associated Person of an Agricultural Trade Option
Merchant was terminated within 90 days prior to the date this Form 3-R is mailed, the new sponsoring firm must provide the
following information and sign the certification. Effective date of registration is the date the Form 3-R is mailed.
Sponsor Name

NFA ID #

Date Form 3-R is mailed:

CERTIFICATION - Must be signed by AP, Listed Individual or authorized signatory.
I hereby certify that all changes and corrections contained or incorporated herein are true to the best of my knowledge and belief.
SPONSOR NAME

NFA ID#

PRINT NAME
SIGNATURE

DATE

WILLFUL FALSIFICATION, MISREPRESENTATION OR OMISSION OF ANY MATERIAL FACT REQUIRED TO BE STATED ON
THIS FORM CONSTITUTES CAUSE FOR DENIAL, SUSPENSION OR REVOCATION OF REGISTRATION AND PROSECUTION
UNDER CRIMINAL STATUTES OF THE INDIVIDUAL AND FIRM MAKING THE ABOVE CERTIFICATION.
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CFTC
NFA

FORM 3-R
(11-99)

INSTRUCTIONS
NOTE: Any reference in the instructions to Form 3-R and in the Form 3-R itself to “Form 7-R, Form 3-R, Form 8-R or
Form 8-T” applies only to the November 1999 versions of these forms created for Agricultural Trade Option Merchants
and their Listed Individuals and Associated Persons.
1 The prompt filing of Part I of this form is required by Commission Regulation 3.13 if the information reported in any of
the items specified in the instructions to Form 7-R or Form 8-R, or supplemental statement thereto, is found to be
incorrect or incomplete, or if changes occur which render that information no longer accurate and current. If you are
reporting changes to disciplinary history, be sure to provide certified copies of applicable documents.
2 Whenever there is an addition of a Listed Individual in Item 10 of Form 7-R, that person must complete a Form 8-R for
Listed Individual of an Agricultural Trade Option Merchant which should be attached to this form unless that individual
is exempt from filing under the provisions of Commission Regulation 3.13.
3 Use this form to promptly amend an application that has been filed, whether or not registration is pending or registration has been granted, unless instructed otherwise.
4 Where to file. Send this form to National Futures Association,200 West Madison Street, Suite 1400, Chicago, Illinois
60606-3447.
5 Report terminations and failures to become associated on Form 8-T, Notice of Termination of an Associated Person or
Listed Individual of an Agricultural Trade Option Merchant, or on NASD Form U-5, Uniform Termination Notice for
Securities Industry Registration.

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