Form SEC 2084 SEC 2084 Form ID

United States

Securities and Exchange Commission

Washington, D.C. 20549

Form ID

OMB APPROVAL
OMB Number:
3235-0328
Expires:
June 30, 2011
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hours per response . . ... . . .....0.15

UNIFORM APPLICATION FOR ACCESS CODES TO FILE ON EDGAR
PART I - APPLICATION FOR ACCESS CODES TO FILE EDGAR
Name of applicant (applicant’s name as specified in its charter, except, if individual, last name, first name,
middle name, suffix (e.g., “Jr.”)

Mailing Address or Post Office Box No.
City

State or Country

Zip

Telephone number ( Include Area and, if Foreign, Country Code)
Applicant is (see definitions in the General Instructions)

Filer

Filing Agent

Training Agent

Transfer Agent

Individual (if you check this
box, you must also check
either Filer, Filing Agent or
Training Agent box)

PART II - FILER INFORMATION (To be completed only by filers that are not individuals)

Filer’s Tax Number or Federal Indentification
Number (Do Not Enter a Social Security
Number)

Doing Business As
Foreign Name (if Foreign Issuer Filer and applicable)

Primary Business Address or Post Office Box No. ( if different from mailing address)
City

State or Country

State of Incorporation

Zip

Fiscal Year End (mm/yy)

PART III - CONTACT INFORMATION (To be completed by all applicants)
Person to receive EDGAR Information, Inquiries and Access Codes

Telephone Number (Include Area, and, if foreign, Country Code)

Mailing Address or Post Office Box No. ( if different from applicant’s mailing address)

City

State or Country

Zip

E-Mail Address
SEC 2084 (03-09)
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Persons who respond to the collection of information contained in this form are not required
to respond unless the form displays a currently valid OMB control number.

PART IV -ACCOUNT INFORMATION(To be completed by filers and filing agents only)
Person to receive SEC Account Information and

Telephone Number (Include Area and, if Foreign,

Billing Invoices

Country Code)

Mailing Address or Post Office Box No. ( if different from applicant’s mailing address)
City

State or County

Zip

PART V - SIGNATURE (To be Completed by all Applicants)
Signature:

Type or Print Name:

Position or Title:

Date:
Intentional misstatements or omissions of facts constitute federal criminal violations.
See 18 U.S.C. 1001.
Section 19(a) of the Securities Act of 1933 (15 U.S.C. 77s(a)), sections 13(a) and 23(a) of the Securities Exchange Act of
1934 (15 U.S.C. 78m(a) and 78w(a)), section 319 of the Trust Indenture Act of 1939 (15 U.S.C. 77sss), section 20 of the
Public Utility Holding Company Act of 1935 (15 U.S.C. 79t) and sections 30 and 38 of the Investment Company Act of 1940
(15 U.S.C. 80a-29 and 80a-37) authorize solicitation of this information. We will use this information to assign system
identification to filers, filing agents, and training agents. This will allow the Commission to identify persons sending
electronic submissions and grant secure access to the EDGAR system.

FORM ID
GENERAL INSTRUCTIONS
USING AND PREPARING FORM ID
Form ID must be filed by registrants, third party filers, or their agents, to whom the Commission previously has not
assigned a Central Index Key (CIK) code, to request the following access codes to permit filing on EDGAR:

·

·
·
·

Central Index Key (CIK) - The CIK uniquely identifies each filer, filing agent, and training agent. We
assign the CIK at the time you make an initial application. You may not change this code. The CIK is
a public number.
CIK Confirmation Code (CCC) - You will use the CCC in the header of your filings in conjunction
with your CIK to ensure that you authorized the filing.
Password (PW) - The PW allows you to log onto the EDGAR system, submit filings, and change your
CCC.
Password Modification Authorization Code (PMAC) - The PMAC allows you to change your pass­
word.

An applicant must file this Form in electronic format via the Commission’s EDGAR Filer Management website. Please see
Regulation S-T (17 CFR Part 232) and the EDGAR Filer Manual for instructions on how to file electronically, including how
to use the access codes.

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The applicant must complete the Form ID electronic filing by also submitting to the Commission a copy of a notarized
paper “authenticating” document. The authenticating document must include the information required to be included in the Form ID
filing, be manually signed by the applicant over the applicant’s typed signature, and confirm the authenticity of the Form ID filing.
Applicants may fulfill the authenticating document requirement by making a copy of the applicant’s electronic Form ID filing, adding
the necessary confirming language, signing it, and having the signature notarized.
If the applicant has prepared the authenticating document before making its electronic Form ID filing, it may submit the
document as an uploaded Portable Document Format (PDF) attachment to the electronic filing. An applicant also may submit the
authenticating document by faxing it to the Commission at (202) 504-2474 or (703) 914-4240 within two business days before or after
its electronic Form ID filing. If submitted by fax after the electronic Form ID filing, the authenticating document must contain the
accession number assigned to the electronic Form ID filing. If the fax is not received timely, the Form ID filing and application for
access codes will not be processed, and the applicant will receive an e-mail message at the contact e-mail address included in the Form
ID filing informing the applicant of the failure to process and providing further guidance. The message will state why the application
was not processed.
For assistance with technical questions about electronic filing, call Filer Support at (202) 551-8900. For assistance with
questions about the EDGAR rules, Division of Corporation Finance filers may call the Office of Information Technology at (202) 551­
3600; and Division of Investment Management filers may call the IM EDGAR Inquiry Line at (202) 551-6989.

You must complete all items in any parts that apply to you. If any item in any part does not apply to you, please
leave it blank.
PART I - APPLICANT INFORMATION (to be completed by all applicants)
Provide the applicant’s name in English.
Please check one of the boxes to indicate whether you will be sending electronic submissions as a filer, filing agent, or
training agent. Mark only one of these boxes per application. If you are an individual, however, also mark the “Indi­
vidual” box.
·

“Filer” - Any individual or entity on whose behalf an electronic filing is made.

·

“Filing Agent” - A financial printer, law firm, or other party, which will be using these access codes to
send a filing or portion of a filing on behalf of a filer.

·

“Training Agent” - Any individual or entity that will be sending only test filings in conjunction with
training other persons.

·

“Transfer Agent”- Any individual or entity planning to register as a Transfer Agent on whose behalf an
electronic filing is made.

·

“Individual” – A natural person.

PART II - FILER INFORMATION (to be completed only by filers that are not individuals)
The filer’s tax or federal identification number is the number issued by the Internal Revenue Service. This section does
not apply to individuals. Accordingly, do not enter a Social Security number. If an investment company filer is organized
as a series company, the investment company may use the tax or federal identification number of any one of its constitu­
ent series. Issuers that have applied for but not yet received their tax or federal identification number and foreign issuers
that do not have a tax or federal identification number must include all zeroes. A “foreign issuer” is an entity so defined
by Securities Act of 1933 (15 U.S.C. 77a et seq.) Rule 405 (17 CFR 230.405) and Securities Exchange Act of 1934 (15 U.S.C.
78a et seq.) Rule 3b-4(b) (17 CFR 240.3b-4(b)). Foreign issuers should include their country of organization.

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A foreign issuer filer must provide its “doing business as” name in the language of the name under which it does busi­
ness and must provide its foreign language name, if any, in the space so marked.
If the filer’s fiscal year does not end on the same date each year (e.g., falls on the last Saturday in December), the filer
must enter the date the current fiscal year will end.

PART III - CONTACT INFORMATION (to be completed by all applicants)
In this section, identify the individual who should receive the access codes and other EDGAR-related information.
Please include an e-mail address that will become your default notification address for EDGAR filings; it will be stored
in the Company Contact Information on the EDGAR Database. EDGAR will send all subsequent filing notifications
automatically to that address. You can have one e-mail address in the EDGAR Company Contact Information. For
information on including additional e-mail addresses on a per filing basis, refer to Volume 1, Section 3.2.2 of the EDGAR
Filer Manual.

PART IV - ACCOUNT INFORMATION (to be completed by filers and filing agents only)

Identify in this section the individual who should receive account information and/or billing invoices from us. We will
use this information to process electronically fee payments and billings. If the address changes, update it via the
EDGAR filing website, or your account statements may be returned to us as undeliverable.

PART V - SIGNATURE (to be completed by all applicants)
If the applicant is a corporation, partnership, trust or other entity, state the capacity in which the representative indi­
vidual, who must be duly authorized, signs the Form on behalf of the applicant.
If the applicant is an individual, the applicant must sign the form.
If another person signs on behalf of the representative individual or the individual applicant, confirm the authority of the
other person to sign in writing in an electronic attachment to the Form. The confirming statement need only indicate that
the representative individual or individual applicant authorizes and designates the named person or persons to file the
Form on behalf of the applicant and state the duration of the authorization.

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