NATIONAL FUTURES ASSOCIATION
FLOOR TRADER ORDER ENTERER APPLICATION
Instructions for Using the Floor Trader Order Enterer Application
READ THESE INSTRUCTIONS CAREFULLY BEFORE COMPLETING OR REVIEWING THE APPLICATION. THE FAILURE TO ANSWER ALL QUESTIONS COMPLETELY AND ACCURATELY OR THE OMISSION OF REQUIRED INFORMATION MAY RESULT IN THE IMPOSITION OF CRIMINAL PENALTIES.
DEFINED TERMS
Words that are underlined in this form are defined terms and have the meanings contained in the Definition of Terms section.
GENERAL
Read the Instructions and Questions Carefully
A question that is answered incorrectly because it was misread or misinterpreted can result in severe consequences. Although this applies to all questions in the application, it is particularly important to the questions in the Disciplinary Information Section.
Rely Only on Advice from NFA Staff
A question that is answered incorrectly because of advice received from a lawyer, employer, a judge or anyone else (other than a member of NFA’s Registration, Compliance, Legal or Information Center (“RCLI”) departments) can result in severe consequences. This also applies to all questions in the form, but is particularly important regarding the Disciplinary Information Section. If the language of a question in the Disciplinary Information Section requires disclosure of a matter, a “Yes” answer to the question is required no matter what other advice has been received from anyone other than NFA’s RCLI staff. Additionally, the order enterer or registrant remains responsible for failures to disclose even if someone completes the form on the order enterer’s or registrant’s behalf.
Update the Information on the Application
If information provided on the application changes or a matter that would have required disclosure on the application occurs after the application is filed, the new information must be promptly filed. Order Enterers should advise their Floor Traders of the new information, and the Floor Trader must file the update on their behalf. The failure to promptly update information can result in severe consequences.
Compliance with Disclosure Requirements of Another Regulatory Body is not Sufficient
With some exceptions, which are described below in the Regulatory and Financial Disclosures sections, if any question requires the provision of information, that information must be provided. In particular, if a question in the Disciplinary Information Section requires disclosure of a matter, the question must be answered “Yes” and additional documents must be provided even if the matter has been disclosed to another regulatory body such as FINRA, an exchange or a state regulator. Similarly, disclosure is required even if another regulatory body does NOT require disclosure of the same matter.
Call NFA with Questions
If there is any question about whether particular information must be provided, whether a particular matter must be disclosed or whether a particular question requires a “Yes” answer, call the NFA Information Center at (800) 621-3570 or (312) 781-1410. Representatives are available from 8:00 a.m. to 5:00 p.m., Central Time, Monday through Friday. If the advice of NFA staff is sought, a written record containing the date of the conversation, the name of the NFA staff person giving the advice and a description of the advice should be made during the conversation and kept in the event an issue concerning disclosure of the matter arises later.
DISCIPLINARY INFORMATION SECTION
Criminal Disclosures
Some common mistakes in answering the criminal disclosure questions involve expungements, diversion programs and similar processes. The Commodity Futures Trading Commission requires a “Yes” answer even if the matter has been expunged or the records sealed, there was no adjudication or finding of guilt, the guilty plea was vacated or set aside or the matter was dismissed upon completion of the diversion program.
Another common error regarding criminal matters concerns matters that do not involve the futures industry. All criminal matters must be disclosed, even if a matter is unrelated to the futures industry, unless the case was decided in a juvenile court or under a Youth Offender law.
Regulatory Disclosures
Regulatory actions taken by the Commodity Futures Trading Commission, NFA or domestic futures exchanges do not need to be disclosed since NFA is already aware of them once they are entered into NFA’s BASIC system.
Financial Disclosures
It is not necessary to disclose arbitration or CFTC reparations matters unless the Order Enterer has failed to pay an award issued in a futures-related arbitration or an order entered in a reparations matter.
Only adversary actions that a bankruptcy trustee or a trustee’s attorney files must be disclosed. Adversary actions that creditors file are not disclosable. A person named as a party to an adversary action in a bankruptcy proceeding must disclose the action, even if the person is not the bankrupt person.
ADDITIONAL DOCUMENTS
For any matter that caused a “Yes” answer, a written explanation detailing the events and conduct must be provided. That explanation can be entered on the Matter pages by giving it a name, e.g., the docket number of the case and describing it.
In addition to the required explanation, other documents about the matter must be sent to NFA. If court documents are unavailable, a letter from the court verifying that must be sent to NFA. If documents other than court documents are unavailable, the person must provide a written explanation for their unavailability.
Like answering the questions correctly, providing all documents to NFA is important. Failure to do so may result in severe consequences.
DEFINITION OF TERMS (The following terms are defined solely for the purpose of using NFA’s Online Registration System.)
ADJUDICATION: in a criminal case, a determination by the court that the defendant is guilty or not guilty.
ADVERSARY ACTION: a lawsuit arising in or related to a bankruptcy case commenced by a creditor or bankruptcy trustee by filing a complaint with the bankruptcy court.
CHARGE: a formal complaint, information, indictment or equivalent instrument containing an accusation of a crime.
ENJOINED: subject to an injunction.
ENTITY: any person other than an individual.
FELONY: any crime classified as a felony and for states and countries that do not differentiate between a felony or misdemeanor, an offense that could result in imprisonment for any period of more than one year. The term also includes a general court martial.
FINANCIAL SERVICES INDUSTRY: the commodities, securities, accounting, banking, finance, insurance, law or real estate industries.
FOUND: subject to a determination that conduct or a rule violation has occurred. The term applies to dispositions of any type, including but not limited to consent decrees or settlements in which the findings are neither admitted nor denied or in which the findings are for settlement or record purposes only.
INTERNAL REVENUE CODE:
Section 7203: Willful Failure to File Return, Supply Information or Pay Tax
Section 7204: Fraudulent Statement or Failure to Make Statement
Section 7205: Fraudulent Withholding Exemption Certificate or Failure to Supply Information
Section 7207: Fraudulent Returns, Statements or Other Documents
INVESTMENT RELATED STATUTES:
• The Commodity Exchange Act
• The Securities Act of 1933
• The Securities Exchange Act of 1934
• The Public Utility Holding Company Act of 1935
• The Trust Indenture Act of 1939
• The Investment Advisers Act of 1940
• The Investment Company Act of 1940
• The Securities Investors Protection Act of 1970
• The Foreign Corrupt Practices Act of 1977
• Chapter 96 of Title 18 of the United States Code
• Any similar statute of a State or foreign jurisdiction
• Any rule, regulation or order under any such statutes; and
• The rules of the Municipal Securities Rulemaking Board
MISDEMEANOR: any crime classified as a misdemeanor and for states and countries that do not differentiate between a felony or misdemeanor, an offense that could result in imprisonment for any period of at least six days but not more than one year. By way of example, an offense for which the maximum period of imprisonment is 60 days would be considered a misdemeanor. The term also includes a special court martial.
OTHER NAME: any name the person is or has been known by. For example, a maiden name, an alias name that you use or are known by, or a previous name if you have changed your legal name.
PERSON: an individual, association, partnership, corporation, limited liability company, limited liability partnership, trust, or other form of business organization.
PRINCIPAL: an individual who is:
• a sole proprietor of a sole proprietorship; or
• a general partner of a partnership; or
• a director, president, chief executive officer, chief operating officer or chief financial officer of a corpora- tion, limited liability company or limited partnership; or
• in charge of a business unit, division or function of a corporation, limited liability company or limited partner- ship if the unit, division or function is subject to regulation by the Commission; or
• a manager, managing member or a member vested with the management authority for a limited liability company or limited liability partnership; or
• a chief compliance officer; or
• an individual who directly or indirectly, through agreement, holding companies, nominees, trusts or other- wise:
- is the owner of 10% or more of the outstanding shares of any class of a registrant’s stock; or
- is entitled to vote 10% or more of any class of a registrant’s voting securities; or
- has the power to sell or direct the sale of 10% or more of any class of a registrant’s voting securities; or
- has contributed 10% or more of a registrant’s capital; or
- is entitled to receive 10% or more of a registrant’s net profits; or
- has the power to exercise a controlling influence over a registrant’s activities that are subject to regulation by the Commission; or
an entity that:
- is a general partner of a registrant; or
- is the direct owner of 10% or more of any class of a registrant’s securities; or
- has directly contributed 10% or more of a registrant’s capital unless such capital contribution consists of subordinated debt contributed by:
an unaffiliated bank insured by the Federal Deposit Insurance Corporation; or
a United States branch or agency of an unaffiliated foreign bank that is licensed under the laws of the United States and regulated, supervised and examined by United States government authorities having regulatory responsibility for such financial institutions; or
an insurance company subject to regulation by any State.
SELF-REGULATORY ORGANIZATION (SRO): a private, non-governmental organization authorized to set and enforce standards or conduct for an industry. NFA, FINRA (formerly known as NASD) and the securities and futures exchanges in the U.S. are examples of domestic SROs.
UNITED STATES CRIMINAL CODE:
Section 152: Concealment of assets, making false claims or bribery in connection with a bankruptcy
Section
1341,
1342 or 1343: Mail fraud
Chapter 25: Counterfeiting and forgery
Chapter 47: Fraud or false statements in a matter within the jurisdiction of a United States department or agency
Chapter
95
or 96: Racketeering and Racketeering Influence
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. Its normal hours are Monday through Friday, from 8:00 AM to 5:00 PM CT.
NATIONAL FUTURES ASSOCIATION
ORDER ENTERER APPLICATION
Indicate the individual’s full legal name. Do not use nicknames or abbreviations. For example, if the individual’s name is Charles, enter Charles, not Chuck.
First & Middle* Last* Suffix
NFA ID#
Floor Trader Information
Enter Floor Trader information.
Floor Trader*
Personal Information
Enter information.
Residential Address
P.O. Box address is not acceptable.
Street Address1*
Street Address2
Street Address3
City**
State* (US Only) Province
Zip/Postal Code**
Country*
Birth Information
Date of Birth*
City
State* (US Only) Province
Country*
Social Security #
*Required to file application
**Required to file application for United States address
Personal Information (continued)
Fingerprint Card Demographic Information
The following information is used to conduct a criminal background check with the U.S. Federal Bureau of Investigations. The FBI requires this information to be submitted with your fingerprints to perform this check.
Gender* Male Female
Race*
Eye Color*
Hair Color*
Height* feet inch(es)
Weight* pounds
Country of Citizenship
E-mail Address
Other Names
Enter any other name by which you are or have been known.
Other Names
First Name Last Name
First Name Last Name
First Name Last Name
First Name Last Name
*Required to file application
Disciplinary Information - Criminal Disclosures
For additional assistance and information on completing this page, refer to the Instructions and Definition of Terms at the beginning of this document.
ANSWER THE FOLLOWING QUESTIONS. YOU MUST ANSWER “YES” TO THE QUESTIONS ON THIS PAGE EVEN IF:
• ADJUDICATION OF GUILT WAS WITHHELD OR THERE WAS NO CONVICTION; OR
• THERE WAS A CONDITIONAL DISCHARGE OR POST-CONVICTION DISMISSAL AFTER SUCCESSFUL COMPLETION OF A SENTENCE; OR
• A STATE CERTIFICATE OF RELIEF FROM DISABILITIES OR SIMILAR DOCUMENT WAS ISSUED RELIEVING THE HOLDER OF FORFEITURES, DISABILITIES OR BARS RESULTING FROM A CONVICTION; OR
• THE RECORD WAS EXPUNGED OR SEALED; OR
• A PARDON WAS GRANTED.
YOU MAY ANSWER “NO” IF THE CASE WAS DECIDED IN A JUVENILE COURT OR UNDER A YOUTH OFFENDER LAW.
A.* (1) Have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever pled guilty or nolo contendere (“no contest”) to or been convicted or found guilty of any felony in any domestic, foreign or military court?
Yes No
B.* (1) Have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever pled guilty to or been convicted or found guilty of any misdemeanor in any domestic, foreign or military court which involves:
• embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property; or
• violation of sections 7203, 7204, 7205 or 7207 of the Internal Revenue Code of 1986; or
• violation of sections 152, 1341, 1342, or 1343 or chapters 25, 47, 95 or 96 of the United States
Criminal Code; or
• any transaction in or advice concerning futures, options, leverage transactions or securities?
Yes No
C.* (1) Are you personally
OR
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
a party to any action, or is there a charge pending, the resolution of which could result in a “Yes” answer to the above questions?
Yes No
Individuals who have never filed an application for registration in the futures industry must answer this question.
For any “Yes” answer to the questions above, have you previously provided NFA or the CFTC all supplemental documentation for all matters requiring a “Yes” answer?*
Yes No
Would you like to provide details of any criminal matter?
Yes No
*Required to file application
Matter Information - Criminal Disclosures
For each matter for which you have not provided all supporting documentation, you must provide a detailed explanation of the event or conduct. You can enter up to three (3) matters in this document. If you have more than three (3) matters which you must explain, please do so in another document such as Microsoft Word and attach it to this document.
If you must provide a detailed explanation for a matter, the explanation must be in writing and sent to NFA or entered below. The explanation must include:
Matter Name:
(e.g., 1999 Theft Arrest/Charge; 99-CM-105)
When and where the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, classification of the charges, plea and sentencing information, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If you are unable to obtain the documents for the criminal matter, you must provide a letter from the court verifying the documents’ unavailability.
Matter Information - Criminal Disclosures (additional matters, if needed)
Matter Name:
(e.g., 1999 Theft Arrest/Charge; 99-CM-105)
When and where the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, classification of the charges, plea and sentencing information, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If you are unable to obtain the documents for the criminal matter, you must provide a letter from the court verifying the documents’ unavailability.
Matter Information - Criminal Disclosures (additional matters, if needed)
Matter Name:
(e.g., 1999 Theft Arrest/Charge; 99-CM-105)
When and where the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, classification of the charges, plea and sentencing information, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If you are unable to obtain the documents for the criminal matter, you must provide a letter from the court verifying the documents’ unavailability.
Disciplinary Information - Regulatory Disclosures
For additional assistance and information on completing this page, refer to the Instructions and Definition of Terms at the beginning of this document.
Answer the following questions.
D.* In any case brought by a domestic or foreign governmental body (other than the CFTC),
(1) have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever been permanently or temporarily enjoined after a hearing or default or as the result of a settlement, consent decree or other agreement, from engaging in or continuing any activity involving:
• any transaction in or advice concerning futures, options, leverage transactions or securities; or
• embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property?
Yes No
E.* In any case brought by a domestic or foreign governmental body (other than the CFTC),
(1) have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever been found after a hearing or default or as the result of a settlement, consent decree or other agreement, to:
• have violated any provision of any investment-related statute or regulation; or
• have violated any statute, rule, regulation or order which involves embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property; or
• have willfully aided, abetted, counseled, commanded, induced or procured such violation by any other person?
Yes No
F.* (1) Have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever been debarred by any agency of the United States from contracting with the United States? Yes No
*Required to file application
Disciplinary Information - Regulatory Disclosures
For additional assistance and information on completing this page, refer to the Instructions and Definition of Terms at the beginning of this document.
Answer the following questions.
G.* (1) Have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever been the subject of any order issued by or a party to any agreement with a domestic or foreign regulatory authority (other than the CFTC), including but not limited to a licensing authority, or self-regulatory organization (other than NFA or a domestic futures exchange) that prevented or restricted your ability to engage in any business in the financial services industry?
Yes No
H.* Are any of the orders or other agreements decribed in Question G currently in effect against you?
Yes No
I.* (1) Are you personally
OR
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
a party to any action, or is there a charge pending, the resolution of which could result in a “Yes” answer to the above questions?
Yes No
Individuals who have never filed application for registration in the futures industry must answer this question.
For any “Yes” answer to the questions above, have you previously provided NFA or the CFTC all supplemental documentation for all matters requiring a “Yes” answer?*
Yes No
Would you like to provide details of any regulatory matter?
Yes No
*Required to file application
Matter Information - Regulatory Disclosures
For each matter for which you have not provided all supporting documentation, you must provide a detailed explanation of the event or conduct. You can enter up to three (3) matters in this document. If you have more than three (3) matters which you must explain, please do so in another document such as Microsoft Word and attach it to this document.
If you must provide a detailed explanation for a matter, the explanation must be in writing and sent to NFA or entered below. The explanation must include:
Matter Name:
(e.g., March 1999 SEC case; FINRA Case No. CM10034)
When the event occurred, parties involved, case number, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Matter Information - Regulatory Disclosures (additional matters, if needed)
Matter Name:
(e.g., March 1999 SEC case; FINRA Case No. CM10034)
When the event occurred, parties involved, case number, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Matter Information - Regulatory Disclosures (additional matters, if needed)
Matter Name:
(e.g., March 1999 SEC case; FINRA Case No. CM10034)
When the event occurred, parties involved, case number, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Disciplinary Information - Financial Disclosures
For additional assistance and information on completing this page, refer to the Instructions and Definition of Terms at the beginning of this document.
Answer the following questions.
J.* Have you currently failed to comply with any order to pay any futures-related civil monetary penalties, restitution amounts, disgorgement amounts, reparation amounts or arbitration awards?
Yes No
K.* (1) Have you personally
or
(2) has any entity of which you were a principal (based on activities that occurred while you were a principal)
ever been the subject of an adversary action brought by, or on behalf of, a bankruptcy trustee?
Yes No
Individuals who have never filed an application for registration in the futures industry must answer this question.
For any “Yes” answer to the questions above, have you previously provided NFA or the CFTC all supplemental documentation for all matters requiring a “Yes” answer?*
Yes No
Would you like to provide details of any financial matter?
Yes No
*Required to file application
Matter Information - Financial Disclosures
For each matter for which you have not provided all supporting documentation, you must provide a detailed explanation of the event or conduct. You can enter up to three (3) matters in this document. If you have more than three (3) matters which you must explain, please do so in another document such as Microsoft Word and attach it to this document.
If you must provide a detailed explanation for a matter, the explanation must be in writing and sent to NFA or entered below. The explanation must include:
Matter Name:
(e.g., 00-R100 Unpaid Award; 98-0125476 Bankruptcy Denied)
When the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Matter Information - Financial Disclosures (additional matters, if needed)
Matter Name:
(e.g., 00-R100 Unpaid Award; 98-0125476 Bankruptcy Denied)
When the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why
documents are not obtainable.
Matter Information - Financial Disclosures (additional matters, if needed)
Matter Name:
(e.g., 00-R100 Unpaid Award; 98-0125476 Bankruptcy Denied)
When the event occurred, parties involved, circumstances, case number and court jurisdiction, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Disciplinary Information - Employment Disclosures
For additional assistance and information on completing this page, refer to the Instructions and Definition of Terms at the beginning of this document.
Answer the following questions.
L.* Have you ever been discharged or permitted to resign for cause as a result of allegations of:
• embezzlement, theft, extortion, fraud, fraudulent conversion, forgery, counterfeiting, false pretenses, bribery, gambling, racketeering or misappropriation of funds, securities or property; or
• failure to supervise another person in the conduct of such person’s activities as a registrant of the CFTC, SEC, NFA, FINRA or other domestic or foreign self-regulatory organization?
Yes No
Individuals who have never filed an application for registration in the futures industry must answer this question.
For any “Yes” answer to the question above, have you previously provided NFA or the CFTC all supplemental documentation for all matters requiring a “Yes” answer?*
Yes No
Would you like to provide details of any employment matter?
Yes No
*Required to file application
Matter Information - Employment Disclosures
For each matter for which you have not provided all supporting documentation, you must provide a detailed explanation of the event or conduct. You can enter up to three (3) matters in this document. If you have more than three (3) matters which you must explain, please do so in another document such as Microsoft Word and attach it to this document.
If you must provide a detailed explanation for a matter, the explanation must be in writing and sent to NFA or entered below. The explanation must include:
Matter Name:
(e.g., ABC Company Discharge)
When the event occurred, parties involved, circumstances, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Matter Information-Employment Disclosures (additional matters, if needed)
Matter Name:
(e.g., ABC Company Discharge)
When the event occurred, parties involved, circumstances, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Matter Information-Employment Disclosures (additional matters, if needed)
Matter Name:
(e.g., ABC Company Discharge)
When the event occurred, parties involved, circumstances, allegations/charges, and the final disposition.
AND IN ADDITION, YOU MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If you are unable to obtain the documents you must provide an explanation on a separate sheet stating why documents are not obtainable.
Employment and Education History
Enter your employment and personal history, working back 10 years. All time must be accounted for, including self-employment, part-time employment, unemployment, military service and full-time education. There are 10 spaces available to submit this information. If more than 10 spaces are needed, complete the information in another document such as Microsoft Word and attach it to this document.
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
*Required to file application
Employment and Education History (additional spaces, if needed)
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
*Required to file application
Employment and Education History (additional spaces, if needed)
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
Month/Year Employment/School
From*: Name*:
To: Location:
(city, state or country)
Position Held and
Reason for Leaving:
*Required to file application
Residential History
List your past residential addresses, working back five (5) years. Post office box address is not acceptable. There are five (5) spaces available to submit this information. If more than five (5) spaces are needed, complete the information in another document such as Microsoft Word and attach it to this document.
Month/Year Address
From*:
To:
Month/Year Address
From*:
To:
Month/Year Address
From*:
To:
Month/Year Address
From*:
To:
Month/Year Address
From*:
To:
*Required to file application
Privacy Act and Paperwork Reduction Act Notice
OMB# 3038-0072
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 2c, 4f, 4k, 4n, 4s, 8a and 19 of the Commodity Exchange Act [7 U.S.C. §§ 6f, 6k, 6n, 6s, 12a and 23]. Under Section 2c, it is unlawful for anyone to engage in off-exchange foreign currency futures transactions or off-exchange foreign currency leveraged, margined or financed transactions with persons who are not eligible contract participants without registration, or exemption from registration, as a retail foreign exchange dealer, futures commission merchant, introducing broker, commodity pool operator or commodity trading advisor, as appropriate. 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 4s of the Commodity Exchange Act [7 U.S.C. §6s], it is unlawful for anyone to act as a swap dealer or major swap participant without being registered in that capacity under the Act. 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, swap dealer, major swap participant, retail foreign exchange dealer, introducing broker, commodity trading advisor, commodity pool operator, leverage transaction merchant or non-natural person floor trader. 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 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 an 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 Form 3-R 0.1 hours
FCM 0.5 hours IB 0.4 hours Form 7-W 0.1 hours
SD 1.0 hour CPO 0.4 hours Form 8-R 0.8 hours
MSP 1.0 hour CTA 0.4 hours Form 8-T 0.2 hours
RFED 0.5 hours FT 0.5 hours Form 8-W 0.1 hours
Floor Trader Agreement
BY FILING THIS FORM 8-R, THE SPONSOR AGREES THAT SUCH FILING CONSTITUTES THE FLOOR TRADER’S
certification that the Form 8-R is, to the best of the floor trader's knowledge, information and belief, true, complete and accurate and that in light of the circumstances under which the sponsor has given them, the answers and statements in the Form 8-R are not misleading in any material respect;
certification that the order enterer has authorized the floor trader to file the Form 8-R on the order enterer's behalf and that the floor trader has authorized the person who files the application to file the Form 8-R and to make the certifications, acknowledgements, authorizations, representations, requests and agreements contained in this Rule;
acknowledgement that the floor trader 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 it made in the Form 8-R;
acknowledgement that while the individual is responsible for entering orders for the floor trader's own account, the floor trader is responsible for maintaining the information in the Form 8-R in a complete, accurate and current manner by filing updates to the information contained therein;
acknowledgement that information contained in the Form 8-R has been supplied to the floor trader for the sole purpose of allowing it to verify the information contained in the Form 8-R; and
representation that the floor trader has taken, and will take, such measures as are necessary to prevent the unwarranted dissemination of any of the information contained in the Form 8-R and the records and documents retained in support of the Form 8-R.
Floor Trader Order Enterer Agreement
BY FILING THIS VERIFICATION, THE ORDER ENTERER OR PRINCIPAL AGREES THAT SUCH FILING CONSTITUTES THE ORDER ENTERER'S
verification that the answers and statements in the application or Form 8-R are true, complete and accurate and that in light of the circumstances under which the order enterer has given them, the answers and statements in the Form 8-R are not misleading in any material respect;
acknowledgement that the order enterer is subject to the imposition of criminal penalties under Section 9(b) of the Act and 18 U.S.C. §1001 for any false statements or omissions made in the Form 8-R;
acknowledgement that the order enterer is responsible at all times for maintaining the information in the Form 8-R in a complete, accurate and current manner by promptly notifying the floor trader whenever any of the information on the Form 8-R is no longer complete, accurate or current and authorizing the floor trader to file updates to correct the information;
acknowledgement that the residential address provided on the Form 8-R may be deemed to be the address for delivery to the order enterer or principal of any written communications from the Commission and NFA, including any summons, complaint, reparations claim, arbitration claim, order, subpoena, request for information, or any other written communication unless the order enterer or principal specifies another address for this purpose;
authorization that NFA may conduct a background investigation of the order enterer and agreement to cooperate promptly and fully, consistent with applicable Federal law, in such investigation, which may include contacting foreign regulatory and law enforcement authorities, including the submission of documents and information to NFA that NFA, in its discretion, may require in connection with such background investigation;
authorization and request that any person, including but not limited to contract markets, or foreign regulatory or law enforcement agencies, furnish upon request to NFA or any agent acting on behalf of NFA any information requested by NFA in connection with any such background investigation conducted by NFA; and
agreement that any person furnishing information to NFA or any agent acting on behalf of NFA in connection with the investigation so authorized is released from any and all liability of whatever nature by reason of furnishing such information to NFA or any agent acting on behalf of NFA;
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |