Form SBSE-C Form SBSE-C

Form SBSE-C

OMB Approval
OMB Number: .....3235-____
Expires:...... ..Month __, 2014
Estimated average burden hours
per response: . . . . . . . _____.
per amendment: . . . . . _____.

Certification for
Registration of Security-based
Swap Dealers and Major Securitybased Swap Participants

FORM SBSE-C INSTRUCTIONS

A. GENERAL INSTRUCTIONS
1. Each security-based swap dealer and major security-based swap participant must file Form SBSE-C to apply for ongoing
registration.
2. ELECTRONIC FILING – The applicant must file Form SBSE-C through the EDGAR system, and must utilize the EDGAR
Filer Manual (as defined in 17 CFR 232. 11) to file and amend Form SBSE-C electronically to assure the timely
acceptance and processing of those filings.1
3. All fields requiring a response must be complete before the filing is accepted.
The mailing address for questions and correspondence is:

FEDERAL INFORMATION LAW AND REQUIREMENTS – SEC’s Collection of Information
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid control number. Sections 15F, 17(a) and 23(a) of the Exchange Act authorize the SEC to collect the information on
this form from registrants. See 15 U.S.C. §§78o, 78o-4, 78o-5, 78q and 78w. Filing of this Form is mandatory. The principal
purpose of this Form is to permit the Commission to determine whether it is in the public interest to approve or disapprove the
application for ongoing registration by the security-based swap dealer or major security-based swap participant. The Commission
maintains a file of the information on this Form and will make the information publicly available. Any member of the public may
direct to the Commission any comments concerning the accuracy of the burden estimate on this Form, and any suggestions for
reducing this burden. This collection of information has been reviewed by the Office of Management and Budget in accordance
with the clearance requirements of 44 U.S.C. §3507. The information contained in this Form is part of a system of records subject
to the Privacy Act of 1974, as amended. The Securities and Exchange Commission has published in the Federal Register the
Privacy Act Systems of Records Notice for these records.

1

As discussed in the release proposing this Form, the Commission is currently developing a system to facilitate
receipt of applications electronically. More specific instructions on how to file this Form may be included in the final
version of the Form.

FORM SBSE-C

Instructions:

Applicant Name: _________________________________
Date:__________

Official Use

SEC Filer No: _________

This certification must be signed by a knowledgeable senior officer of the applicant.

I certify that, after due inquiry, I have reasonably determined that the applicant (1) has the operational, financial, and compliance capabilities to act as a security-based swap dealer or major securitybased swap participant, as applicable, and
(2) I have documented the process by which I reached such determination.

Applicant Name:

Date:

Signature of Knowledgeable Senior Officer:

Name of Knowledgeable Senior Officer:
Title of Knowledgeable Senior Officer