Form TA-1 Form TA-1 Transfer Agent Registration and Amendment Form

Board of Governors of the Federal Reserve System OMB Number 7100-0099 Approval expires December 31, 2019
Federal Deposit Insurance Corporation
OMB Number 3064-0026 Approval expires December 31, 2019
Office of the Comptroller of the Currency
OMB Number 1557-0124 Approval expires December 31, 2019
Page 1 of 3

Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of the Comptroller of the Currency

Transfer Agent Registration and Amendment Form—Form TA-1
Under Sections 17(a)(3), 17A(c), and 23(a) of the Act and the
rules and regulations thereunder, the ARA's are authorized to
solicit from applicants for registration as a transfer agent and
from registered transfer agents the information required to be
supplied by Form TA-1. Disclosure to the ARA of the information
requested in Form TA-1 is a prerequisite to the processing of
Form TA-1.
The information will be used for the principal purpose of
determining whether the ARA should allow an application for

registration to become effective or should deny, accelerate, or
postpone registration to an applicant.
Information supplied on this form will be available for inspection
by any interested person.
An agency may not conduct or sponsor, and an organization (or a
person) is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.

Public reporting for this collection of information is estimated to average 1.25 hours per registration, and 10 minutes per updating amendment, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW,
Washington, DC 20551; or Assistant Executive Secretary, Federal Deposit Insurance Corporation, Washington, DC 20429; or Legislative and Regulatory Activities Division, Office of the
Comptroller of the Currency, Washington, DC 20219; and to the Office of Management and Budget, ATTN: Paperwork Reduction Project (7100-0099, 1557-0124, 3064-0026), Washington,
DC 20503.
1/2017

Form TA-1
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For Official Use Only
Reg/File Number

Transfer Agent Registration and Amendment Form
Please print or type all responses. Read all instructions before completing the form. Applicant must complete all information if
registering as a transfer agent. For amendments, registrant must identify itself and the filing by answering questions 1 through 3.
Thereafter, only answer questions that require amendment in addition to providing the name and signature of the person responsible,
and the date (questions 14-16). Detailed guidance for each item on Form TA-1 appears in Part II (Special Instructions) of the
instructions for Form TA-1.
1. Appropriate Regulatory Agency (check one):

2. Filing Status of this form (check one):

Board of Governors of the Federal Reserve System

Registration

Federal Deposit Insurance Corporation

Amendment to Registration

Office of the Comptroller of the Currency

3. Full name of Registrant organization:

4. Financial Industry Number Standard (FINS) Number:

Full Name

Previous Name (if being amended for name change)

6. Mailing Address:

5. Main Office Location of Registrant:
Street Address

City

Street Address

State

Zip Code

7. Telephone Number:

City

State

Zip Code

8. Registrant Principal Location where Transfer Agent
Processing Activities are:

Area Code / Phone Number
Street Address

City

State

Zip Code

State

Zip Code

State

Zip Code

9. List all other Registrant locations where Transfer Agent Processing Activities are conducted.
(Locations different from responses to questions 5 and 8 above):
Street Address

City

Street Address

State

Zip Code

Street Address

City

City

Street Address

State

Zip Code

City

09/2016

Form TA-1
Page 3 of 3

Transfer Agent Registration and Amendment Form—Continued
10. Does Registrant act (or will it act) as a transfer agent solely for its own securities and/or securities of an affiliate(s)?
Yes

No

11. Has the Registrant contracted to have an outside organization perform transfer agent functions in the Registrant's name?
("Private Label" Servicing)
Yes

No

If Yes, list the name(s) of Private Label Transfer Agents:

Appropriate Regulatory Agency (ARA)
Assigned Registered Transfer Agent Number
8

8

-

8

-

12. Does the Registrant perform any private label transfer agent services for another Registered Transfer Agent?
Yes

No
Appropriate Regulatory Agency (ARA)
Assigned Registered Transfer Agent Number
8

If Yes, list the name(s) of the Named Transfer Agents:

8

-

8

-

8

-

8

-

13. Execution: The Registrant submitting this form, and the person executing it, hereby represent that all the information contained
herein is true, correct, and complete.
Attention: Intentional misstatements or omissions of fact constitute federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C.
78ff(a).

14. Full name of official responsible for form (print or type):
First Name

Middle Name

14.a. Title of official responsible for form:
Title

15.
Last Name

Signature of Official Responsible for form

16.
Date (MM/DD/YYYY)

07/2013