Form 7-R Firm Application

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Firm Name*
NF
A ID#*
NFA

Registration Categories and Membership Information
Check category(ies).
Registration Categories*
Futures Commission Merchant
Introducing Broker
Commodity TTrading
rading Advisor

Commodity Pool Operator
NFA
NF
A Member

Only applicants for NF
A Membership that are also applying for more than one CFTC category
NFA
complete this section. Select one.
Membership Information*
Indicate the category in which the applicant intends to vote on NF
A membership matters.
NFA
Futures Commission Merchant
Introducing Broker
Commodity TTrading
rading Advisor
Commodity Pool Operator

Only applicants for NF
A Membership that are applying as FCMs complete this section.
NFA
Is the applicant a member or has the applicant applied for membership at any United States
commodity exchange?
Yes

No

*Required to file application

-5-

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Business Information
Enter Information. A sole proprietor may use a P
.O. Box address if the business is located in the sole proprietor’
P.O.
proprietor’ss
residence and a complete residential address is provided on the individual application.
For all others, a P
.O. Box address is not acceptable.
P.O.

Business Address
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number*
E-Mail Address
Web Site/URL
Federal EIN
CRD/IARD ID
Applicant’
Applicant’ss Form of Organization*
Sole Proprietorship (Individual)
Partnership
Corporation

Limited Liability Company
Limited Liability Partnership
Trust

Where is the entity incorporated, organized or established: (Sole proprietors do not need to
answer this question.*
State
Country
*Required to file application
**Required to file application for United States address
-6-

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Other Names
Enter any other name the applicant does or has done business as.

Other Names
Name

In Use

Not In Use

Name

In Use

Not In Use

Name
Name

In Use

Not In Use

In Use

Not In Use

Location of Business Records
Only domestic applicants complete this section.
Enter the location of the applicant’
applicant’ss business records and those records required to be kept by regulation under the
Commodity Exchange Act. If the applicant is applying as a CPO or CT
A, this address must be the same as the business
CTA,
address (unless the CFTC has granted an exemption to the applicant). P
.O. Box address is not acceptable.
P.O.

Street Address1*
Street Address2
Street Address3
City*
State*
Zip/Postal Code*
Only foreign applicants complete this section. Select one.
Enter the location of the firm’
firm’ss business records and those records required to be kept by regulation under the
Commodity Exchange Act. If the firm is a CPO or CT
A, this address must be the same as the business address (unless the
CTA,
CFTC has granted an exemption to the firm).

P.O. Box address is not acceptable.
Street Address1*
Street Address2
Street Address3
City**
State*
Province
Zip/Postal Code**
Country*
*Required to file application
**Required to file application for United States address

- continued on next page -7-

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Location of Business Records
Enter the location in the U.S. where the applicant’
A.
applicant’ss books and records will be produced for inspection by the CFTC and NF
NFA.
The office of NF
A located in New YYork,
ork, NY
NFA
The office of NFA located in Chicago, IL

T he following address (P
.O. Box address is not acceptable):
(P.O.
Office of*
Street Address1*
Street Address2
Street Address3
City*
State*
Zip/Postal Code*

*Required to file application
-8-

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Holding Company’
Company’ss Information
Enter the full name of any holding company
company.. If none, continue on to the next section. It is important
A will assign an NF
A ID number to the
that the full name of the holding company is entered. NF
NFA
NFA
holding company if one has not already been assigned. An incorrect name could cause a delay in the
application process.
Full Name

10% or More Interest
Yes

No

Yes

No

Yes

No

Yes

No

Branch Office Information
You can enter up to three (3) branch offices in this document. If you have more than three (3) branch
offices, please add them in another document such as Microsoft Word and attach it to this
document.If none, continue on to the next section.
Branch ID
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
*Required to file application
*Required to file application for United States address

- continued on next page -9-

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Branch Office Information (additional spaces, if needed)
Branch ID
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
Branch ID
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
*Required to file application
**Required to file application for United States address
- 10 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Non-U.S. Regulator Information
Enter the name of each non-U.S. financial services industry regulatory authority or self-regulatory
organization that has regulated the applicant during the past five (5) years.
List of Non-U.S. Regulators

- 11 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Disciplinary Information - Criminal Disclosures
For additional assistance and information on completing this page, refer to the
Instructions and Definition of TTerms
erms at the beginning of this document.
Answer the following questions. The applicant must answer “Y
es” to the questions on
“Yes”
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.

The applicant may answer “no” if the case was decided in a juvenile court or under a
Youth Offender Law
Law..
A.*
Has the applicant 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
B.*

No

Has the applicant 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
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
1986;; or
• violation of sections 152, 1341, 1342, or 1343 or chapters 25, 47, 95 or 96 of the United States
Criminal Code
Code;; or
• any transaction in or advice concerning futures, options, leverage transactions or
securities?

Yes
C.*

No

Is the applicant a party to any action, or is there a charge pending, the resolution of which
could result in a “Y
es” answer to the above questions?
“Yes”
Yes
No

Except applicants that are filing their first application for registration in the futures industry
industry,, all
applicants must answer this question.
For any “Y
es” answer to the questions above, has the applicant previously provided NF
A or the
“Yes”
NFA
CFTC all supplemental documentation for all matters requiring a “Y
es” answer?*
“Yes”
Yes
No
Would you like to provide details of any criminal matter?
Yes
*Required to file application

No
- 12 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Criminal Disclosures
For each matter for which the applicant has not provided all supporting documentation,
provide a detailed explanation of the event or conduct. YYou
ou 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
matter,, the explanation must be in
writing and sent to NF
A or entered below
NFA
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
allegations/charges
charges,, classification of the charges
charges,, plea and sentencing information,
and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges
charges;;
);
• the classification of the offense, (i.e., felony or misdemeanor
misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter
matter,, it must provide a letter
from the court verifying the documents’ unavailability
unavailability..
- 13 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
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
allegations/charges
charges,, classification of the charges
charges,, plea and sentencing information,
and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges
charges;;
);
• the classification of the offense, (i.e., felony or misdemeanor
misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter
matter,, it must provide a letter
from the court verifying the documents’ unavailability
unavailability..

- 14 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
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
allegations/charges
charges,, classification of the charges
charges,, plea and sentencing information,
and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges
charges;;
);
• the classification of the offense, (i.e., felony or misdemeanor
misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter
matter,, it must provide a letter
from the court verifying the documents’ unavailability
unavailability..

- 15 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Disciplinary Information - Regulatory Questions
For additional assistance and information on completing this page, refer to the Instructions and
Definition of TTerms
erms 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), has the applicant
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
bribery,, gambling, racketeering or misappropriation of funds, securities or
property?

Yes
E.*

In any case brought by a domestic or foreign governmental body (other than the CFTC), has the applicant
ever been found
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
forgery,, counterfeiting, false pretenses, bribery
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
F.*

No

Has the applicant ever been debarred by any agency of the United States from contracting with the United
States?

Yes
G.*

No

No

Has the applicant 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 selfregulatory organization (other than NFA or a domestic futures exchange) that prevented or restricted the
applicant’
applicant’ss ability to engage in any business in the financial services industry
industry??

Yes

No
-continued on next page-

*Required to file application
- 16 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Disciplinary Information - Regulatory Questions
For additional assistance and information on completing this page, refer to the Instructions and
Definition of TTerms
erms at the beginning of this document.
Answer the following questions.
H.*

Are any of the orders or other agreements decribed in Question G currently in effect against the applicant?

Yes
I.*

No

Is the applicant a party to any action, or is there a charge pending, the resolution of which could result in a
“Y
es” answer to the above questions?
“Yes”

Yes

No

Except applicants that are filing their first application for registration in the futures industry
industry,, all
applicants must answer this question.
For any “Y
es” answer to the questions above, has the applicant previously provided NF
A or the
“Yes”
NFA
CFTC all supplemental documentation for all matters requiring a “Y
es” answer?*
“Yes”
Yes

No

Would you like to provide details of any regulatory matter?
Yes

No

*Required to file application
- 17 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Regulatory Questions
For each matter for which the applicant has not provided all supporting documentation,
provide a detailed explanation of the event or conduct. YYou
ou 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 the applicant must provide a detailed explanation for a matter
matter,, the explanation must be
A or entered below
NFA
below.. The explanation must include:
in writing and sent to NF
Matter Name:
(e.g., March 1999 SEC case; NASD Case No. CM10034)
When the event occurred, parties involved, case number
number,, allegations/charges, and the final
disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 18 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Regulatory Questions (additional matters, if needed)
Matter Name:
(e.g., March 1999 SEC case; NASD Case No. CM10034)
When the event occurred, parties involved, case number
number,, allegations/charges, and the final
disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 19 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Regulatory Questions (additional matters, if needed)
Matter Name:
(e.g., March 1999 SEC case; NASD Case No. CM10034)
When the event occurred, parties involved, case number
number,, allegations/charges, and the final
disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 20 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Disciplinary Information - Financial Questions
For additional assistance and information on completing this page, refer to the Instructions and
Definition of TTerms
erms at the beginning of this document.
Answer the following questions.
J.*

Has the applicant ever been the subject of an adversary action brought by, or on behalf of, a bankruptcy
trustee?

Yes

No

Except applicants that are filing their first application for registration in the futures industry
industry,, all
applicants must answer this question.
For any “Y
es” answer to the question above, has the applicant previously provided NF
A or the
“Yes”
NFA
CFTC all supplemental documentation for all matters requiring a “Y
es” answer?*
“Yes”
Yes

No

Would you like to provide details of any financial matter?
Yes

No

*Required to file application
- 21 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Financial Questions
For each matter for which the applicant has not provided all supporting documentation,
provide a detailed explanation of the event or conduct. YYou
ou 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 the applicant must provide a detailed explanation for a matter
matter,, the explanation must be
A or entered below
NFA
below.. The explanation must include:
in writing and sent to NF
Matter Name:
(e.g., 00-R100 Unpaid A
ward; 98-0125476 Bankruptcy Denied)
Award;
When the event occurred, parties involved, circumstances, case number and court jurisdiction,
allegations/charges, and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 22 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Financial Questions

(additional matters, if needed)

Matter Name:
(e.g., 00-R100 Unpaid A
ward; 98-0125476 Bankruptcy Denied)
Award;
When the event occurred, parties involved, circumstances, case number and court jurisdiction,
allegations/charges, and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 23 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Matter Information - Financial Questions

(additional matters, if needed)

Matter Name:
(e.g., 00-R100 Unpaid A
ward; 98-0125476 Bankruptcy Denied)
Award;
When the event occurred, parties involved, circumstances, case number and court jurisdiction,
allegations/charges, and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of documentation which show:
• the allegations;
• the final disposition.
If the applicant is unable to obtain the documents it must provide an explanation on a separate
sheet stating why documents are not obtainable.

- 24 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
All applicants complete this section.
Enter the individual to whom all registration data and inquiries are to be directed.

Registration Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number
E-Mail Address
- continued on next page -

*Required to file application
**Required to file application for United States address
- 25 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
Only applicants for NF
A Membership complete this section.
NFA
Enter the individual to whom all membership communications and inquiries are to be directed.

Membership Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
- continued on next page -

*Required to file application
**Required to file application for United States address
- 26 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
Only applicants for NF
A Membership complete this section.
NFA
Enter the individual to whom all accounting inquiries and other miscellaneous inquiries are to be
directed.

Accounting Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
- continued on next page -

*Required to file application
**Required to file application for United States address
- 27 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
Only applicants for NF
A Membership that are applying as FCMs complete this section.
NFA
Enter the individual to whom all assessment fee inquiries are to be directed.

Assessment Fee Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
- continued on next page -

*Required to file application
**Required to file application for United States address
- 28 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
Only applicants for NF
A Membership complete this section.
NFA
Enter the individual to whom all arbitration matters are to be directed.

Arbitration Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address
- continued on next page -

*Required to file application
**Required to file application for United States address
- 29 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
Only applicants for NF
A Membership complete this section.
NFA
Enter the individual to whom all compliance inquiries are to be directed.

Compliance Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number
Fax Number
E-Mail Address

*Required to file application
**Required to file application for United States address
- 30 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
All applicants complete this section.
Enter the information to identify the contact person to whom all enforcement and compliance
communications and inquiries from the CFTC are to be directed. YYou
ou can enter up to three (3)
enforcement/compliance contacts in this document. If you have more than three (3), please add them
in another document such as Microsoft Word and attach it to this document.

Enforcement/Compliance Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number
E-Mail Address*
Confirm E-Mail Address*

*Required to file application
**Required to file application for United States address
- 31 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
All applicants complete this section.
Enter the information to identify the contact person to whom all enforcement and compliance
communications and inquiries from the CFTC are to be directed. YYou
ou can enter up to three (3)
enforcement/compliance contacts in this document. If you have more than three (3), please add them
in another document such as Microsoft Word and attach it to this document.

Enforcement/Compliance Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number
E-Mail Address*
Confirm E-Mail Address*

*Required to file application
**Required to file application for United States address
- 32 -

TEMPLA
TE: DO NOT SEND TO NF
A
TEMPLATE:
NFA
NATIONAL FUTURES ASSOCIATION
FIRM APPLICATION
Contact Information
All applicants complete this section.
Enter the information to identify the contact person to whom all enforcement and compliance
communications and inquiries from the CFTC are to be directed. YYou
ou can enter up to three (3)
enforcement/compliance contacts in this document. If you have more than three (3), please add them
in another document such as Microsoft Word and attach it to this document.

Enforcement/Compliance Contact
First Name*
Last Name*
Title
Street Address1*
Street Address2
Street Address3
City**
State* (US Only)
Province
Zip/Postal Code**
Country*
Phone Number*
Fax Number
E-Mail Address*
Confirm E-Mail Address*

*Required to file application
**Required to file application for United States address
- 33 -