Form SEC-1920 Form T-4

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20459

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FORM T-4

(Name of applicant)

(Address of principal executive offices)

(Name and address of agent for service)
GENERAL INSTRUCTIONS
1.

Rule as to use of Form T-4.

Form T-4 shall be used for applications for exemption filed pursuant to Section 304(c) of the
Trust Indenture Act of 1939.
2.

General Rules and Regulations

The General Rules and Regulations under the Act contain provisions governing applications on
this Form. Attention is particularly directed to Rules 0-1 [17 CFR 260.0-1] and 0-2 [260.0-2], the
rules under Section 304(c) of the Act, and article 2 of the rules under Section 307 of the Act.
3.

Incorporation by reference.

Attention is directed to Rules 7a-28 [17 CFR 260.7a-28] to 7a-32 [17 CFR 260.7a-32], inclusive,
regarding incorporation by reference. In addition to matter which may be incorporated by
reference pursuant to Rules 7a-28 [17 CFR 260.7a-28] and 7a-29 [17 CFR 260.7a-29], the
applicant may incorporate by reference, in answer to any item of the Form, any item or items of a
registration statement, or application for qualification of an indenture, filed with the
Commission.

SEC 1920 (1-07)

Potential persons who are to 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.

FORM T-4
Items 1 to 6, inclusive, may be entirely omitted if exemption is not applied for pursuant to
Section 304(c)(1).
1.

Give the title of the securities the exemption of which is applied for pursuant to Section
304(c)(1) of the Act and identify the indenture or supplemental indenture under which
issued or to be issued.

Instruction — Item 1. If the securities are to be issued under a supplemental indenture which has
not yet been executed, a statement to that effect shall be made.
2.

Indicate each provision of the Act from which the applicant applies for exemption of the
securities referred to in Item 1.

3.

Identify each indenture or agreement which would require the consent of the holders of
securities outstanding thereunder to compliance with any provision or provisions of the Act
and give the title of each class of securities issued and presently outstanding thereunder.

4.

With respect to each provision of the Act indicated in item 2, outline briefly and concisely
the provisions of each indenture or agreement identified in answer to item 3 which requires
the consent of the holders of securities outstanding thereunder to compliance with such
provision of the Act.

5.

With respect to each provision of the Act indicated in item 2, cite and set forth the text of any
provision of any applicable law which would require the consent of the holders of
securities outstanding under any indenture or agreement of the applicant to compliance with
such provision of the Act.

6.

If the applicant does not desire an opportunity for a hearing it may include in the application,
the waiver and request provide for in Rule 4c-4 [17 CFR 260.4c-4].

Items 7 to 11, inclusive, may be entirely omitted if exemption is not applied for pursuant to
Section 304(c)(2).
7.

Give the title and amount of securities exemption of which is applied for pursuant to Section
304(c)(2) of the Act.

8.

Indicate each provision of the Act from which the applicant applies for exemption of the
securities referred to in item 7.

9.

Furnish the following information as to the indenture under which the securities specified in
answer to item 7 were or are to be issued:
The name and address of each trustee.
(b) The aggregate principal amount of securities authorized by the indenture.
(a)

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The title, maturity date, and principal amount of each class (or, if serial, of each series) of
securities outstanding under the indenture at the date of filing the application.
(d) Give the title and amount, if any, of each class or series of securities specified in (c)
which are proposed to be refunded, redeemed, or otherwise retired.
(c)

Instruction — Item 9. If the securities referred to in answer to Item 7 were or are to be issued
under a supplemental indenture, the information is required by this item shall be given as to the
original indenture and all indentures supplemental thereto.
10.

State the approximate number of holders of each class (or, if serial, of each series) of
securities specified in answer to item 9(c).

11.

Give a statement of the material facts necessary to enable the Commission to determine
whether or not compliance with the provisions of the Act indicated in answer to item 8 would
impose an undue burden on the applicant, having due regard to the public interest and the
interest of investors.

Instruction — Item 11. The information required by this item shall be given in such manner as to
enable the Commission to make a separate determination with respect to each provision of the
Act indicated in answer to item 8. Contents of application. This application comprises pages
numbered _________ to _________, consecutively, and the following exhibits:
SIGNATURE
The applicant,

, a corporation

organized and existing under the laws of

, has duly

caused this application to be signed on its behalf by the undersigned, thereunto duly authorized,
and its seal to be hereunto affixed and attested, all in the city of
State of

, on the

and

day of

,

.
(SEAL)

(Applicant)
By

Attest:

(Name)

(Name)
(Title)

(Title)

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Instruction as to signature. The name of each person signing the application shall be typed or
printed beneath the signature. If the applicant is not a corporation, the necessary changes in the
signature shall be made.
EXHIBITS
Instruction as to exhibits. Subject to Rule 7a-29 regarding incorporation of exhibits by
reference, there shall be filed as a part of the application a copy of each indenture, supplemental
indenture, or agreement referred to in answer to items 1, 3, or 9.

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