Form SCI Systems Compliance And Integrity (SEC2919) {SCI}

Securities and Exchange Commission Washington, DC 20549 Form SCI OMB APPROVAL OMB Number: Expires: 3235-0703 , 20 Estimated average burden per response: 25 Hrs. Page 1 of File No. SCI-{name}-YYYY-### SCI Notification and Reporting by: {SCI entity name} Pursuant to Rules 1002 and 1003 of Regulation SCI under the Securities Exchange Act of 1934 InitialWithdrawalSECTION I: Rule 1002 - Commission Notification of SCI Event A.Submission Type (select one only)Rule 1002(b)(1) Initial Notification of SCI eventRule 1002(b)(2) Notification of SCI eventRule 1002(b)(3) Update of SCI event: ####Rule 1002(b)(4) Final Report of SCI EventRule 1002(b)(4) Interim Status Report of SCI eventIf filing a Rule 1002(b)(1) or Rule 1002(b)(3) submission, please provide a brief description:B.SCI Event Type(s) (select all that apply)Systems compliance issueSystems disruptionSystems intrusionC.General Information Required for (b)(2) filings.1)Has the Commission previously been notified of the SCI event pursuant to 1002(b)(1)? yes/no2)Date/time SCI event occurred: mm/dd/yyyy hh:mm am/pm3)Duration of SCI event: hh:mm, or days4)Please provide the date and time when a responsible SCI personnel had reasonable basis toconclude the SCI event occurred:mm/dd/yyyy hh:mm am/pm 5)Has the SCI event been resolved? yes/noa)If yes, provide date and time of resolution:mm/dd/yyyy hh:mm am/pm 6)Is the investigation of the SCI event closed? yes/noa)If yes, provide date of closure: mm/dd/yyyy7)Estimated number of market participants potentially affected by the SCI event: ####8)Is the SCI event a major SCI event (as defined in Rule 1000)? yes/no SEC 2919 (9/15) American LegalNet, Inc. www.FormsWorkFlow.com D. Information about impacted systems: Name(s) of system(s): Type(s) of system(s) impacted by the SCI event (check all that apply): Trading Clearance and settlement Order routing Market data Market regulation Market surveillance Indirect SCI systems (please describe): Are any critical SCI systems impacted by the SCI event (check all that apply)? Yes/No 1) Systems that directly support functionality relating to: Clearance and settlement systems of clearing agencies Openings, reopenings, and closings on the primary listing market Trading halts Initial public offerings The provision of consolidated market data Exclusively-listed securities 2) Systems that provide functionality to the securities markets for which the availability of alternatives is significantly limited or nonexistent and without which there would be a material impact on fair and orderly markets (please describe): SECTION II: Periodic Reporting (select one only) A. Quarterly Reports: For the quarter ended: mm/dd/yyyy Rule 1002(b)(5)(ii): Quarterly report of systems disruptions and systems intrusions with no or a de minimis impact. Rule 1003(a)(1): Quarterly report of material systems changes Rule 1003(a)(2): Supplemental report of material systems changes B. SCI Review Reports Rule 1003(b)(3): Report of SCI review, together with any response by senior management Date of completion of SCI review: mm/dd/yyyy Date of submission of SCI review to senior management: mm/dd/yyyy American LegalNet, Inc. www.FormsWorkFlow.com Title ( ) SECTION III: Contact Information Provide the following information of the person at the {SCI entity name} prepared to respond to questions for this submission: First Name: Last Name: Title: E-Mail: Telephone: Fax: Additional Contacts (Optional) First Name: Last Name: Title: E-Mail: Telephone: Fax: First Name: Last Name: Title: E-Mail: Telephone: Fax: SECTION IV: Signature Confidential treatment is requested pursuant to Rule 24b-2(g). Additionally, pursuant to the requirements of the Securities Exchange Act of 1934, {SCI Entity name} has duly caused this {notification}{report} to be signed on its behalf by the undersigned duly authorized officer: Date: By (Name) 223Digitally Sign and Lock Form224 American LegalNet, Inc. www.FormsWorkFlow.com Exhibit 1: Rule 1002(b)(2) Notification of SCI Event Add/Remove/View Within 24 hours of any responsible SCI personnel having a reasonable basis to conclude that the SCI event has occurred, the SCI entity shall submit a written notification pertaining to such SCI event to the Commission, which shall be made on a good faith, best efforts basis and include: (a) a description of the SCI event, including the system(s) affected; and (b) to the extent available as of the time of the notificat ion: the SCI entity222s current assessment of the types and number of market participants potentially affected by the SCI event; the potential impact of the SCI event on the market; a description of the steps the SCI entity has taken, is taking, or plans to take, with respect to the SCI event; the time the SCI event was resolved or timeframe within which the SCI event is expected to be resolved; and any other pertinent information known by the SCI entity about the SCI event. E xh i b i t 2: Rule 1002(b)(4) Final or Interim Report of SCI Event Add/Remove/View When submitting a final report pursuant to either Rule 1002(b)(4)(i)(A) or Rule 1002(b)(4)(i)(B)(2), the SCI entity shall include: (a) a detailed description of: the SCI entity222s assessment of the types and number of market participants affected by the SCI event; the SCI entity222s assessment of the impact of the SCI event on the market; the steps the SCI entity has taken, is taking, or plans to take, with respect to the SCI event; the time the SCI event was resolved; the SCI entity222s rule(s) and/or governing document(s), as applicable, that relate to the SCI event; and any other pertinent informat ion known by the SCI entity about the SCI event; (b) a copy of any information disseminated pursuant to Rule 1002(c) by the SCI entity to date regarding the SCI event to any of its me mbers or participants; and (c) an analysis of parties that may have experienced a loss, whether monetary or otherwise, due to the SCI event, the number of such parties, and an estimate of the aggregate amount of such loss. When submitting an interim report pursuant to Rule 1002(b)(4)(i)(B)(1), the SCI entity shall include such information to the extent known at the time. E xh i b i t 3 : Rule 1002(b)(5)(ii) Quarterly Report of De Minimis SCI Events Add/Remove/View The SCI entity shall submit a report, within 30 calendar days after the end of each calendar quarter, containing a summary description of systems disruptions and systems intrusions that have had, or the SCI entity reasonably estimates would have, no or a de minimis impact on the SCI entity222s operations or on market participants, including the SCI systems and, for systems intrusions, indirect SCI systems, affected by such SCI events during the applicable calendar quarter. E xh i b i t 4 : Rule 1003 (a) Quarterly Report of Systems Changes Add/Remove/View When submitting a report pursuant to Rule 1003(a)(1), the SCI entity shall provide a report, within 30 calendar days after the end of each calendar quarter, describing completed, ongoing, and planned material changes to its SCI systems and the security of indirect SCI systems, during the prior, current, and subsequent calendar quarters, including the dates or expected dates of commencement and completion. An SCI entity shall establish reasonable written criteria for identifying a change to its SCI systems and the security of indirect SCI systems as material and report such changes in accordance with such criteria. When submitting a report pursuant to Rule 1003(a)(2), the SCI entity shall provide a supplemental report of a material error in or material omission from a report previously submitted under Rule 1003(a)(1). E xh i b i t 5 : Rule 1003(b)(3) Report of SCI review Add/Remove/View The SCI entity shall provide a report of the SCI review, together with any response by senior manage ment, within 60 calendar days after its submission to senior management of the SCI entity. E xh i b i t 6 : Optional Attachments Add/Remove/View This exhibit may be used in order to attach other documents that the SCI entity may wish to submit as part of a Rule 1002(b)(1) initial notification submission or Rule 1002(b)(3) update submission. American LegalNet, I