Form SBSE-BD Application For Registration Of Security-Based Swap Dealers (SEC2926) {SBSE-BD}

American LegalNet, Inc. www.FormsWorkFlow.com FORM SBSE-BD INSTRUCTIONS002 A. GENERAL INSTRUCTIONS 1.003FORM - Form SBSE-BD is the Application for Registration as either a Security-based SwapDealer or Major Security-based Swap Participant (collectively, 223SBS Entities224) by an entity that isregistered or registering with the Commission as a broker or dealer. These SBS Entities must filethis form to register with the Securities and Exchange Commission. An applicant must also fileSchedules C and F, as appropriate. There are no Schedules A, B, D, or E.2.003DEFINITIONS 226 Form SBSE-BD uses the same definitions as in Form BD.3.003ELECTRONIC FILING - This Form SBSE-BD must be filed electronically with the Commissionthrough the EDGAR system, and must utilize the EDGAR Filer Manual (as defined in 17 CFR232. 11) to file and amend Form SBSE-BD electronically to assure the timely acceptance andprocessing of those filings. Additional documents shall be attached to this electronic application.4.003UPDATING - By law, the applicant must promptly update Form SBSE-BD information bysubmitting amendments whenever the information on file becomes inaccurate or incomplete forany reason [17 CFR 240.15Fb2-3]. In addition, the applicant must update any incomplete orinaccurate information contained on Form SBSE-BD prior to filing a notice of withdrawal fromregistration on Form SBSE-W [17 CFR 15Fb3-2(a)].5.003DEFINITION - For purposes of Form SBSE-BD, the term 223unique identification code224 or 223UIC224means a unique identification code assigned to a person by an internationally recognizedstandards-setting system that is recognized by the Commission [pursuant to Rule 903(a) ofRegulation SBSR (17 CFR 242.903(a))].6.003FEDERAL INFORMATION LAW AND REQUIREMENTS - An agency may not conduct orsponsor, and a person is not required to respond to, a collection of information unless it displaysa currently valid control number. Sections 15F, 17(a) and 23(a) of the Exchange Act authorize theSEC to collect the information on this form from registrants. See 15 U.S.C. 24724778o-10, 78q and78w. Filing of this form is mandatory. The principal purpose of this Form is to permit theCommission to determine whether the applicant meets the statutory requirements to engage inthe security-based swap business. The Commission maintain[s] a file of the information on thisform and will make information collected via the form publicly available. Any member of the publicmay direct to the Commission any comments concerning the accuracy of the burden estimate onthis Form, and any suggestions for reducing this burden. This collection of information has beenreviewed by the Office of Management and Budget in accordance with the clearancerequirements of 44 U.S.C. 2473507. The information contained in this form is part of a system ofrecords subject to the Privacy Act of 1974, as amended. The Securities and ExchangeCommission has published in the Federal Register the Privacy Act Systems of Records Notice forthese records.B. FILING INSTRUCTIONS 1.003FORMATa.003Items 1-7 and the accompanying Schedules must be answered and all fields requiring aresponse must be completed before the filing will be accepted.b.003Failure to follow instructions or properly complete the form may result in the applicationbeing delayed or rejected.c.003 Applicant must complete the execution screen certifying that Form SBSE-BD andamendments thereto have been executed properly and that the information containedtherein is accurate and complete.d.003To amend information, the applicant must update the appropriate Form SBSE-BDscreens.e.003A paper copy, with original signatures, of the initial Form SBSE-BD filing and Schedulesmust be retained by the applicant and be made available for inspection upon a regulatoryrequest.The mailing address for questions and correspondence is: The Securities and Exchange Commission002Washington, DC 20549002 American LegalNet, Inc. www.FormsWorkFlow.com CRD No.: UIC No. (if any): Website/URL: Contact Employee: Name: Title: Telephone Number: Email Address: Chief Compliance Officer designated by the applicant in accordance with Exchange Act Section 15F(k): Name: Title: Telephone Number: Email Address: FORM SBSE-BD Application for Registration as a Security-based Swap Dealer and Major Security-based Swap Participant that is Registered as a Broker-Dealer Official Use Official Use Only WARNING: Failure to keep this form current and to file accurate supplementary information on a timely basis, or the failure to keep accurate books and records or otherwise to comply with the provisions of law applying to the conduct of business as an SBS Entity, would violate the Federal securities laws and may result in disciplinary, administrative, injunctive or criminal action. INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) [ ] APPLICATION [ ] AMENDMENT 1.Exact name and CRD number of the applicant: A. Full name of the applicant: B. C D. E. 2.A.The applicant is registering as a security-based swap dealer: [ ] Yes [ ] No B.The applicant is registering as a major security-based swap participant: [ ] Yes [ ] No Because it: (check all that apply) [ ] maintains a substantial security-based swap position [ ] has substantial counterparty exposure [ ] is highly leveraged relative to its capital position 3.A.The applicant is presently registered with the Commodity Futures Trading Commission as a: [ ] Swap Dealer [ ] Major Swap Participant B. The applicant is registering with the Commodity Futures Trading Commission as a: [ ] Swap Dealer [ ] Major Swap Participant 4.Is the applicant subject to regulation by a prudential regulator, as defined in Sec. 1a(39) of the Commodity Exchange Act.[ ] Yes [ ] No If 223yes,224 identify the prudential regulator: . 5.Is the applicant registered with the Commission as an over-the-counter derivatives dealer?[ ] Yes [ ] No 6.Briefly describe the applicant222s business: 7.Is the applicant registered with a foreign financial regulatory authority?[ ] Yes [ ] No If 223yes,224 list all such registrations on Schedule F, Page 1, Section II. EXECUTION: The applicant consents that service of any civil action brought by or notice of any proceeding before the Securities and Exchange Commission in connection with the applicant222s security-based swap activities, unless the applicant is a nonresident SBS Entity , may be given by registered or certified mail or confirmed telegram to the applicant222s contact employee at the main address, or mailing address if different, given in Items 1E and 1F. If the applicant is a nonresident SBS Entity, it must complete Schedule F to designate a U.S. agent for service of process. The undersigned certifies that he/she has executed this form on behalf of, and with the authority of, said applicant. The undersigned and applicant represent that the information and statements contained herein, including schedules attached hereto, and other information filed herewith are current, true and complete. The undersigned and applicant further represent that to the extent any information previously submitted is not amended such information is currently accurate and complete. Date (MM/DD/YYYY) Name of Applicant By: Signature Name and Title of Person Signing on Applicant222s behalf This page must always be completed in full. DO NOT WRITE BELOW THIS LINE 226 FOR OFFICIAL USE ONLY American LegalNet, Inc. www.FormsWorkFlow.com iler No: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Schedule C of FORM SBSE-BD LIST OF 15Fb6-1 ENTITIES Applicant Name: Date: SEC FOfficial Use Each applicant shall use Schedule C to identify each person associated with it, as of the date it files an application to register with the Commission, that is not a natural person and that is subject to statutory disqualification (as described in Exchange Act Sections 3(a)(39)(A) through (F)) that the security-based swap dealer or security-based swap participant permits to effect or be involved in effecting security-based swaps on its behalf pursuant to Rule 15Fb6-1. NAME Official Use Only American LegalNet, Inc. www.FormsWorkFlow.com ame and Title: ate: S