SEC-Form-42-CA-42-SD-42-SRO-42-AMD.doc - Applicant/Clearing Agency/Securities Depository Name Date SEC FORM 42-CA/42-SD/42-SRO/42-AMD APPLICATION FOR

SEC-Form-42-CA-42-SD-42-SRO-42-AMD.doc - Applicant/Clearing...

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Applicant/Clearing Agency/Securities Depository Name: ____________________________________________ Date: ________________ SEC FORM 42-CA/42-SD/42-SRO/42-AMD APPLICATION FOR REGISTRATION AS CLEARING AGENCY, SECURITIES DEPOSITORY, SELF REGULATORY ORGANIZATION AND AMENDMENTS THERETO NEW APPLICATION AS A CLEARING AGENCY NEW APPLICATION AS A SECURITIES DEPOSITORY AMENDMENTS This amendment pertains to items _______________________________________ 1. CHECK THE APPLICABLE BOXES: Clearing Agency engaged solely in the business of a Securities Depository Clearing Agency engaged in the business of a Securities Depository Clearing Agency not engaged in the business of a Securities Depository WARNING: Failure to keep this form current and to file accurate supplementary information on a timely basis or failure to otherwise comply with the Securities Regulation Code and rules and regulations adopted thereunder, including enforcement of its rules against its Participants may result in disciplinary, administrative, injunctive or criminal action. INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE CRIMINAL VIOLATIONS. 2. EXACT NAME, BUSINESS ADDRESS, MAILING ADDRESS, IF DIFFERENT, AND TELEPHONE NUMBER OF THE APPLICANT (Use Supplemental Reporting Page, SRP, if necessary.) A. Full name of applicant: ____________________________________________________________ (1) Previous name, if amended: _____________________________________________________ (2) Name under which activities of clearing agency/securities depository are conducted: __________________________________________________________________________ B. Tax Identification Number: _______________________________________________________ C. If this filing makes a name change on behalf of the applicant, enter the previous name and specify whether the name change is the (1) applicant name or (2) business name: ______________________________________________________________________________ (1) (2) D. Applicant’s principal address: (Number and Street, City and Postal Code) ______________________________________________________________________________ Other locations where applicant performs clearing agency functions: ______________________________________________________________________________ E. Mailing address, if different: ______________________________________________________________________________ F. Business Telephone Number: ___________________ Facsimile Number: _______________ G. Contact Employee/Person in charge of applicant’s clearing agency/securities depository activities: (Name and Title): ______________________________________________________________ Telephone Number: ___________________________ Facsimile Number: _______________ 3. CONSTITUTION AND ORGANIZATION (Use Supplemental Reporting Page, SRP, if necessary.) A. Indicate registration number, date and place applicant obtained its legal status ( i.e ., place of incorporation, where partnership agreement was filed) and check the applicable box: SEC Registration No.: _______________________ Place of Registration: _______________ Date of Registration: ________________________ (MM/DD/YYYY) Corporation Partnership 1 SRC Form 42-CA/42-SD/42-SRO/42-AMD Revised 2015
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Applicant/Clearing Agency/Securities Depository Name: ____________________________________________ Date: ________________ B. Describe whether activities are primarily conducted by a division, subdivision or other entity within the applicant’s organization (organizational structure): ______________________________________________________________________________ 4. CAPITALIZATION A. Authorized Capital Stock: _____________________________ B. Subscribed Capital Stock: _____________________________ C. Paid-up Capital Stock: ________________________________ 5. FISCAL YEAR END: ____________________________________ 6. NAME AND ADDRESS of External Auditor of applicant: ______________________________________ ______________________________________________________________________________________ 7. Does the AUDIT include a review of internal controls of clearing agency/securities depository activities?
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