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Transfer Application-The NASDAQ Global Market Or The NASDAQ Global Select Market Form. This is a Official Federal Forms form and can be use in Additional Listing Applications NASDAQ.
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The NASDAQ Stock Market®
Transfer Application:
The NASDAQ Global Market® or
The NASDAQ Global Select Market®
This application should be completed by a company listed on The NASDAQ Capital Market®
that wishes to transfer its listing to The NASDAQ Global Market or The NASDAQ Global
Select Market.*
PART I
A. Company Information
COMPANY NAME
ADDRESS OF PRINCIPAL EXECUTIVE OFFICES
ADDRESS
PHONE
FAX
WEBSITE
B. Market Choice: An issuer seeking to list on either the Global Select Market or the Global
Market will be approved for the market tier with the highest listing standards that the company meets.
NASDAQ Global Market
NASDAQ Global Select Market
C. Company Contacts
Please provide the name, title and email address of the individual(s) to be designated as company
contact(s) for this application. Attach a separate sheet if the address for a designated contact person
differs from the address of the principal executive offices listed above.
NAME
TITLE
EMAIL
NAME
TITLE
EMAIL
NAME
TITLE
EMAIL
PART II
Security Information
Description of issue(s) to be listed (include current symbol(s), par or stated value, warrant expiration
date and exercise price, ratio for American Depositary Shares to underlying shares, and other relevant
information):
*If the company is seeking to list, pursuant to, or in connection with, a merger with a NASDAQ® listed company,
the issuer cannot utilize this transfer request form and must complete a full Listing Application.
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PART III
A. Additional Documentation and Information
The fact that an applicant may meet NASDAQ’s numerical guidelines does not necessarily mean that its
application will be approved. In connection with the review of any application, and as set forth in the
NASDAQ Listing Rules, NASDAQ reserves the right to request additional information or documentation,
public or non-public, deemed necessary to make a determination regarding a security’s qualification for
initial inclusion, including but not limited to, any material provided to or received from the Securities
and Exchange Commission or other regulatory authority.
Please provide the following information in a separate attachment to this application.
Board Members and Executive Officers
Provide a list of all board members and executive officers who have joined the company in the past
twelve months. Identify which of these individuals the company deems to be independent directors,
as defined in NASDAQ Listing Rule 5605(a)(2), and list the board committee(s) of which the director is
a member.
Regulatory Proceedings/Litigation
1. With respect to the company, its predecessors and its subsidiaries, provide a detailed description of
all inquiries, investigations, lawsuits, litigation, arbitration, hearings, or any other legal or
administrative proceedings commenced within the past ten years:
a)
that are or were initiated or conducted by any regulatory, civil or criminal agency (including but
not limited to the SEC, FINRA, PCAOB, state securities regulators, Commodities Futures Trading
Commission, Department of Justice, state bar associations, state boards of accountancy, or any
foreign regulatory, civil or criminal authority); or
b)
in which claims material to the company are or were asserted under federal and/or state
securities, tax or bankruptcy laws; or
c)
in which claims material to the company are or were asserted otherwise alleging fraud, deceit or
misrepresentation. To the extent that such items have been disclosed in the company’s SEC
filings, the applicant may refer to and/or submit copies of the relevant SEC’s filings in which
such matters were disclosed in lieu of providing a detailed description.
In connection with all proceedings that have been concluded, please provide documentation, which
reflects the final disposition of each proceeding. The company should update Staff promptly of any
and all material developments related to the matters identified in the response to these questions
and should supplement its response if additional matters arise while its application is pending.
2.
With respect to current executive officers, directors, and ten percent or greater shareholders,
provide a detailed description of all inquiries, investigations, lawsuits, litigation, arbitration,
hearings, or any other legal or administrative proceedings:
a) that are or were initiated or conducted by any regulatory, civil or criminal agency (including but
not limited to the SEC, FINRA, PCAOB, state securities regulators, Commodities Futures Trading
Commission, Department of Justice, state bar associations, state boards of accountancy, or any
foreign regulatory, civil or criminal authority); or
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b) in which claims are or were asserted otherwise alleging fraud, deceit or misrepresentation and
seeking damages in excess of $100,000.
[Note: With respect to questions 2a and 2b, there is no limit on the time frame covered by the
request.]
Upon review of the information provided by the applicant, Staff may request additional information,
such as copies of all court and administrative filings, and documents, which reflect the substance of the
allegations of any proceedings described above, and the sanctions imposed, including but not limited
to, complaints, indictments, opinions, orders, final judgments, letters of censure, consents,
undertakings and SEC formal orders of investigation.
B. Affirmation – Please sign and date the application.
I,
, as
NAME OF INDIVIDUAL
of
TITLE
COMPANY NAME
hereby certify, to the best of my knowledge and belief, that the information contained in the
application is true and correct, as of the date below, and will notify NASDAQ promptly of any material
changes.
Signature of Company Officer
SIGNATURE
DATE
C. Submission
Send the Application and supporting documentation to:
The NASDAQ Stock Market LLC
Listing Qualifications
9600 Blackwell Road
Rockville, MD 20850
Phone: +1 301 978 8008
©April 2009, The NASDAQ OMX Group, Inc. All rights reserved. The NASDAQ Stock Market, NASDAQ, The NASDAQ Global
Select Market, The NASDAQ Global Market and The NASDAQ Capital Market are registered trademarks of The NASDAQ OMX
Group, Inc.
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