Notification Form - Change In Company Record
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Notification Form - Change In Company Record Form. This is a Official Federal Forms form and can be use in General Forms NASDAQ.
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Notification: Change in Company Record
Pursuant to Rule 5250(e)(3), The NASDAQ Stock Market requires notification when a NASDAQlisted company requests a change of its name, a change in the par value or title of its securities,
or a voluntary change in its trading symbol. The fee in connection with a change in the company
record is $2,500. Please submit your payment according to the directions provided on the Check
Payment Form or according to the wiring instructions.
Completed forms can be emailed to firstname.lastname@example.org or faxed to +1 866 601 9862.
Please contact Corporate Data Operations Staff directly at +1 877 308 0523 with any questions.
TITLE OF SECURITY
Please provide contacts for the purposes of processing this form.
TYPE OF CHANGE
PAR VALUE OR TITLE OF SECURITIES
*When a company changes its name, it is also required to execute a new Listing Agreement.
NEW COMPANY NAME
NEW TITLE OF SECURITY
NEW PAR VALUE
NEW CUSIP/CINS NUMBER*
*The CUSIP Service Bureau can be reached at +1 212 438 6565 or www.cusip.com.
Effective Date of the Change on NASDAQ (open of business):
If the Company intends to change is trading symbol, has a new symbol been reserved?
N/A If yes, please indicate new symbol:
*NASDAQ recommends that a symbol be reserved online prior to completion of this form.
Date all legal filings were or are anticipated to be effective, if applicable:
Date of shareholder approval of change, if applicable:
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