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Form ID Uniform Application For Access Code To File On Edgar (SEC2084) Form. This is a Official Federal Forms form and can be use in Securities And Exchange Commission.
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1 U.S. Securities and Exchange Commission Washington, DC 20549 FORM ID OMB APPROVAL OMB Number: 3235-0328 Expires: Estimated average burdenhours per response: 0.15 UNIFORM APPLICATION FOR ACCESS CODES TO FILE ON EDGAR PART I227APPLICATION FOR ACCESS CODES TO FILE ON EDGAR Name of applicant (Applicant222s name as speci037ed in its charter, except, if individual, last name, 037rst name, middle name, suf037x [e.g., 223Jr.224]) Mailing Address or Post Of037ce Box No. City State or Country Zip Telephone number (include Area and, if Foreign, Country Code) Applicant is (see de037nitions in the General Instructions): Individual (if you check this box, you must also check another box that appropriately describes you) Clearing Agency Filer Filing Agent Institutional Investment Manager (Form 13F Filer) Investment Company, Business Development Company or Insurance Company Separate Account Large Trader Municipal Advisor Municipal Securities Dealer Nationally Recognized Statistical Rating Organization Non-Investment Company Applicant under the Investment Company Act of 1940 Security-Based Swap Data Repository Security-Based Swap Dealer and Major Security-Based Swap Participant Security-Based Swap Execution Facility Training Agent Transfer Agent Filer222s Tax or Federal Identi037cation Number (do not enter Social Security Number) Doing Business As Foreign Name (if Foreign Issuer Filer and applicable) Primary Business Address or Post Of037ce Box No. (if different from mailing address) City State or Country Zip State of Incorporation Fiscal Year End (mm/yy) SEC 2084 (01-13) American LegalNet, Inc. www.FormsWorkFlow.com Person to receive EDGAR Information, Inquiries and Access Codes Telephone Number (Include Area and, if Foreign, Country Code) Mailing Address or Post Of037ce Box No. (if different from applicant222s mailing address) City State or Country Zip E-Mail Address Person to receive SEC Account Information and Billing Invoices Telephone Number (Include Area and, if Foreign, Country Code) Mailing Address or Post Of037ce Box No. (if different from applicant222s mailing address) City State or Country Zip Signature Type or Print Name Position or Title Date Intentional misstatements or omissions of facts constitute federal criminal violations. See 18 U.S.C. 1001. Section 19(a) of the Securities Act of 1933 (15 U.S.C. 77s(a)), sections 13(a) and 23(a) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a) and 78w(a)), section 319 of the Trust Indenture Act of 1939 (15 U.S.C. 77sss), and sections 30 and 38 of the Investment Company Act of 1940 (15 U.S.C. 80a-29 and 80a-37) authorize solicitation of this information. We will use this information to assign system identi037cation to 037lers, 037ling agents, and training agents. This will allow the Commission to identify persons sending electronic submissions and grant secure access to the EDGAR system. 2 American LegalNet, Inc. www.FormsWorkFlow.com FORM ID GENERAL INSTRUCTIONS USING AND PREPARING FORM ID FORM ID must be 037led by all applicant types listed on this Form, or their agents, to whom the Commission previously has not assigned a Central Index Key (CIK) code, to request the following access codes to permit 037ling on EDGAR: CIK at the time you make an initial application. You may not change this code. The CIK is a public number. CIK to ensure that you authorized the 037ling. An applicant must 037le this Form in electronic format via the Commission222s EDGAR Filer Management website. Please see Regulation S-T (17 CFR Part 232) and the EDGAR Filer Manual for instructions on how to 037le electronically, including how to use the access codes. The applicant must complete the Form ID electronic 037ling by also submitting to the Commission a copy of a notarized paper 223authenticating224 document. The authenticating document must include the information required to be included in the Form ID 037ling, be manually signed by the applicant over the applicant222s typed signature, and con037rm the authenticity of the Form ID 037ling. Applicants may ful037ll the authenticating document requirement by making a copy of the applicant222s electronic Form ID 037ling, adding the necessary con037rming language, signing it, and having the signature notarized. If the applicant has prepared the authenticating document before making its electronic Form ID 037ling, it may submit the document as an uploaded Portable Document Format (PDF) attachment to the electronic 037ling. An applicant also may submit the authenticating document by faxing it to the Commission at (202) 504-2474 or (703) 914-4240 within two business days before or after its electronic Form ID 037ling. If submitted by fax after the electronic Form ID 037ling, the authenticating document must contain the accession number assigned to the electronic Form ID 037ling. If the fax is not received timely, the Form ID 037ling and application for access codes will not be processed, and the applicant will receive an e-mail message at the contact e-mail address included in the Form ID 037ling informing the applicant of the failure to process and providing further guidance. The message will state why the application was not processed. For assistance with technical questions about electronic 037ling, call Filer Support at (202) 551-8900. For assistance with questions about the EDGAR rules, Division of Corporation Finance 037lers may call the Of037ce of Information Technology at (202) 551-3600; and Division of Investment Management 037lers may call the IM EDGAR Inquiry Line at (202) 551-6989. You must complete all items in any parts that apply to you. If any item in any part does not apply to you, please leave it blank. 3 American LegalNet, Inc. www.FormsWorkFlow.com Provide the applicant222s name in English. Please check one of the boxes to indicate whether you will be sending electronic submissions as a clearing agency, 037ler, 037ling agent, institutional investment manager, investment company, large trader, municipal advisor, municipal securities dealer, nationally recognized statistical rating organization, non-investment company applicant under the Investment Company Act of 1940, security-based swap data repository, security-based swap dealer, security-based swap execution facility, training agent, or transfer agent. Mark only one of these boxes per application. If you are an individual, however, also mark the 223Individual224 box. For purposes of this Form, the term 223person224 includes either an individual or entity. In addition, please note that the following de037nitions are to facilitate the correct selection of 223applicant type224 and are not intended to amend or otherwise change any provision of the federal securities laws or the regulations promulgated thereunder. Finally, to the extent that a de037nition cross-references a particular statute, such de037nition shall also include any rules or regulations promulgated by the Commission further re037ning the statutory de037nition. Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(23)). Form ID applicant type (other than 223Individual224, as noted in the Instructions above). 037ling or portion of a 037ling on behalf of a 037ler. Section 13(f) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78m(f)(6)(A)). that meets the de037nition of 223investment company224 in Section 3 of the Investment Company Act of 1940, as amended (See 15 U.S.C. 80a-3), or otherwise registers an offering of its securities on a registration form adopted by the Commission under such Act, including management companies, face-amount certi037cate companies, unit investment trusts, business development companies, and insurance company separate accounts (including any separate account which would be required to be registered under the Investment Company Act of 1940 except for the exclusion provided by Section 3(c)(11) of such Act and which 037les a registration statement on Form N-3 or Form N-4). Exchange Act of 1934, as amended (See 17 CFR 240.13h-1(a)(1)). Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78o-4(e)(4)). (30) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(30)). ratin