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Form ID Uniform Application For Access Code To File On Edgar (SEC2084) ID - Official Federal Forms
| Form ID Uniform Application For Access Code To File On Edgar (SEC2084) Form. This is a national form and can be used in Securities And Exchange Commission . |
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U.S. Securities and Exchange Commission Washington, DC 20549 OMB APPROvAL OMB Number: 3235-0328 Expires: November 30, 2013 Estimated average burden hours per response: 0.15 Form ID UNIForm APPLICATIoN For ACCESS CoDES To FILE oN EDGAr PART I--APPLICATION FOR ACCESS CODES TO FILE ON EDGAR Name of applicant (Applicant's name as specified in its charter, except, if individual, last name, first name, middle name, suffix [e.g., "Jr."]) _____________________________________________________________________________ Mailing Address or Post Office Box No. __________________________________________________________ City _________________________ State or Country ________________________ Zip __________________ Telephone number (include Area and, if Foreign, Country Code) _______________________________________ Applicant is (see definitions 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 PART II--FILER INFORMATION (To be completed only by filers that are not individuals) Filer's Tax or Federal Identification Number (do not enter Social Security Number) ________________________ Doing Business As ___________________________________________________________________________ Foreign Name (if Foreign Issuer Filer and applicable) ________________________________________________ Primary Business Address or Post Office Box No. (if different from mailing address) ___________________________________________________________________________________________ City _________________________ State or Country ________________________ Zip __________________ State of Incorporation __________________________________Fiscal Year End (mm/yy) __________________ Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a current valid OMB control number. SEC 2084 (1-13) 1 American LegalNet, Inc. www.FormsWorkFlow.com PART III--CONTACT INFORMATION (To be completed by all applicants) Person to receive EDGAR Information, Inquiries and Access Codes ___________________________________ Telephone Number (Include Area and, if Foreign, Country Code) ______________________________________ Mailing Address or Post Office Box No. (if different from applicant's mailing address) ___________________________________________________________________________________________ City _________________________ State or Country ________________________ Zip __________________ E-Mail Address ____________________________________________________________________________ PART IV--ACCOUNT INFORMATION (To be completed by filers and filing agents only) Person to receive SEC Account Information and Billing Invoices _______________________________________ Telephone Number (Include Area and, if Foreign, Country Code) ______________________________________ Mailing Address or Post Office Box No. (if different from applicant's mailing address) ___________________________________________________________________________________________ City _________________________ State or Country ________________________ Zip __________________ PART V--SIGNATURE (To be completed by all applicants) 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 identification to filers, filing 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 filed 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 filing on EDGAR: · · · · Central Index Key (CIK)--The CIK uniquely identifies each filer, filing agent, and training agent. We assign the CIKat the time you make an initial application. You may not change this code. The CIK is a public number. CIK Confirmation Code (CCC)--You will use the CCC in the header of your filings in conjunction with your CIK to ensure that you authorized thefiling. Password(PW)--The PW allows you to log onto the EDGAR system, submit filings, and change your CCC. Password Modification Authorization Code (PMAC)--The PMAC allows you to change your password. An applicant must file this Form in electronic format via the Commission's EDGAR Filer Management website. Please see Regulation S-T (17 CFR Part 232) and the EDGAR Filer Manual for instructions on how to file electronically, including how to use the access codes. The applicant must complete the Form ID electronic filing by also submitting to the Commission a copy of a notarized paper "authenticating" document. The authenticating document must include the information required to be included in the Form ID filing, be manually signed by the applicant over the applicant's typed signature, and confirm the authenticity of the Form ID filing. Applicants may fulfill the authenticating document requirement by making a copy of the applicant's electronic Form ID filing, adding the necessary confirming language, signin
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