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This is a Official Federal Forms form that can be used for General Forms within NASDAQ.
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Check Payment Form If paying by check, please complete this form and include it along with your payment. If paying by wire, please click here for instructions. All checks should be made payable to The Nasdaq Stock Market LLC at the following address: For payments sent by regular mail: The Nasdaq Stock Market LLC--LBX 90200 PO Box 780200 Philadelphia, PA 19178-0200 COMPANY NAME ADDRESS ADDRESS REMITTER NAME (if different than Company Name) AMOUNT CHECK NO For payments sent by overnight mail: The Nasdaq Stock Market LLC--LBX 90200 401 Market Street Philadelphia, PA 19106 SYMBOL PLEASE INDICATE REASON FOR PAYMENT BY CHECKING ONE OF THE FOLLOWING BOXES: New Company Application and Entry: The application fee is $25,000 for the Global or Global Select Market, $5,000 for the Capital Market, and $1,000 for companies applying to list Closed End Funds, Exchange Traded Funds, Index Fund Shares or other structured products. The remainder of the entry fee is due prior to the first day of trading. If the Company does not list within 12 months of submitting its application, it will be assessed an additional non-refundable $5,000 application fee each 12 months thereafter to keep its application open. Nasdaq will credit all application fees paid by the Company in connection with an application that has not been closed towards the Entry Fee payable upon listing. Interpretation Request: The fee in connection with such a request is $5,000 for a regular request, where a company generally requires a response within four weeks, and $15,000 for an expedited request, where a company requires a response in more than one week but less than four weeks. Hearing or Appeal Request: The fee in connection with a hearing or an appeal of a Hearing Panel decision to the Nasdaq Listing and Hearing Review Council is $10,000. Substitution Listings and Changes in the Company Record: The fee in connection with a change in the company record is $7,500; the fee in connection with a substitution listing is $15,000. These changes are report using the Company Event Form. SPAC Substitution Listing Fee: There is a $15,000 substitution listing fee in connection with a SPAC that completes a business combination. Transfer Application: The fee for companies transferring from the Global or Global Select Market to the Capital Market is $5,000. Compliance Plan Review: There is a $5,000 fee in connection with the review of a compliance plan. American LegalNet, Inc. www.FormsWorkFlow.com