Form SEC 2084 SEC 2084 Form ID

U.S. Securities and Exchange Commission
Washington, DC 20549

FORM ID

OMB APPROVAL
OMB Number:
3235-0328
Expires:
May 31, 2019
Estimated average burden
hours per response:
0.15

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 specifed in its charter, except, if individual, last name, frst name, middle name,
suffx [e.g., “Jr.”]) _____________________________________________________________________________
Mailing Address or Post Offce Box No. __________________________________________________________
City _________________________ State or Country ________________________ Zip___________________
Telephone number (include Area and, if Foreign, Country Code) _______________________________________
Access codes will be used to submit draft registration or draft offering statement.
Applicant is (see defnitions 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 Identifcation Number (do not enter Social Security Number) ________________________
Doing Business As ___________________________________________________________________________
Foreign Name (if Foreign Issuer Filer and applicable) ________________________________________________
Primary Business Address or Post Offce 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 (01-13)

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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 Offce 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 Offce 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 identifcation to flers, fling agents, and training agents. This will allow the Commission to identify
persons sending electronic submissions and grant secure access to the EDGAR system.

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FORM ID

GENERAL INSTRUCTIONS

USING AND PREPARING FORM ID

FORM ID must be fled 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 fling
on EDGAR:
•

Central Index Key (CIK)—The CIK uniquely identifies each filer, filing agent, and training agent. We assign the
CIK at 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 the fling.

•

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 fle 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 fle
electronically, including how to use the access codes.
The applicant must complete the Form ID electronic fling 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 fling, be manually signed by the applicant over the applicant’s typed signature, and
confrm the authenticity of the Form ID fling. Applicants may fulfll the authenticating document requirement by
making a copy of the applicant’s electronic Form ID fling, adding the necessary confrming language, signing it, and
having the signature notarized.
If the applicant has prepared the authenticating document before making its electronic Form ID fling, it may submit
the document as an uploaded Portable Document Format (PDF) attachment to the electronic fling. 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 fling. If submitted by fax after the electronic Form
ID fling, the authenticating document must contain the accession number assigned to the electronic Form ID fling.
If the fax is not received timely, the Form ID fling 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 fling 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 fling, call Filer Support at (202) 551-8900. For assistance
with questions about the EDGAR rules, Division of Corporation Finance flers may call the Offce of Information
Technology at (202) 551-3600; and Division of Investment Management flers 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.

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PART I—APPLICANT INFORMATION (To be completed by all applicants)

Provide the applicant’s name in English.
Please check one of the boxes to indicate whether you will be sending electronic submissions as a clearing agency,
fler, fling 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 “Individual” box.
For purposes of this Form, the term “person” includes either an individual or entity. In addition, please note that
the following defnitions are to facilitate the correct selection of “applicant type” 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 defnition cross-references a particular statute, such defnition shall also include any rules or
regulations promulgated by the Commission further refning the statutory defnition.
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“Individual”—A natural person.

•

“Clearing Agency”—Any person that is a “clearing agency” as defined in Section 3(a)(23) of the Securities
Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(23)).

•

“Filer”—Any person on whose behalf an electronic filing is made that is not otherwise covered by another
Form ID applicant type (other than “Individual”, as noted in the Instructions above).

•

“Filing Agent”—A financial printer, law firm, or other person, which will be using these access codes to send a
fling or portion of a fling on behalf of a fler.

•

“Institutional Investment Manager (Form 13F Filer)”—Any person that is required to file a Form 13F under
Section 13(f) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78m(f)(6)(A)).

•

“Investment Company, Business Development Company or Insurance Company Separate Account”—Any person
that meets the defnition of “investment company” 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 certifcate 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 fles a registration statement on Form N-3 or Form N-4).

•

“Large Trader”—Any person that is a “large trader” as defined by Rule 13h-1(a)(1) under the Securities
Exchange Act of 1934, as amended (See 17 CFR 240.13h-1(a)(1)).

•

“Municipal Advisor”—Any person that is a “municipal advisor” as defined in Section 15B(e)(4) of the
Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78o-4(e)(4)).

•

“Municipal Securities Dealer”—Any person that is a “municipal securities dealer” as defined in Section 3(a)
(30) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(30)).

•

“Nationally Recognized Statistical Rating Organization”—Any person that is a “nationally recognized statistical
rating organization” as defned in Section 3(a)(62) of the Securities Exchange Act of 1934, as amended.
(See 15 U.S.C. 78c(a)(62)).

•

“Non-Investment Company Applicant under the Investment Company Act of 1940”—Any person submitting an
application for an order seeking an exemption under the Investment Company Act of 1940, as amended.

•

“Security-Based Swap Data Repository”—Any person that is a “security-based swap data repository” as defined
in Section 3(a)(75) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(75)).

•

“Security-Based Swap Dealer and Major Security-Based Swap Participant”—Any person that is a “securitybased swap dealer” or a “major security-based swap participant” as each term is defned in Sections 3(a)(71)
and (67) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(71) and (67)).
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“Security-Based Swap Execution Facility”—Any person that is a “security-based swap execution facility” as
defned in Section 3(a)(77) of the Securities Exchange Act of 1934, as amended. (See 15 U.S.C. 78c(a)(77)).

•

“Training Agent”—Any person that will be sending only test filings in conjunction with training other persons.

•

“Transfer Agent”—Any person planning to register as a Transfer Agent as defined in Section 3(a)(25) of the
Securities Exchange Act of 1934, as amended, on whose behalf an electronic fling is made. (See 15 U.S.C.
78c(a)(25)).
PART II—FILER INFORMATION (To be completed only by filers that are not individuals)

The fler’s tax or federal identifcation number is the number issued by the Internal Revenue Service. This section
does not apply to individuals. Accordingly, do not enter a Social Security number. If an investment company fler
is organized as a series company, the investment company may use the tax or federal identifcation number of any
one of its constituent series. Issuers that have applied for but not yet received their tax or federal identifcation
number and foreign issuers that do not have a tax or federal identifcation number must include all zeroes. A “foreign
issuer” is an entity so defned by Securities Act of 1933 (15 U.S.C. 77a et seq.) Rule 405 (17 CFR 230.405) and the
Securities Exchange Act of 1934 (15 U.S.C. 78a et seq.) Rule 3b-4(b) (17 CFR 240.3b-4(b)). Foreign issuers should
include their country of organization.
A foreign issuer fler must provide its “doing business as” name in the language of the name under which it does
business and must provide its foreign language name, if any, in the space so marked.
If the fler’s fscal year does not end on the same date each year (e.g., falls on the last Saturday in December), the
fler must enter the date the current fscal year will end.
PART III—CONTACT INFORMATION (To be completed by all applicants)

In this section, identify the individual who should receive the access codes and other EDGAR-related information.
Please include an e-mail address that will become your default notifcation address for EDGAR flings; it will be
stored in the Company Contact Information on the EDGAR Database. EDGAR will send all subsequent fling
notifcations automatically to that address. You can have one e-mail address in the EDGAR Company Contact
Information. For information on including additional e-mail addresses on a per fling basis, refer to Volume 1,
Section 3.2.2 of the EDGAR Filer Manual.
PART IV—ACCOUNT INFORMATION (To be completed by filers and filing agents only)

Identify in this section the individual who should receive account information and/or billing invoices from us. We
will use this information to process electronically fee payments and billings. If the address changes, update it via the
EDGAR fling website, or your account statements may be returned to us as undeliverable.
PART V—SIGNATURE (To be completed by all applicants)

If the applicant is a corporation, partnership, trust or other entity, state the capacity in which the representative
individual, who must be duly authorized, signs the Form on behalf of the applicant.
If the applicant is an individual, the applicant must sign the Form.
If another person signs on behalf of the representative individual or the individual applicant, confrm the authority
of the other person to sign in writing in an electronic attachment to the Form. The confrming statement need only
indicate that the representative individual or individual applicant authorizes and designates the named person or
persons to fle the Form on behalf of the applicant and state the duration of the authorization.
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