102 Identification of Special Accounts

Commodity Futures Trading Commission
Identification of "Special Accounts"

OMB No. 3038-0009

For Administrative Use Only
Trader Code:
Firm Code:

NOTICE: Failure to file a report required by the Commodity Exchange Act and the regulations thereunder, or the
filing of a false or fraudulent report, may be a basis for administrative action under 7 U.S.C. Section 9, and may
be punishable by fine or imprisonment, or both, under 7 U.S.C. Section 13 or 18 U.S.C. Section 1001.
INSTRUCTIONS TO FUTURES COMMISSION MERCHANTS, CLEARING MEMBERS, AND FOREIGN BROKERS
Assign a reporting number to each special account when it is reportable for the first time in futures or options. If
an account has been assigned a number for reporting in futures (options), use the same number for reporting
options (futures). Such reporting number must not be changed or assigned to any other special account without
prior approval of the Commodity Futures Trading Commission. For a futures and/or option account, transmit the
form to the Commission.

PLEASE TYPE OR PRINT
1.

Check one of "a," "b," or "c" for the special account and give identifying information as directed below:
a.

House omnibus or
Customer omnibus account of a futures commission merchant, clearing member, or foreign broker.
Report the information in "d" below for that firm. In addition, complete items 6 through 11.

b.

Account(s) owned and controlled by the same person or legal entity, such as a corporation or partnership (or controlled by
an employee or officer of the entity). Report the information in "d" below for the person or other legal entity who owns and
controls the account(s). In addition, complete items 2 and 4 through 11.

c.

Account(s) controlled by an advisor or legal entity who is independent of the account owner. Report the information in "d"
below for the advisor or legal entity controlling the special account. In addition, complete items 3 through 11.

d.

Name:

Reporting Number:
If Individual, Last, First, Middle Initial

Street:

Business Phone:

City:

State/Country:

If Individual, Employer

Zip/Postal Code:
Job Title:

If "b" or "c" is checked, is the above-identified person or legal entity registered as a:
Commodity trading advisor
Securities investment advisor

Yes
Yes

No
No

If this special account is reported in the name of a business, such as a corporation, give the name of an officer or employee
to contact:
Name:

Job Title:
Last, First, Middle Initial

2.

If item 1.b is checked, complete the following:
a.

Check as many as apply to the legal entity identified in 1.d above.
Individual
Sole Proprietorship
Other (Specify)

b.

Trust
Corporation

Partnership
Limited Liability Corporation

Joint

Principal business or occupation:

CFTC Form 102 (07/01)
Previous Editions Obsolete

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2.

c.

Report on an attachment all account numbers and account names included in this special account, if different than identified
in 1.d above.

d.

Report all persons or entities not identified in 1.d above who have a 10 percent or more financial interest in this special
account, including limited partners, indicating with an asterisk those having discretionary trading authority with respect to this
account. If none, write "none." Use a continuation sheet, if necessary.
Name:
Last, First, Middle Initial

Location:
City and State or Country

e.

Report all persons other than those above who control the trading of accounts included in the special account. Use a
continuation sheet, if necessary. If there are more than five such persons, show "multiple controllers" in the space below.
Name:
Last, First, Middle Initial

Location:
City and State or County

3.

Controlled Accounts. If you checked item 1.c, complete "a" or "b" below.
a.

If ten or more accounts are controlled by the advisor, check this box.

b.

If fewer than ten accounts are controlled by the advisor, on an attachment provide for each account the account number and
names and locations of persons having a ten percent or more financial interest in the account.

NOTE: Exchanges using this form may require the following information:

4.

a.

If ten or more accounts are controlled by the advisor, provide the account number and name of each pool controlled by
the advisor, and the name and location of the commodity pool operator.

b.

If fewer than ten accounts are controlled by the advisor, for each account provide the account number and name and
location(s) of person(s) having a ten percent or more financial interest in the account. For commodity pools, provide the
account number, the name of the pool, and the name and location of the commodity pool operator.

Are trades and positions in this special account usually associated with commercial activity of the account owner in related cash
commodities (i.e., positions considered as hedging in futures or options)?
Yes
No
If yes, list those specific futures or option markets in which the trader hedges. Use a continuation sheet, if necessary.

5.

Name, location, and business phone number of the account executive handling the account. (If account executive is in a foreign
country, list country and city.)
Name:

Business Phone:
Last, First, Middle Initial

Location:
City and State or Country

6.

Firm Name and Address:

7.

Name (Print)

8.

Title:

9.

Business Phone:

11.

10.

Date:

Signature:

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