Form 8-T Individual Withdrawal

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
READ THESE INSTRUCTIONS CAREFULLY BEFORE COMPLETING OR REVIEWING THE APPLICATION.
THE FAILURE TO ANSWER ALL QUESTIONS COMPLETELY AND ACCURATELY OR THE OMISSION OF
REQUIRED INFORMATION MAY RESULT IN THE DENIAL OR REVOCATION OF REGISTRATION.
This document is not an Individual Withdrawal Notice form. Do not send this document to NFA. It is a
template that you may use to assist in filing the electronic notice.
You may fill out the template online and save and/or print it when you are finished or you can download
the template and/or print it and fill it out later.
Not every section applies to every individual. Certain sections apply depending on the whether some
or all of the individual’s registration categories with the individual’s sponsor are being withdrawn. The
text above these sections explains who must complete the section. In the electronic notice, only the
applicable sections will appear.
Withdrawal Reason and Disciplinary Information Sections
These sections concern matters that are required to be disclosed if all of the individual’s registration
categories with the sponsor are being withdrawn.
The Disciplinary Information section does not need to be completed if the individual’s registration
categories are being terminated because the individual is deceased.
Only Sponsors that are SEC registered Broker-Dealers may elect to complete the Disciplinary
Information-Form U5 section.
DEFINED TERMS
Words that are underlined in this form are defined terms and have the meanings contained in the
Definition of Terms section.
The following instructions apply to the Disciplinary Information-Form 8-T section.
GENERAL
Read the Instructions and Questions Carefully
A question that is answered incorrectly because it was misread or misinterpreted can result in severe
consequences, including denial or revocation of registration. Although this applies to all questions in the
application, it is particularly important to the questions in the Disciplinary Information Section.
Rely Only on Advice from NFA Staff
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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
A question that is answered incorrectly because of advice received from a lawyer, employer, a judge
or anyone else (other than a member of NFA’s Registration, Compliance, Legal or Information Center
(“RCLI”) departments) can result in severe consequences, including denial or revocation of registration.
This also applies to all questions in the form, but is particularly important regarding the Disciplinary
Information Section. If the language of a question in the Disciplinary Information Section requires
disclosure of a matter, a “Yes” answer to the question is required no matter what other advice has been
received from anyone other than NFA’s RCLI staff. Additionally, the applicant or registrant remains
responsible for failures to disclose even if someone completes the form on the applicant’s or registrant’s
behalf.
Update the Information on the Application
If information provided on the application changes or a matter that would have required disclosure on
the application occurs after the application is filed, the new information must be promptly filed. APs and
Principals should advise their Sponsors of the new information, and the Sponsor must file the update
on their behalf. The failure to promptly update information can result in severe consequences, including
denial or revocation of registration.
Compliance with Disclosure Requirements of Another Regulatory Body is not Sufficient
With some exceptions, which are described below in the Regulatory and Financial Questions sections,
if any question requires the provision of information, that information must be provided. In particular,
if a question in the Disciplinary Information Section requires disclosure of a matter, the question must
be answered “Yes” and additional documents must be provided even if the matter has been disclosed
to another regulatory body such as FINRA, an exchange or a state regulator. Similarly, disclosure is
required even if another regulatory body does NOT require disclosure of the same matter.
Call NFA with Questions
If there is any question about whether particular information must be provided, whether a particular
matter must be disclosed or whether a particular question requires a “Yes” answer, call the NFA
Information Center at (800) 621-3570 or (312) 781-1410. Representatives are available from 8:00 a.m. to
5:00 p.m., Central Time, Monday through Friday. If the advice of NFA staff is sought, a written record
containing the date of the conversation, the name of the NFA staff person giving the advice and a
description of the advice should be made during the conversation and kept in the event an issue
concerning disclosure of the matter arises later.
DISCIPLINARY INFORMATION SECTION
Criminal Disclosures
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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
Some common mistakes in answering the criminal disclosure questions involve expungements, diversion
programs and similar processes. The Commodity Futures Trading Commission requires a “Yes” answer
even if the matter has been expunged or the records sealed, there was no adjudication or finding of guilt,
the guilty plea was vacated or set aside or the matter was dismissed upon completion of the diversion
program.
Another common error regarding criminal matters concerns matters that do not involve the futures
industry. All criminal matters must be disclosed, even if a matter is unrelated to the futures industry,
unless the case was decided in a juvenile court or under a Youth Offender law.
Regulatory Disclosures
Regulatory actions taken by the Commodity Futures Trading Commission, NFA or domestic futures
exchanges do not need to be disclosed since NFA is already aware of them once they are entered into
NFA’s BASIC system.
Financial Disclosures
It is not necessary to disclose arbitration or CFTC reparations matters unless the applicant or registrant
has failed to pay an award issued in a futures-related arbitration or an order entered in a reparations
matter.
Only adversary actions that a bankruptcy trustee or a trustee’s attorney files must be disclosed.
Adversary actions that creditors file are not disclosable. A person named as a party to an adversary
action in a bankruptcy proceeding must disclose the action, even if the person is not the bankrupt
person.
ADDITIONAL DOCUMENTS
For any matter that caused a “Yes” answer, a written explanation detailing the events and conduct must
be provided. That explanation can be entered on the Matter pages by giving it a name, e.g., the docket
number of the case, and describing it in the text box. Alternatively, the explanation can be sent in hard
copy format to NFA.
In addition to the required explanation, other documents about the matter must be sent to NFA. If court
documents are unavailable, a letter from the court verifying that must be sent to NFA. If documents
other than court documents are unavailable, the person must provide a written explanation for their
unavailability.
Like answering the questions correctly, providing all documents to NFA is important. Failure to do so will
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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
delay the registration process and may result in a denial of the application.
DEFINITION OF TERMS (The following terms are defined solely for the purpose of using NFA’s Online
Registration System.)
10% OR MORE INTEREST: direct or indirect ownership of 10% or more of an applicant’s or registrant’s stock; entitlement to vote or empowered to sell 10% or more of an applicant’s or registrant’s voting securities; contribution of
10% or more of an applicant’s or registrant’s capital; or entitlement to 10% or more of an applicant’s or registrant’s
net profits.
ADJUDICATION: in a criminal case, a determination by the court that the defendant is guilty or not guilty.
ALIAS: another name utilized by an individual or previously used by an entity.
CHARGE: a formal complaint, information, indictment or equivalent instrument containing and accusation of a
crime.
DBA: abbreviation for Doing Business As. The firm is doing business under this name.
ENJOINED: subject to an injunction.
ENTITY: any person other than an individual.
FELONY: any crime classified as a felony and for states and countries that do not differentiate between a felony
or misdemeanor, an offense that could result in imprisonment for any period of more than one year. The term also
includes a general court martial.
FINANCIAL SERVICES INDUSTRY: the commodities, securities, accounting, banking, finance, insurance, law or
real estate industries.
FOUND: subject to a determination that conduct or a rule violation has occurred. The term includes consent
decrees and settlements in which the findings are neither admitted nor denied or in which the findings are for
settlement or record purposes only.
INTERNAL REVENUE CODE:
Section 7203: Willful Failure to File Return, Supply Information or Pay Tax
Section 7204: Fraudulent Statement or Failure to Make Statement
Section 7205: Fraudulent Withholding Exemption Certificate or Failure to Supply Information
Section 7207: Fraudulent Returns, Statements or Other Documents
INVESTMENT RELATED STATUTES:
• The Commodity Exchange Act
• The Securities Act of 1933
• The Securities Exchange Act of 1934
• The Public Utility Holding Company Act of 1935
• The Trust Indenture Act of 1939
• The Investment Advisers Act of 1940
• The Investment Company Act of 1940
• The Securities Investors Protection Act of 1970
• The Foreign Corrupt Practices Act of 1977
• Chapter 96 of Title 18 of the United States Code
• Any similar statute of a State or foreign jurisdiction
• Any rule, regulation or order under any such statutes; and

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INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
• The rules of the Municipal Securities Rulemaking Board
MISDEMEANOR: any crime classified as a misdemeanor and for states and countries that do not differentiate between a felony or misdemeanor, an offense that could result in imprisonment for any period of at least six days but
not more than one year. By way of example, an offense for which the maximum period of imprisonment is 60 days
would be considered a misdemeanor. The term also includes a special court martial.
PERSON: an individual, association, partnership, corporation, limited liability company, limited liability partnership,
trust, or other form of business organization.
PRINCIPAL: an individual who is:
• a sole proprietor of a sole proprietorship;
• a general partner of a partnership;
• a director, president, chief executive officer, chief operating officer or chief financial officer of a corporation, limited liability company or limited partnership;
• in charge of a business unit, division or function of a corporation, limited liability company or limited partnership if the unit, division or function is subject to regulation by the Commission; or
• a manager, managing member or a member vested with the management authority for a limited liability company
or limited liability partnership; or
• an individual who directly or indirectly, through agreement, holding companies, nominees, trusts or otherwise:
- is the owner of 10% or more of the outstanding shares of any class of a registrant’s stock;
- is entitled to vote 10% or more of any class of a registrant’s voting securities;
- has the power to sell or direct the sale of 10% or more of any class of a registrant’s voting securities;
- has contributed 10% or more of a registrant’s capital;
- is entitled to receive 10% or more of a registrant’s net profits; or
- has the power to exercise a controlling influence over a registrant’s activities that are subject to
regulation by the Commission; or
an entity that:
- is a general partner of a registrant; or
- is the direct owner of 10% or more of any class of a registrant’s securities; or
- has directly contributed 10% or more of a registrant’s capital unless such capital contribution
consists of subordinated debt contributed by:
♦ an unaffiliated bank insured by the Federal Deposit Insurance Corporation;
♦ a United States branch or agency of an unaffiliated foreign bank that is licensed under the
laws of the United States and regulated, supervised and examined by United States government authorities having regulatory responsibility for such financial institutions; or
♦ an insurance company subject to regulation by any State.
SELF-REGULATORY ORGANIZATION (SRO): a private, non-governmental organization authorized to set and enforce standards or conduct for an industry. NFA, FINRA (formerly known as NASD), and the securities and futures
exchanges in the U.S. are examples of domestic SROs.
UNITED STATES CRIMINAL CODE:
Section 152:
Concealment of assets, making false claims or bribery in connection with a bankruptcy
Section 1341,
1342 or 1343: Mail fraud
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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Instructions for Using the Individual Withdrawal Template
Chapter 25:
Chapter 47:
Chapter 95
or 96:

Counterfeiting and forgery
Fraud or false statements in a matter within the jurisdiction of a United States department or
agency
Racketeering and Racketeering Influence

Additional Assistance
Additional information regarding registration requirements and specific topics can be found on the Registration
page of NFA’s web site at www.nfa.futures.org. NFA’s Information Center, (800-621-3570 or 312-781-1410), is also
available to provide assistance. It’s normal hours are Monday through Friday, from 8:00 AM to 5:00 PM CT.

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Individual Name*
Individual NFA ID#*
Sponsor Name*:
Sponsor NFA ID#*
Withdrawal Categories*
Enter the withdrawal date for each category being withdrawn:
Category

Withdrawal Date

ASSOCIATED PERSON
BRANCH MANAGER
PRINCIPAL
FOREX ASSOCIATED PERSON
Complete this section only if all of the individual’s registration categories with the Sponsor are being
withdrawn.
Withdrawal Reasons*
Select one:
Deceased
Discharged
Permitted to Resign
Voluntary
Other

*Required to file withdrawal

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Complete this section only if all of the individual’s registration categories with the Sponsor are being
withdrawn.
Do not complete if the individual is deceased.
Only Sponsors that are SEC registered Broker-Dealers may elect to complete this section in lieu of the
Disciplinary Information-Form 8-T section.

Disciplinary Information - Form U5*
Answer the following questions.
Investigation Disclosure
A.*

Currently is, or at termination was, the individual the subject of an investigation
or proceeding by a domestic or foreign governmental body or self-regulatory
organization with jurisdiction over investment-related businesses?

YES NO

Internal Review Disclosure
B.*

Currently is, or at termination was, the individual under internal review for fraud
or wrongful taking of property, or violating investment-related statutes,
regulations, or rules or industry standards of conduct?

YES NO

Criminal Disclosure
C.*

While employed by or associated with your firm, or in connection with events
that occurred while the individual was employed by or associated with your firm,
was the individual:
1. convicted of or did the individual plead guilty or nolo contendere (“no
contest”) in a domestic, foreign or military court to any felony?
2. charged with any felony?
3. convicted of or did the individual plead guilty or nolo contendere (“no
contest”) in a domestic, foreign or military court to a misdemeanor
involving: investments or an investment-related business, or any fraud,
false statements or omissions, wrongful taking of property, bribery,
perjury, forgery, counterfeiting, extortion, or a conspiracy to commit any
of these offenses?
4. charged with a misdemeanor specified in C3?

YES NO

Regulatory Action Disclosure
D.*

While employed by or associated with your firm, or in connection with events that
occurred while the individual was employed by or associated with your firm, was the
individual involved in any disciplinary action by a domestic or foreign governmental body or
self regulatory organization (other than those designated as a “minor rule violation” under
a plan approved by the U.S. Securities and Exchange Commission) with jurisdiction over
the investment-related businesses?

*Required to file withdrawal

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YES NO

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Disciplinary Information - Form U5 continued*
Customer Complaint/Arbitration/Civil Litigation Disclosure
E.*

(1) In connection with events that occurred while the individual was employed by or
associated with your firm, was the individual named as a respondent/defendant in an
investment-related, consumer-initiated arbitration or civil litigation which alleged that the
individual was involved in one or more sales practice violations and which:
(a) is still pending, or;
(b) resulted in an arbitration award or civil judgment against the individual,
regardless of amount, or;
(c) was settled, prior to May 18, 2009, for an amount of $10,000 or more, or;
(d) was settled, on or after May 18, 2009, for an amount of $15,000 or more?
(2) In connection with events that occurred while the individual was employed by or
associated with your firm, was the individual the subject of an investment-related,
consumer-initiated (written or oral) complaint, which alleged that the individual was involved in
one or more sales practice violations, and which:
(a) was settled, prior to May 18, 2009, for an amount of $10,000 or more, or;
(b) was settled, on or after May 18, 2009, for an amount of $15,000 or more?
(3) In connection with events that occurred while the individual was employed by or associated
by or with your firm, was the individual the subject of an investment-related, consumer-initiated,
written complaint, not otherwise reported under questions E(2) above, which:
(a) would be reportable under question 14I(3)(a) on Form U4, if the individual were
still employed by your firm, but which has not previously been reported on the
individual’s Form U4 by your firm; or
(b) would be reportable under question 14I(3)(b) on Form U4, if the individual were
still employed by your firm, but which has not previously been reported on the
individual’s Form U4 by your firm.

ANSWER QUESTIONS (4) AND (5) BELOW ONLY FOR ARBITRATION CLAIMS OR CIVIL
LITIGATION FILED ON OR AFTER MAY 18, 2009.
(4) In connection with events that occured while the individual was employed by or associated
with your firm, was the individual the subject of an investment-related, consumer-initiated,
arbitration claim or civil litigation which alleged that the individual was involved in one or more
sales practice violations, and which:
(a) was settled for an amount of $15,000 or more, or;
(b) resulted in an abitration award or civil judgment against any named respondent(s)/
defendant(s), regardless of amount?
(5) In connection with events that occured while the individual was employed by or associated
with your firm, was the individual the subject of an investment-related, consumer-initiated,
arbitration claim or civil litigation not otherwise reported under question E(4) above, which:
(a) would be reportable under question 14I(5)(a) on Form U4, if the individual were still
employed by your firm, but which has not previously been reported on the individual’s
Form U4 by your firm; or

*Required to file withdrawal

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YES NO

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Disciplinary Information - Form U5 continued*
E.

YES NO
(5) continued.
(b) would be reportable under question 14I(5)(b) on Form U4, if the individual were still
employed by your firm, but which has not previously been reported on the individual’s
Form U4 by your firm.

Termination Disclosure
F.*

Did the individual voluntarily resign from your firm, or was the individual discharged or
permitted to resign from your firm, after allegations were made that accused the individual
of:
1. violating investment-related statutes, regulations, rules or industry standards of
conduct?
2. fraud or the wrongful taking of property?
3. failure to supervise in connection with investment-related statutes, regulations,
rules or industry standards of conduct?

YES NO

ADDITIONAL FILIINGS
The individual must provide additional documentation for each matter disclosed above unless the individual has previously
provided all documentation for that matter. If the individual must provide additional documentation, the individual may
provide a hard copy U5 DRP or complete an electronic Matter Information page. Check all that apply.
No additional documentation needs to be provided.
Hardcopy U5 DRP(s) will be provided.
Matter Information page will be completed.

*Required to file withdrawal

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Complete this section only if all of the individual’s registration categories with the Sponsor are being
withdrawn.
Do not complete if the individual is deceased.

Disciplinary Information - Form 8-T*
Answer the following questions.
Criminal Disclosures
A.*

While associated or affiliated with your firm, has the individual pled guilty or nolo
contendere (“no contest”) to or been convicted of or found guilty of any felony in any
domestic, foreign or military court?
Yes

B.*

No

While associated or affiliated with your firm, has the individual pled guilty to or been
convicted or found guilty of any misdemeanor in any domestic, foreign or military court
which involves:
• Embezzlement, theft, extortion, fraud, fraudulent conversion, forgery,
counterfeiting, false pretenses, bribery, gambling, racketeering or
misappropriation of funds, securities or property;
• Violation of sections 7203, 7204, 7205 or 7207 of the Internal Revenue Code of 1986;
• Violation of sections 152, 1341, 1342 or 1343 or chapter 25, 47, 95 or 96 of the United
States Criminal Code; or
• Any transaction in or advice concerning futures, options on futures, leverage
transactions or securities?
Yes

No
Regulatory Disclosure

C.*

While associated or affiliated with your firm, was the individual the subject of any order
issued by a domestic or foreign regulatory authority (excluding the CFTC) or selfregulatory organization (other than NFA or a domestic futures exchange) that prevented
or restricted the individual’s ability to engage in any business in the financial services
industry?
Yes

*Required to file withdrawal

No

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Disciplinary Information - Form 8-T continued*
Financial Disclosure
D.*

Does the individual have any unpaid futures or securities-related civil monetary
penalties, reparation amounts or arbitration awards?
Yes

No

Pending Action Disclosure
E.*

Is the individual a party to any action, or is there a charge pending, the resolution of
which could result in a “yes” answer to the questions in the Criminal Disclosures or
Regulatory Disclosures section?
Yes

No
ADDITIONAL FILIINGS

The individual must provide additional documentation for each matter disclosed above unless the
individual has previously provided all documentation for that matter. If the individual must provide
additional documentation, the individual may provide hard copy documentation or complete an
electronic Matter Information page. Check all that apply.
No additional documentation needs to be provided.
Hardcopy documentation will be provided.
Matter Information page will be completed

*Required to file withdrawal

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NATIONAL FUTURES ASSOCIATION
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Matter Information
For each matter for which the individual has not provided all supporting documentation, provide a detailed
explanation of the event or conduct. You can enter up to three (3) matters in this document. If you have more
than three (3) matters which you must explain, please do so in another document such as Microsoft Word and
attach it to this document.
The explanation must be in writing and sent to NFA or entered below. The explanation must include:

Matter Name:
(e.g., 1999 Theft Arrest/Charge; 00-R100 Unpaid Award, FINRA Case No. CM10000)
When and where the event occurred, parties involved, circumstances, case number and court
jurisdiction, allegations/charges (if criminal matter), classification of the charges, plea and sentencing
information (if criminal matter), and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter, it must provide a letter from the court verifying the
documents’ unavailability.
FOR NON-CRIMINAL MATTERS:
Copies of the documentation which show:
• the allegations; and
• the final disposition.
If the applicant is unable to obtain the documents for the non-criminal matter, it must provide an explanation stating why
documents are not obtainable.

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NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Matter Information - Additional Matters, if needed
Matter Name:
(e.g., 1999 Theft Arrest/Charge; 00-R100 Unpaid Award, FINRA Case No. CM10000)
When and where the event occurred, parties involved, circumstances, case number and court
jurisdiction, allegations/charges (if criminal matter), classification of the charges, plea and sentencing
information (if criminal matter), and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter, it must provide a letter from the court verifying the
documents’ unavailability.
FOR NON-CRIMINAL MATTERS:
Copies of the documentation which show:
• the allegations; and
• the final disposition.
If the applicant is unable to obtain the documents for the non-criminal matter, it must provide an explanation stating why
documents are not obtainable.

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NATIONAL FUTURES ASSOCIATION
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Matter Information - Additional Matters, if needed
Matter Name:
(e.g., 1999 Theft Arrest/Charge; 00-R100 Unpaid Award, FINRA Case No. CM10000)
When and where the event occurred, parties involved, circumstances, case number and court
jurisdiction, allegations/charges (if criminal matter), classification of the charges, plea and sentencing
information (if criminal matter), and the final disposition.

AND IN ADDITION, THE APPLICANT MUST PROVIDE THE FOLLOWING:
Copies of court documentation which show:
• the charges;
• the classification of the offense, (i.e., felony or misdemeanor);
• the plea, sentencing and probation information, as applicable; and
• the final disposition.
If the applicant is unable to obtain the documents for the criminal matter, it must provide a letter from the court verifying the
documents’ unavailability.
FOR NON-CRIMINAL MATTERS:
Copies of the documentation which show:
• the allegations; and
• the final disposition.
If the applicant is unable to obtain the documents for the non-criminal matter, it must provide an explanation stating why
documents are not obtainable.

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Privacy Act and Paperwork Reduction Act Notice
OMB# 3038-0023
Privacy Act and Paperwork Reduction Act Notice
The information in Forms 7-R, 7-W, 8-R and 8-T and on the fingerprint card is being collected pursuant to authority granted
in Sections 2c, 4f, 4k, 4n, 8a and 19 of the Commodity Exchange Act [7 U.S.C. §§ 6f, 6k, 6n, 12a and 23]. Under Section 2c, it
is unlawful for anyone to engage in off-exchange foreign currency futures transactions or off-exchange foreign currency
leveraged, margined or financed transactions with persons who are not eligible contract participants without registration, or
exemption from registration, as a retail foreign exchange dealer, futures commission merchant, introducing broker, commodity
pool operator or commodity trading advisor, as appropriate. Under Section 4d of the Commodity Exchange Act [7 U.S.C.
§6d], it is unlawful for anyone to act as a futures commission merchant or introducing broker without being registered in
that capacity under the Act. Under Section 4m of the Commodity Exchange Act [7 U.S.C. §6m], it is unlawful for a commodity
trading advisor or commodity pool operator to make use of the mails or any means or instrumentality of interstate commerce
in connection with his business as a commodity trading advisor or commodity pool operator without being registered in the
appropriate capacity under the Act, except that a commodity trading advisor who, during the course of the preceding 12
months, has not furnished commodity trading advice to more than 15 persons and does not hold himself out generally to the
public as a commodity trading advisor, need not register. Under Section 19 of the Commodity Exchange Act [7 U.S.C. §23]
and Section 31.5 of the CFTC’s regulations, it is unlawful for anyone to act as a leverage transaction merchant without being
registered in that capacity under the Act.
The information requested in Form 7-R is designed to assist NFA and the CFTC, as appropriate, in determining whether the
application for registration should be granted or denied and to maintain the accuracy of registration files. The information
in Form 7-W is designed to assist NFA and the CFTC in determining whether it would be contrary to the requirements of
the Commodity Exchange Act, or any rule, regulation or order thereunder, or the public interest to permit withdrawal from
registration.
The information requested in Form 8-R and on the fingerprint card will be used by the CFTC or NFA, as appropriate, as a basis
for initiating an inquiry into the individual’s fitness to be an associated person, floor broker or floor trader or to be a principal
of a futures commission merchant, retail foreign exchange dealer, introducing broker, commodity trading advisor, commodity
pool operator or leverage transaction merchant. Portions of the information requested in Form 8-R will be used by the CFTC
and, in appropriate cases, by NFA, to confirm the registration of certain associated persons. The information requested in
Form 8-T will be used by the CFTC, and, in appropriate cases, by NFA, to record the registration status of the individual and,
in appropriate cases, as a basis for further inquiry into the individual’s fitness to remain in business subject to the CFTC’s
jurisdiction.
With the exception of the social security number, all information in Forms 8-R and 8-T must be furnished. Disclosure of the
social security number is voluntary. Disclosure of the Federal employer identification number is voluntary. The Social security
number and the Federal employer identification number are sought pursuant to the Debt Collection Improvement Act of
1996. Under the Debt Collection Improvement Act, a social security number or a taxpayer identifying number furnished to the
CFTC as part of the registration process can be used for purposes of collecting and reporting on any debt owed to the U.S.
Government, including civil monetary penalties. The furnishing of a social security number or Federal employer identification
number, however, assists the CFTC and NFA in identifying individuals and firms and therefore expedites the processing of
those forms.
The failure by an applicant, registrant or principal to timely file a properly completed Form 7-R and all other related required
filings may result in the denial of an application for registration or withdrawal thereof or, in the case of an annual records
maintenance fee, treating the registrant as having petitioned for withdrawal. Failure by an applicant, registrant or principal
to timely file or cause to be filed a properly completed Form 8-R or 8-T, any other required related filings, or a fingerprint card

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TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Privacy Act and Paperwork Reduction Act Notice
may result in the lapse, denial, suspension or revocation of registration, withdrawal of the application or other enforcement or
disciplinary action by the CFTC or NFA.
With the exception of the fingerprint card, any information contained in the Personal Information Section and any information
contained in Matter Information pages related to the Disciplinary Information Sections on Form 8-R and on Form 8-T or Item
7 on Form 8-W, the Forms 7-R, 7-W, 8-R and 8-T are considered by the CFTC to be public records and will be available for
inspection by any person. Copies will be maintained by National Futures Association, Registration Department, Suite 1800,
300 S. Riverside Plaza, Chicago, IL 60606-6615. Further, the CFTC or NFA may disclose the fingerprint card and any other
information described above to third parties pursuant to routine uses which the CFTC has published in the Federal Register
or as otherwise authorized under the Privacy Act, [5 U.S.C. §552a], and the Commodity Exchange Act. Disclosure of such
information may be made by the CFTC as follows: (1) in connection with administrative proceedings or matters in litigation; (2)
in connection with investigations; (3) where the information is furnished to regulatory, self-regulatory and law enforcement
or other governmental agencies to assist them in meeting responsibilities assigned to them by law or made available to any
member of Congress who is acting in his or her capacity as a member of Congress; (4) where disclosure is required under
the Freedom of Information Act [5 U.S.C. §552]; (5) in connection with an employer’s hiring or retention of an employee; (6)
in connection with the verification of information submitted for sponsorship purposes; (7) in other circumstances in which
the withholding of such information appears unwarranted; and (8) in connection with legally required or authorized reports.
Disclosure may be made by NFA in accordance with rules approved by the CFTC.
If an individual believes that the placing in the CFTC’s or NFA’s public files of any of the information contained in the Personal
Information Section or in Matter Information pages related to Disciplinary Information on Form 8-R and on Form 8-T or Item
7 on Form 8-W, or on the fingerprint card would constitute an unwarranted invasion of his personal privacy, the individual
may petition the CFTC, pursuant to 17 CFR 145.9, to treat such information as confidential in response to requests under
the Freedom of Information Act (FOIA) [5 U.S.C. §552]. The CFTC will make no determination as to confidential treatment of
information submitted unless and until the information is the subject of an FOIA request. The filing of a petition for confidential
treatment, however, does not guarantee that the information will be treated confidentially in response to an FOIA request.
Forms which have not been prepared and executed in compliance with applicable requirements may not be acceptable for
filing. Acceptance of this form shall not constitute any finding that the information is true, current or complete. Misstatements
or omissions of fact may constitute federal criminal violations [7 U.S.C. §13 and 18 U.S.C. §1001] or grounds for disqualification
from registration.
This notice is provided in accordance with the requirements of the Privacy Act, [5 U.S.C. §552a(e)(3)] and summarizes some
of an individual’s rights under the Privacy Act [5 U.S.C. §552a] and the Freedom of Information Act [5 U.S.C. §552]. Individuals
desiring further information should consult the CFTC’s regulations under the Privacy Act, 17 CFR Part 146, and under the
Freedom of Information Act, 17 CFR Part 145, and the CFTC’s annual notice, published in the Federal Register, pursuant to the
Privacy Act, of the existence and character of each system of records maintained by the CFTC.
You are not required to provide the information requested on a form subject to the Paperwork Reduction Act unless the form
displays a valid OMB Control Number.
The time needed to complete and file Form 7-R, Form 3-R, Form 7-W, Form 8-R and Form 8-T and Form 8-W may vary depending
upon individual circumstances. The estimated average times are:
Form 7-R
FCM
RFED
IB
CPO
CTA

30 minutes
30 minutes
24 minutes
24 minutes
24 minutes

Form 3-R
Form 7-W
Form 8-R
Form 8-T
Form 8-W

3 minutes
3 minutes
20 minutes
6 minutes
3 minutes

TEMPLATE: DO NOT SEND TO NFA
NATIONAL FUTURES ASSOCIATION
INDIVIDUAL WITHDRAWAL
Firm Certification Statement
BY FILING THIS FORM 8-T, THE SPONSOR AGREES THAT SUCH FILING CONSTITUTES THE SPONSOR’S
certification that the answers and the information provided in the Form 8-T are true, complete and
accurate and that in the light of the circumstances under which the sponsor has given them, the answers
and statements in the Form 8-T are not misleading in any material respect; certification that the person
who electronically files the Form 8-T on behalf of the sponsor is authorized by the sponsor to file the
Form 8-T on behalf of the sponsor and to make all required certifications and acknowledgements; and
acknowledgement that the sponsor is subject to the imposition of criminal penalties under Section 9(a) of
the Act and 18 U.S.C. §1001 for any false statements or omissions made in the Form 8-T.