Securities and Exchange Commission
Washington, D.C. 20549
OMB APPROVAL OMB Number: 3235-0328 Expires: June 30, 2011 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 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 either Filer, Filing Agent or Training Agent box)
PART II - FILER INFORMATION (To be completed only by filers that are not individuals)
Filer's Tax Number or Federal Indentification Number (Do Not Enter a 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)
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)
E-Mail Address SEC 2084 (03-09) 1 Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. State or Country Zip
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 County 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), section 20 of the Public Utility Holding Company Act of 1935 (15 U.S.C. 79t) 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.
FORM ID GENERAL INSTRUCTIONS USING AND PREPARING FORM ID Form ID must be filed by registrants, third party filers, 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 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 filing. 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 pass word.
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, signing it, and having the signature notarized. If the applicant has prepared the authenticating document before making its electronic Form ID filing, it may submit the document as an uploaded Portable Document Format (PDF) attachment to the electronic filing. 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 filing. If submitted by fax after the electronic Form ID filing, the authenticating document must contain the accession number assigned to the electronic Form ID filing. If the fax is not received timely, the Form ID filing 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 filing 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 filing, call Filer Support at (202) 551-8900. For assistance with questions about the EDGAR rules, Division of Corporation Finance filers may call the Office of Information Technology at (202) 551 3600; and Division of Investment Management filers 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. 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 filer, filing agent, or training agent. Mark only one of these boxes per application. If you are an individual, however, also mark the "Indi vidual" box. · · "Filer" - Any individual or entity on whose behalf an electronic filing is made. "Filing Agent" - A financial printer, law firm, or other party, which will be using these access codes to send a filing or portion of a filing on behalf of a filer. "Training Agent" - Any individual or entity that will be sending only test filings in conjunction with training other persons. "Transfer Agent"- Any individual or entity planning to register as a Transfer Agent on whose behalf an electronic filing is made. "Individual" A natural person.
PART II - FILER INFORMATION (to be completed only by filers that are not individuals) The filer's tax or federal identification 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 filer is organized as a series company, the investment company may use the tax or federal identification number of any one of its constitu ent series. Issuers that have applied for but not yet received their tax or federal identification number and foreign issuers that do not have a tax or federal identification number must include all zeroes. A "foreign issuer" is an entity so defined by Securities Act of 1933 (15 U.S.C. 77a et seq.) Rule 405 (17 CFR 230.405) and 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 filer must provide its "doing business as" name in the language of the name under which it does busi ness and must provide its foreign language name, if any, in the space so marked. If the filer's fiscal year does not end on the same date each year (e.g., falls on the last Saturday in December), the filer must enter the date the current fiscal 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 notification address for EDGAR filings; it will be stored in the Company Contact Information on the EDGAR Database. EDGAR will send all subsequent filing notifications 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 filing 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 filing 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 indi vidual, 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, confirm the authority of the other person to sign in writing in an electronic attachment to the Form. The confirming statement need only indicate that the representative individual or individual applicant authorizes and designates the named person or persons to file the Form on behalf of the applicant and state the duration of the authorization.