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efta-efta01468629DOJ Data Set 10CorrespondenceEFTA Document EFTA01468629
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EFTA DisclosureText extracted via OCR from the original document. May contain errors from the scanning process.
Fax: 212.577.4506
E-Mail: [email protected]
INSTITUTIONAL SUITABILITY CERTIFICATE AFFIRMATIVE INDICATION OF
EXERCISE OF INDEPENDENT JUDGMENT (Pursuant to FINRA Rule 2111)1
In connection with any recommended2 transaction or investment strategy by a
registered broker-dealer, the undersigned
acknowledges on behalf of the Institution named below that:
I
II.
It is an Institutional Account as defined in FINRA Rule 4512(c)3;
It (1) is capable of evaluating investment risks independently, both in
general and with regard to all transactions and
investment strategies involving a security or securities; and (2) will
exercise independent judgment in evaluating the
recommendations of any broker-dealer or its associated persons, unless it
has otherwise notified the broker-dealer in
writing;
III.
It will notify Dealogic and each broker-dealer servicing the Institutional
Account if anything in this Certificate ceases to
be true;
IV. This Certificate and the information contained herein may be shared with
broker-dealers or third parties, including via a
secure database or electronic platform established by Dealogic; and
V. He or she is authorized to sign on behalf of the Institutional Account
named below.
By signing this Certificate, the undersigned affirms that the above
statements are accurate but does not waive any rights afforded
under U.S. federal or state securities laws, including without limitation,
any rights under Section 10(b) of the Securities
Exchange Act of 1934, as amended, and the rules and regulations promulgated
thereunder.
NOTE: This Certificate shall apply with respect to all recommended
transactions and investment strategies involving
securities that are entered into by the "Institutional Account" named in
this Certificate, whether for the account of such
Institutional Account or for the account of any beneficial owner that has
delegated decision making authority to such
Institutional Account.
1 Available at http://www.finra.org/Industry/Regulation/FINRARules/
2 As defined in FINRA Rules.
3 The term "Institutional Account" means the account of: (1) a bank, savings
and loan association, insurance company or registered
investment company; (2) an investment adviser registered either with the SEC
under Section 203 of the Investment Advisers Act or
with a state securities commission (or any agency or office performing like
functions); or (3) any other person (whether a natural
person, corporation, partnership, trust or otherwise) with total assets of
at least $50 million as of the date of this Certificate
(whether such assets are invested for such person's own account or under
management for the account of others).
EFTA01468629
Institution Account Name
Address, City, State, Zip
Name of Authorized Signatory
U.S. Tax ID / EIN (if applicable)
Title of Authorized Signatory
Telephone
Email Address
Signature of Authorized Signatory
Date
Copyright 0 2011. Dealogic LLC. All Rights Reserved. Only (i) client(s) of
Dealogic; or (ii) parties permitted by a Dealogic client may use this
letter. All other
usage other an stated is unauthorized. Dealogic LLC 120 Broadway, 8th Floor,
New York, NY 10271 U.S.A • 212.577.4520 • www.dealogic.com
EFTA01468630
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