Register with SIC®

This form should be completed and filed by all institutions subject to Rule 17f-1 which are not exempt from the registration provisions of the rule and

01. Who have not submitted a registration form for the Lost and Stolen Securities Program to the Commission's designee.

02. Who have not submitted a Registration form to the Commission's designee and desire to amend their prior registration to either update the information or change their inquiry participation status.

The institutions subject to Rule 17f-1 are as follows:
Every national securities exchange member, thereof registered securities association, broker-dealer, municipal securities dealer, registered transfer agent, registered clearing agency, participant therein, member of the federal reserve system and banks whose deposits are insured by the FDIC.

Brokers and dealers whose only business is conducted on a national securities exchange and who do not conduct public business, and broker-dealers who limit their business to sales of variable contracts or limited partnership, are exempt from the registration provisions of Rule 17f-1.

SIC® will do its utmost to avoid billing those exempt participants. If a participant believes to be exempt it must notify SIC® with that information within 60 days of initially contacting SIC® or before May 1 or November 1 whichever is the closest to the initial contact date. SIC® invoices twice a year, therefore all participants applying for exemption must have the proper paperwork completed by the above dates or they will be invoiced as a full participant.

Institutions should not complete this form if they previously registered in the Lost and Stolen Securities Program by submission of a registration form, the data submitted thereon is current, and they do not desire to change their inquiry participation status. If a registered institution does not submit this form, the prior election of inquiry participation status will continue and be binding.

* All registration forms sent to the Securities Information Center must be sent with the original signatures.

Part I:
A. FINS Numbers (Financial Industry Numbering Standard)
FINS Numbers are assigned by DTCC. If an institution is uncertain as to whether it has a FINS number, they should contact DTCC. If an institution has NOT been assigned a number, they can go to the DTCC website, and fill out the FINS application form. Once this form is complete, the institution can fax or mail it to the contact information provided on the form.

B. Type of Institution
If no classification describes the institution, the institution is not subject to Rule 17f-1. If the institution desires to participate in the Program as a "permissive inquirer", a special application must be made to the Commission.

Part II - Election of Inquiry Participation Status
Direct Inquirer
To register as a Direct Inquirer, Please complete items A, B, and C of Part II, in addition to Part IV. Direct inquirers will be able to make inquiries of the database directly and will be charged usage fees and registration fees as described in the appendix of the Securities Exchange Act Release No.15289.

A. Registration of Access Stations
An Access Station is the location from which the inquiries or reports are made, and to which printed confirmations of inquiries or reports received by the commission's designee will be sent. Each access station is assigned an access code by SIC®. All direct inquirers MUST have at least one primary access station (code). If all access stations will be at the address indicated in Part I of the registration form, and all confirmations for that station are to be sent to the "person responsible for the institution's compliance with Rule 17f-1", leave the first box- Registration of Access Stations- blank or write "same", and indicate the number of access stations where requested.

If the primary access station will be different from Part I of the registration form, attach a sheet indicating where the Access Station(s) will be and write "see attached" under registration of access stations. Institutions establishing secondary access stations should also append to this form a list of addresses, titles, and names of responsible individuals for each station.

B. Optional Prompt Confirmation Service
The Prompt Confirmation Service is no longer available. Institutions receive confirmations immediately when submitting inquiries or reports online through the SIC® website.

Registrants should note that usage and registration fees have increased since Securities and Exchange Act Release No. 15289 was published in 1978. Please contact SIC® to obtain pricing information.

Part III - Election of Inquiry Participation Status
Indirect Inquirer
To register as an Indirect Inquirer, complete Part III, in addition to Part I and Part IV. Indirect inquirers will not be able to make inquiries directly thus must make arrangements with a registered direct inquirer to inquire on their behalf. Indirect inquirers should be aware that the institution making inquiries on their behalf might assess costs and service charges.

Part IV - Agreement and Signatures
A. Agreement
Read this statement carefully before signing. It explains the basic responsibilities of both the registrant and SIC®. No registrations or agreements will be accepted without original signatures.

B. Names and Signatures of Persons Making Reports on Behalf of the Institution
Both Direct and Indirect Inquirers are required to report missing, lost or stolen securities directly to SIC®. A registration cannot be accepted without at least one original signature in this section.