Fillable Transfer Agent Registration and Amendment Form TA-1 2017

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Transfer Agent Registration and Amendment Form TA-1 2017

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The Transfer Agent Registration and Amendment Form TA-1 2017 form is 3 pages long and contains:

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  • 11 check-boxes
  • 56 other fields

Country of origin: US
File type: PDF

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Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of the Comptroller of the Currency
Public reporting for this collection of information is estimated to average 1.25 hours per registration, and 10 minutes per updating amendment, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden, to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW,
Washington, DC 20551; or Assistant Executive Secretary, Federal Deposit Insurance Corporation, Washington, DC 20429; or Legislative and Regulatory Activities Division, Office of the
Comptroller of the Currency, Washington, DC 20219; and to the Office of Management and Budget, ATTN: Paperwork Reduction Project (7100-0099, 1557-0124, 3064-0026), Washington,
DC 20503.
Transfer Agent Registration and Amendment Form—Form TA-1
Under Sections 17(a)(3), 17A(c), and 23(a) of the Act and the
rules and regulations thereunder, the ARA's are authorized to
solicit from applicants for registration as a transfer agent and
from registered transfer agents the information required to be
supplied by Form TA-1. Disclosure to the ARA of the information
requested in Form TA-1 is a prerequisite to the processing of
Form TA-1.
The information will be used for the principal purpose of
determining whether the ARA should allow an application for
registration to become effective or should deny, accelerate, or
postpone registration to an applicant.
Information supplied on this form will be available for inspection
by any interested person.
An agency may not conduct or sponsor, and an organization (or a
person) is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.
1/2017
Board of Governors of the Federal Reserve System OMB Number 7100-0099 Approval expires December 31, 2019
Federal Deposit Insurance Corporation OMB Number 3064-0026 Approval expires December 31, 2019
Office of the Comptroller of the Currency OMB Number 1557-0124 Approval expires December 31, 2019
Page 1 of 3
Form TA-1
Page 2 of 3
Transfer Agent Registration and Amendment Form
1.
Appropriate Regulatory Agency (check one):
Board of Governors of the Federal Reserve System
Federal Deposit Insurance Corporation
Office of the Comptroller of the Currency
2. Filing Status of this form (check one):
Registration
Amendment to Registration
09/2016
For Official Use Only
Reg/File Number
Please print or type all responses. Read all instructions before completing the form. Applicant must complete all information if
registering as a transfer agent. For amendments, registrant must identify itself and the filing by answering questions 1 through 3.
Thereafter, only answer questions that require amendment in addition to providing the name and signature of the person responsible,
and the date (questions 14-16). Detailed guidance for each item on Form TA-1 appears in Part II (Special Instructions) of the
instructions for Form TA-1.
Full Name
Previous Name (if being amended for name change)
3. Full name of Registrant organization:
5. Main Office Location of Registrant:
Zip CodeStateCity
Street Address
7. Telephone Number:
Area Code / Phone Number
Street Address
City State Zip Code
6. Mailing Address:
8. Registrant Principal Location where Transfer Agent
Processing Activities are:
Street Address
City State Zip Code
Zip CodeStateCity
Street Address
Zip Code
Street Address
City State Zip Code
StateCity
Street Address
Zip CodeStateCity
Street Address
9. List all other Registrant locations where Transfer Agent Processing Activities are conducted.
(Locations different from responses to questions 5 and 8 above):
4. Financial Industry Number Standard (FINS) Number:
13. Execution: The Registrant submitting this form, and the person executing it, hereby represent that all the information contained
herein is true, correct, and complete.
Attention: Intentional misstatements or omissions of fact constitute federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C.
78ff(a).
8
8
-
-
-
-
8
8
8
-
Appropriate Regulatory Agency (ARA)
Assigned Registered Transfer Agent Number
If Yes, list the name(s) of the Named Transfer Agents:
12.
Does the Registrant perform any private label transfer agent services for another Registered Transfer Agent?
14. Full name of official responsible for form (print or type):
11.
Has the Registrant contracted to have an outside organization perform transfer agent functions in the Registrant's name?
("Private Label" Servicing)
If Yes, list the name(s) of Private Label Transfer Agents:
Appropriate Regulatory Agency (ARA)
Assigned Registered Transfer Agent Number
-
8
8
8
-
-
Transfer Agent Registration and Amendment Form—Continued
10.
Does Registrant act (or will it act) as a transfer agent solely for its own securities and/or securities of an affiliate(s)?
First Name Middle Name Last Name
14.a. Title of official responsible for form:
Title
Form TA-1
Page 3 of 3
16.
Date (MM/DD/YYYY)
15.
Signature of Official Responsible for form
07/2013
Yes No
Yes No
Yes No
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Transfer Agent Registration and Amendment Form TA-1 2017

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Completed 27 January 2020

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