FORM 21-101F4 CESSATION OF OPERATIONS REPORT FOR ALTERNATIVE TRADING SYSTEM 1. Identification: A. Full name of alternative trading system (if sole proprietor, last, first and middle name): B. Name(s) under which business is conducted, if different from item 1A: 2. Date alternative trading system proposes to cease carrying on business as an ATS: 3. If cessation of business was involuntary, date alternative trading system has ceased to carry on business as an ATS: 4. Please check the appropriate box: the ATS intends to carry on business as an exchange and has filed Form 21-101F1. the ATS intends to cease to carry on business. the ATS intends to become a member of an exchange. THE FILER CONSENTS TO HAVING THE INFORMATION ON THIS FORM AND ATTACHED EXHIBITS PUBLICLY AVAILABLE. EXHIBITS File all Exhibits with the Cessation of Operations Report. For each exhibit, include the name of the ATS, the date of filing of the exhibit and the date as of which the information is accurate (if different from the date of the filing). If any Exhibit required is inapplicable, a statement to that effect shall be furnished instead of such Exhibit. Exhibit A The reasons for the alternative trading system ceasing to carry on business as an ATS. Exhibit B A list of each of the securities the alternative trading system trades. Exhibit C The amount of funds and securities, if any, held for subscribers by the alternative trading system, or another person or company retained by the alternative trading system to hold funds and securities for subscribers and the procedures in place to transfer or to return all funds and securities to subscribers.
CERTIFICATE OF ALTERNATIVE TRADING SYSTEM The undersigned certifies that the information given in this report is true and correct. DATED at _____________ this ______ day of ______________ 20__ (Name of alternative trading system) (Name of director, officer or partner - please type or print) (Signature of director, officer or partner) (Official capacity - please type or print)
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