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UNITED STATES

SECURITIES AND 

EXCHANGE COMMISSION

Washington, D.C. 20549

FORM TA-W

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OMB Number : 3235-0151

Expires : December 31, 2026

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NOTICE OF WITHDRAWAL FROM REGISTRATION 

AS TRANSFER AGENT 

 PURSUANT TO SECTION 17A OF THE SECURITIES EXCHANGE ACT OF 

1934 

Check to show blank box for Form Version: 1.0.0 printing

1(a).Filer CIK: 1(b).Filer CCC:

1(c). Live/Test Live Test Filing? 

1(d). Return Yes Copy? 

The registrant may provide a single e-mail address for contact purposes. 

1(e)(i). Contact Name: 1(e)(ii).Contact phone 1(e)(iii).Contact E-mail 

Number: Address:

The registrant may provide additional e-mail addresses for those 

persons the filer would like to receive notification e-mails regarding the filing. 

1(f).Notification E-mail Address:

2. Transfer Agent File No.: 084 -

3. Full name of registrant:

4. Name under which transfer agent activities are conducted, if different from

above:

SEC 1669 (12-06) 

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. 
 

5. Address of registrants principle place of business:

5(a).Address1

5(b).Address2 

5(c).City 

5(d).State or Country 

5(e).Postal Code 

6. Furnish registrant's reasons for ceasing the performance of transfer agent

functions or for otherwise requesting withdrawal of its registration:

7. Furnish the last date registrant performed transfer agent functions as defined

by Section 3(a)(25) of the Act for any security, including debt and equity,

registered under Section 12 of the Act or which would be required to be

registered except for the exemption from registration provided by paragraph

(g)(2)(B ) or (g)(2)(G) of that section.

7(a). Does registrant have any intention of performing in the near future a 

transfer agent function for any such security? 

Yes No

8. Is registrant directly or indirectly involved in any legal actions or proceedings

or aware of any potential claims against it in connection with its performance of

transfer agent functions for any security?

Yes No

8(a). If so, furnish complete information with respect to each: 

8(a)(i). Individual named in the action or claim: 

8(a)(ii). Title of the action or claim: 8(a)(iii).Action date:

8(a)(iv).Court or body name and location: 
8(a)(v). Description of the action or claim: 

8(a)(vi).Disposition of action or claim: 

9. Are there any unsatisfied judgments or liens against registrant arising out of

its performance of transfer agent functions for any security?

Yes No

9(a). If so, furnish complete information regarding each judgment or lien. 

9(a)(i). Individual named in the action or claim: 

9(a)(ii). Title of the action or claim: 9(a)(iii).Action date:

9(a)(iv).Court or body name and location: 

9(a)(v). Description of the action or claim: 

9(a)(vi).Disposition of action or claim: 

10. For each issue for which registrant acted as transfer agent and for any 

issues for which registrant assumed transfer agent functions since the last 

amendment to Form TA-1, furnish:

10(a). Is there a successor transfer agent? 

Yes No

10(b). Name of successor transfer agents: 

10(c). Address: 

10(c)(i).Address 1 

10(c)(ii).Address 2 

10(c)(iii).City 
10(c)(iv).State or Country 

10(c)(v).Postal Code 

10(d). Is the successor transfer agent registered as a transfer agent pursuant 

to the Act? 

Yes No

11.For each issue for which registrant acted as transfer agent and for any issues 

for which registrant assumed transfer agent functions since the last amendment 

to Form TA-1, furnish: name(s) and address(es) of the person(s) who has or will 

have custody or possession of the books and records which the registrant 

maintained in connection with its performance of transfer agent functions.

11(a). Name of Custodian 

11(b). Address: 

11(b)(i).Address 1 

11(b)(ii).Address 2 

11(b)(iii).City 

11(b)(iv).State or Country 

11(b)(v).Postal Code 

12. Furnish the name(s) and address(es), if different from Item 11, where such

books and records will be located.

12(a). Name of Custodian 

12(b). Address: 

12(b)(i).Address 1 

12(b)(ii).Address 2 

12(b)(iii).City 
 

12(b)(iv).State or Country 

12(b)(v).Postal Code 

SIGNATURE:The registrant submitting this Form and its attachments and the 

person executing it represent that it and all materials filed in 

connection with it contain a true, correct and complete statement 

of all required information. Registrant also consents to make the 

books and records it is required to preserve by Rules 17Ad-6 and 

17Ad-7 under the Securities Exchange Act of 1934 (17 CFR 

240.17Ad-6 and 240.17Ad-7) available for examination by 

authorized representatives of the Commission during the period 

the rules require registrant to preserve such books and records 

and authorizes the person having custody of such books and 

records to make them available to such representatives.

13(a).Signature of Official responsible for Form: 13(b).Telephone number:

13(c).Title of Signing Officer:

13(d).Date signed 

Month/Day/Year):
UNITED STATES 

SECURITIES AND EXCHANGE COMMISSION 

Washington, D.C. 20549 

FORM TA-W 

Instructions for Use of Form TA-W 

Notice of Withdrawal from Registration as a Transfer Agent 

Pursuant to Section 17A of the Securities Exchange Act of 1934 

ATTENTION: This electronic Form TA-W is to be filed only by SEC registrants. All 

other registrants withdraw from registration as a transfer agent with their appropriate 

regulatory authority and should obtain instructions on withdrawal from registration as a 

transfer agent from such authority. 

Certain sections of the Securities Exchange Act of 1934 applicable to transfer 

agents are referenced or summarized below. Registrants are urged to review all 

applicable provisions of the Securities Exchange Act of 1934, the Securities Act of 1933, 

and the Investment Company Act of 1940, as well as the applicable rules promulgated by 

the SEC under those Acts. 

I. General Instructions for Filing Form TA-W 

A. Terms and Abbreviations. The following terms and abbreviations are used

throughout these instructions:

1. “Act” refers to the Securities Exchange Act of 1934.

2. “ARA” refers to the appropriate regulatory agency, as defined in Section

3(a)(34)(B) of the Act. See General Instruction D below.

3. “Form TA-1” is the Form filed as a registration and includes the Form and any

attachments to that Form.

4. “Registrant” refers to the entity on whose behalf Form TA-1 is filed.
5. “SEC” or “Commission” refers to the U.S. Securities and Exchange Commission.

6. “Transfer agent” is defined in Section 3(a)(25) of the Act as any person who

engages on behalf of an issuer of securities or on behalf of itself as an issuer in at

least one of the functions enumerated therein.

7. “Independent, Non-Issuer Transfer Agent” refers to an entity which acts as a

transfer agent for other than its own securities or securities of an affiliate.

8. “Regulation S-T” is the SEC’s regulation containing the rules related to filing

electronic documents in EDGAR. 17 CFR 232 et seq.

9. “EDGAR” (Electronic Data Gathering, Analysis, and Retrieval) is defined in Rule

11 of Regulation S-T, 17 CFR 232.11, as the computer system for the receipt,

acceptance, review, and dissemination of documents submitted to the

Commission in electronic format.

10. “EDGAR Filer Manual,” is the manual prepared by the SEC setting out the

technical format requirements for an electronic submission to EDGAR.

11. “EDGARLite” is an application in EDGAR that registrants may use to create the

electronic Form TA-W for submission to EDGAR.

B. Who Must File. Pursuant to Section 17A(c)(4)(B) of the Act, a registered transfer

agent may, upon such terms and conditions as the ARA for such transfer agent deems

necessary or appropriate in the public interest, for the protection of investors, or in

furtherance of the purposes of Section 17A the Act, withdraw from registration by

filing a written notice of withdrawal with such ARA.
C. When to File. Before a registrant may withdraw from registration as a transfer agent, 

it must file a notice of withdrawal from registration as a transfer agent with the 

Commission on Form TA-W. 

D. How to File. Registrants file electronically in EDGAR. Registrants may prepare the 

Form using EDGARLite and should refer to the EDGAR Filer Manual, which is 

available on the SEC’s Web site at www.sec.gov for instructions for preparing and 

submitting electronic forms as well as for the technical requirements for filing in 

EDGAR. A Form TA-W which is not completed properly may be suspended as not 

acceptable for filing. Acceptance of this Form, however, does not mean that the 

Commission has found that it has been filed as required or that the information 

submitted therein is true, correct or complete. 

Registrants that are granted a hardship exemption from electronic filing under Rule 

202 of Regulation S-T, 17 CFR 232.202, will be provided with instructions on how 

and where to file a paper Form TA-W. 

E. Records. Each registrant must keep an exact copy of any filing for its records. 

Registrants should refer to 17 CFR 240.17Ad-6 and 240.17Ad-7 for information 

regarding the recordkeeping rules for transfer agents. 

F. Effective Date. In accordance with the rules adopted by the Commission, notice to 

withdraw from registration filed by a transfer agent shall become effective on the 

60th day after the filing thereof with the Commission or within such shorter period of 

time as the Commission may determine. If a notice to withdraw from registration is 

filed with the Commission any time subsequent to the date of issuance of an order 

instituting proceedings pursuant to Section 17A(c)(3)(A), or if prior to the effective 
 

date of the notice of withdrawal the Commission institutes such a proceeding or a 

proceeding to impose terms and conditions upon such withdrawal, the notice of 

withdrawal shall not become effective except at such time and upon such terms and 

conditions as the Commission deems necessary or appropriate in the public interest, 

for the protection of investors, or in furtherance of the purposes of Section 17A. 

II. Special Instructions for Filing Form TA-W 

A. Electronic Filing. Beginning [insert effective date of the rule], all transfer agent 

forms (Form TA-1, Form TA-2, and Form TA-W) filed with the SEC must be filed 

electronically in EDGAR. 

B. Exemptions from Electronic Filing. The SEC may, in limited cases, grant an 

exemption from electronic filing where the filer can show that an electronic filing 

requirement creates an unreasonable burden or expense. Registrants should refer to 

Rule 202 of Regulation S-T, 17 CFR 232.202, and to the SEC's Web site, 

www.sec.gov, for information on applying for a hardship exemption. 

C. Withdrawal from Registration. Registrants must provide full and complete responses 

in the appropriate format. 

1. Information relating to electronic filing. As EDGAR filers, registrants are 

required to provide the following: 

a. Whether the Form is a “live” or “test” filing submission; 

b. Whether the registrant would like a Return Copy of the filing; 

c. The registrant’s CIK;

d. The registrant’s CCC; 

e. The contact e-mail address for the registrant; and 
f. The notification e-mail address(es) for the registrant regarding the status of the 

submission. 

For more information regarding the above requirements see the EDGAR Filer 

Manual, Volume I (General Requirements). A registrant that is granted a 

continuing hardship exemption pursuant to Rule 202 of Regulation S-T, 17 CFR 

232.202, need only provide its CIK. 

2. All items on the Form must be answered in full. Individuals’ names must be given 

in full. 

D. Execution of Form TA-W. A duly authorized official or a principal of the registrant 

must execute Form TA-W and any amendments thereto on behalf of that registrant. 

For a corporate registrant, the term official includes the chairman or vice-chairman of 

the board of directors, the chairman of the executive committee, or any officer of the 

corporation who is authorized by the corporation to sign Form TA-W on its behalf. 

For a non-corporate registrant, duly authorized principal means a principal of the 

registrant who is authorized to sign Form TA-W on its behalf. 

The official or principal of the registrant shall execute Form TA-W by providing an 

electronic signature pursuant to Rule 302, Signatures, of Regulation S-T, 17 CFR 

232.302. The official or principal of the registrant must provide his or her full name in 

typed format in the signature box of the Form and must manually sign a signature page or 

other document authenticating, acknowledging, or otherwise adopting his or her signature 

that appears in typed Form within the electronic filing. The signature page or other such 

document shall be signed at or before the time the electronic filing is made, shall be 

retained by the transfer agent for a period of five years, and shall be made available to the 
Commission or its staff upon request. 

By executing Form TA-W, the registrant agrees and consents that notice of any 

proceeding under the Act by the SEC involving the registrant may be given by sending

such notice by registered or certified mail to the registrant, “Attention Officer in Charge 

of Transfer Agent Activities,” at its principal office for transfer agent activities as given 

in response to Question 3.c. of Form TA-1. 

III. Notice 

Under Sections 17, 17A(c) and (23)(a) of the Act and the rules and regulations 

thereunder, the Commission is authorized to solicit from registered transfer agents the 

information required to be supplied by this Form. Disclosure to the Commission of the 

information requested in Form TA-W is a prerequisite to the processing of a notice of 

withdrawal of registration as a transfer agent. The information will be used for the 

principal purpose of enabling the Commission to determine whether it is necessary or 

appropriate in the public interest, for the protection of investors, or in furtherance of the 

purposes of Section 17A of the Act that the withdrawal be denied, postponed or subject to 

specific terms and conditions. Information supplied on this Form will be included 

routinely in the public files of the Commission and will be available for inspection by any 

interested person.