Form SBSE-C OMB Approval 

OMB Number: 3235-0696 

Expires: April 30, 2022

Estimated average burden hours 

per response: 41 hours 

Certifications for 

Registration of Security-based 

Swap Dealers and Major Securitybased Swap Participants 

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. 

SEC 2927 (1/16)
FORM SBSE-C INSTRUCTIONS 

A. GENERAL INSTRUCTIONS 

1.	 Each security-based swap dealer and major security-based swap participant must file Form SBSE-C to register as a 

security-based swap dealer or major security-based swap participant. 

2.	 ELECTRONIC FILING – The applicant must file Form SBSE-C through the EDGAR system, and must utilize the EDGAR 

Filer Manual (as defined in 17 CFR 232. 11) to file and amend Form SBSE-C electronically to assure the timely 

acceptance and processing of those filings. 

3. All fields requiring a response must be complete before the filing is accepted. 

The mailing address for questions and correspondence is: 

The Securities and Exchange Commission
 

Washington, DC 20549
 

FEDERAL INFORMATION LAW AND REQUIREMENTS – SEC’s Collection of Information 

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a 

currently valid control number. Sections 15F, 17(a) and 23(a) of the Exchange Act authorize the SEC to collect the information on 

this form from registrants. See 15 U.S.C. §§78o, 78o-4, 78o-5, 78q and 78w. Filing of this Form is mandatory. The principal 

purpose of this Form is to permit the Commission to determine whether it is in the public interest to approve or disapprove the 

application for ongoing registration by the security-based swap dealer or major security-based swap participant. The Commission 

maintains a file of the information on this Form and will make the information publicly available. Any member of the public may 

direct to the Commission any comments concerning the accuracy of the burden estimate on this Form, and any suggestions for 

reducing this burden. This collection of information has been reviewed by the Office of Management and Budget in accordance 

with the clearance requirements of 44 U.S.C. §3507. The information contained in this Form is part of a system of records subject 

to the Privacy Act of 1974, as amended. The Securities and Exchange Commission has published in the Federal Register the 

Privacy Act Systems of Records Notice for these records. 
FORM SBSE-C 

Certification 1 

Applicant Name: _________________________________ 

Date:__________ SEC Filer No: _________ 

Official Use 

INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. 

See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) 

Instructions: This Certification 1 must be signed by a senior officer of the applicant. 

I certify that - 

(1) after due inquiry, I have reasonably determined that the applicant has developed and implemented written policies and 

procedures reasonably designed to prevent violation of federal securities laws and the rules thereunder, and 

(2) I have documented the process by which I reached such determination. 

Applicant Name: Date: 

Signature of Senior Officer: Name of Senior Officer: 

Title of Senior Officer 
 

 

 

FORM SBSE-C 

Certification 2 

Applicant Name: _________________________________ 

Date:__________ SEC Filer No: __________ 

Official Use 

INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE FEDERAL CRIMINAL VIOLATIONS. 

See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) 

Instructions: This certification must be signed by the applicant’s Chief Compliance Officer designated pursuant to Exchange 

Act Section 15F(k) or by his or her designee. 

For purposes of this Form, the term associated person shall have the meaning as specified in Section 3(a)(70) of 

the Exchange Act [15 U.S.C. 78c(a)(70)]. 

The applicant certifies that it -

(a) has performed background checks on all of its associated persons who are natural persons and who effect or are 

involved in effecting security-based swaps on its behalf, and 

(b) neither knows, nor in the exercise of reasonable care should have known, that any associated person who effects 

or is involved in effecting security-based swaps on its behalf is subject to a statutory disqualification, as described 

in Sections 3(a)(39)(A) through (F) of the Securities Exchange Act of 1934 (15 U.S.C. 78c(a)(39)(A) – (F)), unless 

otherwise specifically provided by rule, regulation or order of the Commission. 

Applicant Name: Date: 

Signature of Chief Compliance Officer or Designee: 

Name of Chief Compliance Officer or Designee: If Designee, Title of Designee: