Contingent Trade Reporting Form

General Information

Individual submitting report

Name: *
Title: *
Email: *
Approved Participant: *

SAM authorized person executing the contingent transaction

Name: *
SAM user id: *
Phone: *
Fax:

Details of the contingent transaction

Counterparty name: *
Trade date and time: *
2013   -   05   -   
 :   

Futures contract component

Symbol: *
Quantity: *
(With no thousands separator)
Contract month & year: *  - 
 
Buyer: *
Seller: *
Price of the transaction: *
(With no thousands separator)

Cash component or OTC derivative instrument of the contingent transaction

Description: *
Quantity or value: *
(With no thousands separator)
 
Buyer: *
Seller: *
Market value: *
(With no thousands separator)
Additional Information:
Authorized person means a SAM Authorized Person or any other person authorized by a regulator or a self-regulatory organization to deal in futures contracts.

The transmission of the above information to the Bourse and the subsequent validation and dissemination of the transaction by the Market Monitoring Department will not preclude the Bourse from initiating any analysis and/or investigation to ensure that the transaction has been made in accordance with the requirements of the Rules of the Bourse or of the Procedure for the Execution of EFP/EFR/SUBS Transactions. If, following such analysis or investigation, it appears that the transaction was not in full compliance with applicable regulatory requirements, the Bourse has the discretion to initiate a disciplinary process.