E-mail: [email protected] Phone: 312 460-1941 Position Transfer Form Trading Permit Holders (TPHs) seeking to effect an on-floor position transfer pursuant to CBOE Rule 6.49A are required to complete and submit this form and a spreadsheet detailing each component of the transfer package. Option class ___________________ Position transfer trade date of ___________________ Seller: __________________ Buyer: __________________ TPH Firm Name TPH Firm Name Seller:__________________ Buyer:__________________ Acronym/Account Number Acronym/Account Number Seller:__________________ Buyer:__________________ Clearing Firm Number Clearing Firm Number X__________________________________ X__________________________________ Signature Signature X___________________________________ Designee Name/ FB Acronym Date ______________________ Total Long Equity Options Value _______________ Total Long Index Options Value _____________ Total Short Equity Options Value _______________ Total Short Index Options Value _____________ Reason for transfer: ____________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ (over) Certification Relating to CBOE Sales Value Fee The CBOE Sales Value Fee is assessed by CBOE to TPHs for sales of securities resulting from on-floor position transfers between unaffiliated TPHs. The term “affiliate” has the meaning set forth in CBOE Rule 1.1(j). Complete the certification below if the transactions identified above represent an on-floor position transfer (1) between affiliated TPHs or (2) between TPHs acting as agent and results in no change in beneficial ownership. CERTIFICATION I certify that the transactions identified above and by way of this submission represent an on-floor position transfer (1) between affiliated TPHs (as defined in CBOE Rule 1.1(j)), or (2) between TPHs acting as agent and results in no change in beneficial ownership, and are therefore not subject to the CBOE Sales Value Fee. I understand that this certification is subject to examination, review, and verification by CBOE staff. Seller: Trading Permit Holder (Individual) Name / Title: Trading Permit Holder Firm Name: Phone Number/ E-mail: Buyer: Trading Permit Holder (Individual) Name / Title: Trading Permit Holder Firm Name: Phone Number/ E-mail: 2
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