Form 94-101F2
DERIVATIVES CLEARING SERVICES

Section 1 – Regulated clearing agency information

1. Full name of regulated clearing agency:
2. Contact information of person authorized to deliver this form

Name and title:

Telephone:

Email:

Section 2 – Description of derivatives

1. Identify each derivative or class of derivatives for which the regulated clearing agency offers clearing services in respect of which a Form 94-101F2 has not previously been delivered.
2. For each derivative or class of derivatives referred to in item 1, describe all significant attributes of the derivative or class of derivatives including

(a)          the standard practices for managing life-cycle events associated with the derivative or class of derivatives, as defined in the following instruments:

(i)           in Alberta, British Columbia, New Brunswick, Newfoundland and Labrador, the Northwest Territories, Nova Scotia, Nunavut, Prince Edward Island, Saskatchewan and Yukon, Multilateral Instrument 96-101 Trade Repositories and Derivatives Data Reporting;

(ii)          in Manitoba, Manitoba Securities Commission Rule 91-507 Trade Repositories and Derivatives Data Reporting;

(iii)          in Ontario, Ontario Securities Commission Rule 91-507 Trade Repositories and Derivatives Data Reporting;

(iv)         in Québec, Regulation 91-507 respecting Trade Repositories and Derivatives Data Reporting,

(b)          the extent to which the transaction is confirmable electronically,

(c)          the degree of standardization of the contractual terms and operational processes,

(d)          the market for the derivative or class of derivatives, including its participants, and

(e)          the availability of pricing and liquidity of the derivative or class of derivatives within Canada and internationally.

3. Describe the impact of providing clearing services for each derivative or class of derivatives referred to in item 1 on the regulated clearing agency's risk management framework and financial resources, including the protection of the regulated clearing agency on the default of a participant and the effect of the default on the other participants.
4. Describe the impact, if any, on the regulated clearing agency's ability to comply with its regulatory obligations should the regulator or securities regulatory authority determine a derivative or class of derivatives referred to in item 1 to be a mandatory clearable derivative.
5. Describe the clearing services offered for each derivative or class of derivatives referred to in item 1.
6. If applicable, attach a copy of every notice the regulated clearing agency provided to its participants for consultation on the launch of the clearing service for a derivative or class of derivatives referred to in item 1 and a summary of concerns received in response to the notice.

Section 3 – Certification

CERTIFICATE OF REGULATED CLEARING AGENCY

I certify that I am authorized to deliver this form on behalf of the regulated clearing agency named below and that the information in this form is true and correct.

DATED at ____________ this ___________ day of __________, 20___

___________________________________________________

(Print name of regulated clearing agency)

___________________________________________________

(Print name of authorized person)

___________________________________________________

(Print title of authorized person)

___________________________________________________

(Signature of authorized person)