FORM 24-102F1
CLEARING AGENCY SUBMISSION TO
JURISDICTION AND APPOINTMENT OF
AGENT FOR SERVICE OF PROCESS

1. Name of clearing agency (the "Clearing Agency"):

_____________________________________________________

2. Jurisdiction of incorporation, or equivalent, of Clearing Agency:

_____________________________________________________

3. Address of principal place of business of Clearing Agency:

_____________________________________________________

4. Name of the agent for service of process (the "Agent") for the Clearing Agency:

_____________________________________________________

5. Address of the Agent in____________[name of local jurisdiction]:

_____________________________________________________

6. The ____________ [name of securities regulatory authority] ("securities regulatory authority") issued an order recognizing the Clearing Agency as a clearing agency pursuant to securities legislation, or the securities regulatory authority issued an order exempting the Clearing Agency from the requirement to be recognized as a clearing agency pursuant to such legislation, on ____________.
7. The Clearing Agency designates and appoints the Agent as its agent upon whom may be served a notice, pleading, subpoena, summons or other process in any action, investigation or administrative, criminal, quasi-criminal, penal or other proceeding arising out of or relating to or concerning the activities of the Clearing Agency in ____________ [name of local jurisdiction]. The Clearing Agency hereby irrevocably waives any right to challenge service upon its Agent as not binding upon the Clearing Agency.
8. The Clearing Agency agrees to unconditionally and irrevocably attorn to the non-exclusive jurisdiction of (i) the courts and administrative tribunals of ____________ [name of local jurisdiction] and (ii) any proceeding in any province or territory arising out of, related to, concerning or in any other manner connected with the regulation and oversight of the activities of the Clearing Agency in ____________ [name of local jurisdiction].
9. The Clearing Agency must file a new submission to jurisdiction and appointment of agent for service of process in this form at least 30 days before the Clearing Agency ceases to be recognized or exempted by the securities regulatory authority, to be in effect for six years from the date it ceases to be recognized or exempted unless otherwise amended in accordance with section 10.
10. Until six years after it has ceased to be recognized or exempted by the securities regulatory authority, the Clearing Agency must file an amended submission to jurisdiction and appointment of agent for service of process at least 30 days before any change in the name or above address of the Agent.
11. The Clearing Agency agrees that this submission to jurisdiction and appointment of agent for service of process is to be governed by and construed in accordance with the laws of ____________ [name of local jurisdiction].

Dated: ______________________

_____________________________________

Signature of the Clearing Agency

_____________________________________

Print name and title of signing officer of the Clearing Agency

AGENT

CONSENT TO ACT AS AGENT FOR SERVICE

I, _______________________ [name of Agent in full; if a corporation, full corporate name] of _________________________ [business address], hereby accept the appointment as agent for service of process of _______________________ [name of Clearing Agency] and hereby consent to act as agent for service pursuant to the terms of the appointment executed by ___________________ [name of Clearing Agency] on ____________ [date].

Dated: ______________________

______________________________________

Signature of Agent

______________________________________

Print name of person signing and, if Agent is not an individual, the title of the person