FORM 21-101F3 QUARTERLY REPORT OF ALTERNATIVE TRADING SYSTEM ACTIVITIES Alternative Trading System Name: ___________________________________ Period covered by this report: ___________________ to ______________ THE FILER CONSENTS TO HAVING THE INFORMATION ON THIS FORM AND ATTACHED EXHIBITS PUBLICLY AVAILABLE. 1. Identification: A. Full name of alternative trading system (if sole proprietor, last, first and middle name): B. Name(s) under which business is conducted, if different from item 1A: C. Alternative trading system's main street address: 2. Attach as Exhibit A, a list of all subscribers at any time during the period covered by this report. 3. Attach as Exhibit B, a list of all securities that were traded on the alternative trading system at any time during the period covered by this report. 4. (a) Provide the details requested in the form set out in the chart below for each type of security traded on the alternative trading system for transactions during regular trading hours during the quarter. Enter "None", "N/A" or "0" where appropriate. (b) Provide the details requested in the form set out in the chart below for each type of security traded on the alternative trading system for transactions during after hours trading sessions during the quarter. Enter "None", "N/A" or "0" where appropriate. Category of Securities Average Daily Total Trading Total Number of Trades Dollar Value of Volume Trading Volume A. Exchange-traded securities Equity securities Preferred securities Debt securities Options
Category of Securities Average Daily Total Trading Total Number of Trades Dollar Value of Volume Trading Volume B. Unlisted debt securities -Government debt securities Domestic Foreign C. Unlisted debt securities - Corporate debt securities Domestic D. Foreign Exchange- Traded Securities Equity securities Preferred securities Debt securities Options E. Other Specify types of securities 5. Provide the total trading volume for each security traded on the alternative trading system in the form set out in the chart below. Enter "None", "N/A" or "0" where appropriate. Category of Securities Total Trading Volume for Each Security A. Exchange-traded securities Equity securities [name of securities] Preferred securities [name of securities] Debt securities [name of securities] Options [name of securities] B. Unlisted debt securities – Government debt securities Domestic [by issuer and maturity] Foreign [by issuer and maturity]
Category of Securities Total Trading Volume for Each Security C. Unlisted debt securities – Corporate debt securities Domestic [by issuer and maturity] D. Foreign Exchange-Traded Securities Equity securities [name of securities] Preferred securities [name of securities] Debt securities [name of securities] Options [name of securities] E. Other Specify securities 6. Attach as Exhibit C, a list of all persons granted, denied, or limited access to the alternative trading system during the period covered by this report, designating for each person (a) whether they were granted, denied, or limited access; (b) the date the alternative trading system took such action; (c) the effective date of such action; and (d) the nature of any denial or limitation of access. CERTIFICATE OF ALTERNATIVE TRADING SYSTEM The undersigned certifies that the information given in this report relating to the alternative trading system is true and correct. DATED at___________this____ day of ______________ 20__ (Name of alternative trading system) (Name of director, officer or partner - please type or print) (Signature of director, officer or partner) (Official capacity - please type or print)
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