Form ID Application Submission

Form ID Questionnaire - Companies

Please complete the below sections of the Form ID application for SEC EDGAR codes.

Email

Please enter the email address where you’d like the completed Form ID sent. Once you receive it, please sign and get it notarized, then return to us at edgar@colonialfilings.com.

Company business information

Company Legal Name:

Company Street Address:

City

State

ZIP

Country

Address is for a non-U.S. location (do not select if address is for U.S. territory): *

Yes

No

Company Telephone Number:

Company Tax ID Number

Doing Business As Name, if different from Legal Name:

US State of Incorporation:

Fiscal Year End (mm/dd):

Company website, if any:

Single-Member Company?

You should select “Yes” if the company only has a single individual who acts as the sole equity holder, director, and officer (or, in the case of an entity without directors and officers, holds position(s) performing similar activities as a director and officer).

Yes

No

Is Prospective Account Administrator 1 the applicant (for an individual applicant), or an employee of the applicant or its affiliate (for a company applicant)?

Yes

No

Employer

CIK

Company is applying for EDGAR access to submit non public draft registration/offering statements on submission types DRS or DOS.

Selecting "Yes" will prevent the new CIK number and EDGAR account information from being made publicly available on SEC.gov until a public filing is made. This option is only available for companies who plan to submit submission types DRS or DOS.

Yes

No

Company Violations

Has the applicant (company) been criminally convicted as a result of a federal or state securities law violation, or civilly or administratively enjoined, barred, suspended, or banned in any capacity (e.g., officer or director bar, prohibition from associating with brokers, dealers, investment advisers, and/or other securities entities, or bar from participation in certain industries), as a result of a federal or state securities law violation?

Yes

No

Is the company in good standing in its state or country of incorporation?

Generally, this means a company is legally authorized to do business in that state or country and has filed all required reports and paid all related fees to the relevant jurisdiction.

Yes

No

Primary Contact Information

To be used for Billing purposes, as well as the SEC’s point of contact. Primary Contact will also be the individual signing the Form ID.

Primary Contact, First Name:

Primary Contact, Middle Name

Primary Contact, Last Name:

Primary Contact, Title:

Primary Contact, Name of Employer:

Important: If the Employer entered is different from the Company Legal Name entered in the first section, please provide a separate notarized POA to edgar@colonialfilings.com that authorizes you to sign on behalf of the Company Legal Name.

Is the Primary Contact's Address the same as the Company's entered in the first section?

Yes

No

Primary Contact, Street Address

City

State

Zip

Country

Address is for a non-U.S. location (do not select if address is for U.S. territory): *

Yes

No

Primary Contact, Email Address:

Primary Contact, Telephone Number:

Violations of federal or state securities laws

Has the individual being authorized as Primary Contact been criminally convicted as a result of a federal or state securities law violation, or civilly or administratively enjoined, barred, suspended, or banned in any capacity (e.g., officer or director bar, prohibition from associating with brokers, dealers, investment advisers, and/or other securities entities, or bar from participation in certain industries), as a result of a federal or state securities law violation?

Yes

No

By submitting this form, I authorize Colonial Filings to prepare and submit my Form ID to the SEC. I agree to pay $100 processing fee upon invoicing.