ICE FUTURES U.S., INC. M 01 APPLICATION FOR MEMBERSHIP

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1 APPLICATION FOR MEMBERSHIP TICE: Discounts for trading shall not be granted for any individual member who was not an equity member as of January 12, The undersigned hereby applies for membership on the ICE Futures U.S., Inc. Exchange. 1. Last Name First Name M.I. Date of Birth Citizenship Social Security # Driver License ID # State 2. Home Address City State Zip Code Country 3. Firm Name Business Address City State Zip Code Country address: 4. Telephone Numbers: Home Business Mobile (Cell) 5. Contact Information: (a) designate an office within the County of New York as a place where papers may be served upon you: (b) designate an address to receive notifications: 6. If you are registered with the CFTC/NFA, indicate registration number and category: 7. State the purpose of applying for membership (check all that apply): Non-Floor Trading Member Floor Broker* Local /Trader* Confer Member Privileges to my firm** If Conferring Privileges, state firm name: * If you are applying for floor trading privileges, a completed Form F01 must accompany this application. * * If you intend to confer member firm privileges, a completed Form C 01 and C02 must accompany this application. 8. List all bank accounts (i.e. PASSBOOK, CD, W, CHECKING, etc.) and all firms with which you have carried securities or commodities accounts during the past five (5) years. (If additional space is required, attach a separate sheet.) Firm/Bank Name Full Address Account No./Type Dates opened/closed

2 9. SCHEDULE OF FINANCIAL DATA CURRENT ASSETS: 1. Cash in Banks (including certificates of deposit) (Note 1) 2. US Government Obligations at Market (Note 2) 3. Municipal Obligations at Market (Note 2) 4. Securities at Market (Note 2) 5. Equity in Commodity Accounts (Note 3) 6. Trade Receivables, net of allowance for uncollectibles (Note 4) Accounts Receivable Notes and Loans Receivable 7. Miscellaneous Current Assets (Note 5) 8. Total Current Assets (Lines 1-7) CURRENT LIABILITIES 9. Deficit in Commodity Accounts (Note 3) 10. Trade Payables: (Note 4) Accounts Payable Notes and Loans Payable 11. Other Current Payables (Note 6) Credit Cards Unsecured Loans As of 12. State and/or Local Income Taxes 13. Federal Income Taxes Payable 14. Total Current Liabilities (Lines 9-13) 15. Net Worth (Line 8 less line 14) TES TO SCHEDULE OF FINANCIAL DATA* Note 1: Attach bank statements supporting cash balances indicated. Note 2: Attach account statements describing obligation, quantity and market value. Note 3: Attach commodity account statements. Note 4: Attach documentation for any trade receivable and/or payables listed. An uncollectible receivable is deemed to mean any receivable not collected within one month of it being accrued. Note 5: Miscellaneous current assets may include any other asset listed in categories 1-6 which is readily marketable. Attach a detailed list showing description and market value of any asset you elect to include under this category. Note 6: List any other liabilities which are currently due and payable such as credit cards, school loans and unsecured loans. *Supporting documentation is not required if financial data is certified by a CPA. 10. List the names of employers within the last ten (10) years. Include current employer, previous employment and college attendance. Include post-secondary education if it occurred within the last ten (10) years. From To Business Name, Address Nature of Position Reason Mo./Yr. Mo./Yr. And Telephone Number Business Held for Leaving

3 11. List the educational institutions you have attended starting with the most recently attended and include graduate school, specialized training, college, and high school. Dates Institution (From/To) Address Degree Earned 12. List the U.S. commodity exchange(s) of which you are currently a member, and any exchange of which you were a member within the last ten (10) years. If you currently have floor trading privileges on a particular exchange, please specify the name of your guarantor and the badge number and alpha code for each such membership. Dates Exchange (From/To) Guarantor Badge Number Alpha Code 13. Give a brief explanation of the extent and nature of your experience in the futures and/or physical commodities industry. 14. What type AND how will you obtain your NYBOT Membership? (Check One of Each): TYPE NYBOT Membership TO BE OBTAINED BY Transfer from Bid for a Membership in the Exchange s open market Whose funds will be used to purchase the NYBOT Membership? 15. If you are an employee of a member firm which is having the NYBOT Membership transferred to you, will the membership be subject to an ABC agreement? If yes, a completed Form S 06 must accompany this application For questions if the response is yes please provide an explanation and the details, including dates, of the matter to which the question pertains. 16. Are you aware of any pending or outstanding lawsuits, or claims against, or investigations of, any persons which arise from your business dealings? 17. Has a surety company ever refused you a bond or has a surety company ever paid against your account? 18. Are you permanently or temporarily enjoined by order, judgement or decree of any court of competent jurisdiction, the Securities and Exchange Commission ( SEC ) or the Commodity Futures Trading Commission ( Commission or CFTC ) from engaging in or continuing any conduct or practice in connection with the purchase or sale of commodities or securities?

4 19. Are you or have you ever been subject to an order of the Commission denying trading privileges on any contract market, or suspending or expelling you from membership on any contract market? 20. Are you or have you ever been suspended or expelled from any commodity or securities exchange, related clearing organization, registered futures association, the National Association of Securities Dealers, Inc., or any other self-regulatory organization or other business or professional association for violation of any rule of such organization? 21. Have you ever been the subject of any of the following events: a refusal to admit, withdrawal or revocation of any registration or license, withdrawal of any application for membership, cease and desist order, temporary or permanent injunction, denial of trading privileges, or the imposition of any sanction or discipline through an adverse determination or voluntary settlement, any suspension, expulsion, bar, fine, censure, denial of registration or membership, or otherwise (i) (ii) (iii) by a commodity or securities exchange, related clearing organization, registered futures association, the National Association of Securities Dealers, Inc., or any self-regulatory organization or other business or professional association? by the SEC, the CFTC or the securities commission or equivalent authority of any state, territory, the District of Columbia or foreign country? any federal court, state court, quasi-governmental body or regulatory agency not mentioned above? 22. Have you ever been convicted or found guilty of any felony or misdemeanor? 23. Have you ever been barred by any agency of the United States from contracting with the United States? 24. Are you aware of the issuance of a formal order of investigation (or its equivalent) or the commencement, by the issuance or service of a written complaint (or its equivalent), of any judicial, administrative or selfregulatory proceeding, as the case may be, against you by the CFTC, the SEC, the securities commission or equivalent authority of any state, territory, the District of Columbia or foreign country, or any commodity or securities exchange or related clearing organization, or any registered futures or securities association, or any self-regulatory organization or other business or professional organization? 25. Have you ever, either individually or as a principal, been subject to any liquidation, arrangement, reorganization, receivership, assignment for the benefit of creditors or other bankruptcy or insolvency proceeding, under state or federal law, within the past ten (10) years? I understand that the Exchange may conduct, or cause to be conducted, an investigation of my financial status, character, general reputation and business history, and I hereby give the Exchange permission to request any such information. I hereby agree that, if I am accepted as a NYBOT Member or otherwise into the Exchange, I will observe and be bound by and will comply with all the provisions of the certificate of incorporation, by-laws, rules, resolutions, orders, decisions, awards, requirements and procedures of the Exchange as now in effect, hereafter adopted or hereafter amended. I certify that the information contained in this application and any attachments hereto is true, complete and accurate. I agree to notify the Exchange of any changes which may hereafter occur with respect to any information requested in this application. Signature of Applicant Date

5 CONSUMER REPORT DISCLOSURE TICE AND AUTHORIZATION This Consumer Report Disclosure Notice and Authorization is to inform you that ICE Futures U.S., Inc. may obtain or cause to be obtained a consumer report as part of a background investigation. Such a report, which may contain information bearing on your credit standing, character, general reputation, personal characteristics, or mode of living, including but not limited to criminal records, driving records and education will be used for purposes of determining your eligibility for membership. By signing this form below, you authorize ICE Futures U.S., Inc. to obtain or cause to be obtained a consumer report and hereby release ICE Futures U.S., Inc., its agents, directors, employees and members from any and all liability for damages of whatever kind, which may at any time result to you, your heirs, or family arising from or related to, the authorization granted herein. Signature of Applicant Date The applicant is required to appear before the Membership Committee when notified to do so. Failure of the applicant to appear will be understood to be a withdrawal by the applicant of the application.