Clearing Firm ID No. Asset Account ID No.
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1 CLEARING MEMBER SETTLEMENT AND CUSTODY LISTING AND DEBIT AUTHORIZATION Clearing Firm ID No. Asset Account ID No. NOTE: CLEARING MEMBER FIRM MUST CONTACT ITS DESIGNATED S AND EXECUTE ALL DEBIT AUTHORITY DOCUMENTATION THAT ALLOWS CME TO DEBIT THE APPROPRIATE BANK (S) FOR CME SETTLEMENT PURPOSES. USD Settlement Bank Account Number(s): SEGREGATED CLEARED SWAPS GUARANTY FUND DEPOSIT Bank of America NA Bank of China Ltd, NY Branch Bank of New York Mellon Barclays Bank PLC Brown Brothers Harriman & Co. Citibank N.A., NY JP Morgan Chase, NY Fifth Third Bank Lakeside Bank NOTE: USD BANK S MUST BE AT A US BRANCH OF ONE OF THE APPROVED BANKS ABOVE. IF CLEARING FIRM HAS NO S AT ANY BANK ABOVE, CONTACT CME CLEARING AT FOR ASSISTANCE. Non-USD FUTURES Settlement Bank Account Number(s): CURRENCY AUD CAD Citibank NA, Canada Branch SEGREGATED
2 CURRENCY CHF CNH/CNY GBP EUR JPY MXN NOK NZD SEK SEGREGATED TRY ZAR
3 Non-USD OTC Settlement Bank Account Number(s): CURRENCY AUD CLEARED SWAPS CAD Citibank Canada CHF CZK DKK EUR GBP HKD HUF
4 CURRENCY CLEARED SWAPS JPY MXN NOK NZD PLN SEK SGD ZAR
5 By signing below, you are authorizing CME to unilaterally debit any of the accounts listed above in accordance with CME rules, policies and procedures and in amounts solely determined by CME. In addition, you represent that you are an authorized signatory on the accounts provided on this form, and that all accounts are owned by the Clearing Member Firm. (Clearing Member Firm) (Signature) (Printed Name) (Title) ( Address) (Telephone Number) (Date)
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