Required for: Market Maker applicants only.

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  Financial Statement (Sample)
  *** PLACEHOLDER — FINAL DOCUMENT PENDING ***
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FINANCIAL STATEMENT — MARKET MAKER (SAMPLE)

Market Maker applicants must submit a financial statement for the firm. A financial statement is
required; it need NOT be audited. The sample layout below shows the level of detail expected — you
may submit your firm's own financial statements in place of this sample. Download this sample for
reference, then upload your own financial statement in the portal.

  STATEMENT OF FINANCIAL CONDITION (as of ____ / ____ / ________)
    Assets
      Cash and cash equivalents.......: $ ____________________
      Receivables.....................: $ ____________________
      Securities / inventory..........: $ ____________________
      Other assets....................: $ ____________________
      Total assets....................: $ ____________________
    Liabilities and equity
      Payables........................: $ ____________________
      Other liabilities...............: $ ____________________
      Total liabilities...............: $ ____________________
      Members' / stockholders' equity.: $ ____________________

  STATEMENT OF INCOME (period ____ / ____ / ________ to ____ / ____ / ________)
      Revenue.........................: $ ____________________
      Expenses........................: $ ____________________
      Net income......................: $ ____________________

(This is a placeholder sample describing the intended content only. A FINANCIAL statement is required
— an AUDITED statement is NOT required. The final, authoritative sample will replace this document.)