SSR-1 Form
Exemption Notification by Market Makers
This exemption notification should be used by a person (‘Notifier’) that is notifying the Financial
Conduct Authority (FCA) of its intention to employ the exemption referred to in Article 17 (1) of
Regulation (EU) No 236/2012 of the European Parliament and the Council of 14 March 2012 on short
selling and certain aspects of credit default swaps (‘SSR’), providing that its Home Member State is
the UK in accordance with Article 2 (1) (i) of the SSR and the FCA being the Competent Authority.
1. Identity of Notifier
1.1 Full Name
(Including legal form of Notifier)
1.2 Status of the Notifier:
(Mark relevant status with ‘X’)
Credit institution
Investment firm
Third country entity as referred to in
Article 17 (8) of the SSR
Firm as referred to in point (1) of
Article 2(1) of Directive 2004/39/EC
1.3 Address
(Registered office. If registered office is not in
UK, address for service in the UK)
1.4 Country
1.5 Phone number (include country code)
1.6 Email address
/ Notifier’s web site URL
1.7 BIC Code
(If applicable)
2. Contact person for the purpose of the exemption notification
2.1 Full name
2.2 Contact address
2.3 Phone number (include country code)
2.4 Fax number (include country code)
2.5 E-mail address
2.6 Other information
(Functional relationship with person requesting
the exemption)
3. Notification
3.1 The Notifier mentioned in (1) notifies that it performs market making activities as set
out in Article 2 (1)(k) of the SSR in relation to the financial instruments included in
Annex I-A / Annex I-B and that it is a member of at least one of the trading venues in
which the relevant financial instrument is traded. The information included in Annex
II provides evidence of the Notifier’s membership in the relevant trading venues.
3.2 Please specify the market making activities performed according to Article 2 (1)(k) of
the SSR:
4. Exemption notification
The Notifier mentioned in (1) intends to use the exemption referred to in paragraph 1,
Article 17 of the SSR from (yyyy)/(mm)/(dd) (*)
(*) The exemption notification should be sent to the FCA at least 30 calendar days before the
Notifier intends to use the exemption.
5. Date of notification
(The exemption notification should be sent to
the FCA at least 30 calendar days before the
Notifier intends to use the exemption)
(yyyy) / (mm) / (dd)
6. Signature
Print name:
Name and signature of the Notifier’s
representative
Signature:
I am authorised to give this notification on
behalf of the Notifier