ICE Clear Europe: US Environmental Deliveries Buyer Registry Account Disclosure Form

To: / (Insert Name of Seller FCM) / Seller Clearing Member Mnemonic: / (Insert Mnemonic)
From: / (Insert Your Firm Name (buyer FCM) / Buyer Clearing Member Mnemonic: / (Insert Mnemonic)
Buyer Clearing Member Contacts:
Contact Name: / Phone: / email: / Role:
EU Clearing Representative / (insert name of European clearing contact) / (insert phone) / (insert email) / (insert "Primary" or "Backup"
US Clearing Representative / (Insert name of US clearing contact) / (insert phone) / (insert email) / (insert "Primary" or "Backup"
Clearing Member Level:
Product 1: / Product 2: / Product 3: / Product 4: / Product 5:
Product:
Contract Code:
Lots Long Facing This Seller Clearing Member:
Registry*:

Delivery Account Level:

Product: / Lots Long: / Underlying
Units Long: / Account Name at Registry for Delivery: / Account # for Delivery: / Entity Reference Code (CCA Only): / Account Rep. Contact Name: / Account Rep. Phone: / Account Rep. Email:
(Insert product for this account) / (Insert lots long for
this account) / (Insert underlying commodity length for this account) / (Insert exact name of Customer or FCM account for delivery as it appears in the registry) / (Insert Customer or FCM account # if applicable) / (Applicable for the CITSS Registry only) / (Insert Customer or FCM Account Rep. Name) / (Insert Customer or FCM Account Rep. Phone) / (Insert Customer or FCM Account Rep Email)
Instructions:
1. This form must be sent to the selling clearing member with who they have been matched by 4pm Chicago / 10pm London on Last Trade Day + 2.
2. The buyer clearing member must copy the Clearing House on the communication at
* Registries: The applicable Registries are: REC CT and REC MA - NEPOOL GIS, REC NJ - PJM GATS, RGGI - RGGI COATS, CCA - California MTS, SO2 and
NOx - US EPA Clear Air Markets Division