Notice of Basis Order
(all fields with *are required)   9/24/2022
Participant Identifier: * Confirm #:
Reporter: *
Email Address: *
Details of Client Order
Date/Time of Receipt: *   24 hour clock
Transaction: *
Underlying Index: *

Order Size: *
Details of Offsetting Hedge Transaction
Effective Index Level of Hedge Trades: *   Max 4 Decimals
Time of Execution of Hedge Transaction: From: *   To:   24 hour clock
Details of Client Fill
Date/Time of Fill Report: *     24 hour clock
Price to Client: *
Basis included in price (please report in cents/share): * Max 4 Decimals
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