Notice of Basis Order
(all fields with *are required)   4/18/2014
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 3 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): *