EasyFile CFTC Form PQR Template

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POOL QUARTERLY REPORT FOR COMMODITY POOL OPERATORS Name: MY POOL LISA Ending Date: 9/30/2013 NFA ID: P087320 COVER PAGE Enter the highest NAV during the Reporting Period: 501,000,000 0160 Enter the total funds allocated to futures and swaps as of the reporting date: 401,000,000 0161 Have you filed an SEC Form PF for this pool in lieu of the CFTC Filing No 0162 Does this pool only invest in other pools No 0163 Page 1 of 31 Created On: 10/8/2013 1:29:06 PM
POOL QUARTERLY REPORT FOR COMMODITY POOL OPERATORS Name: MY POOL LISA Ending Date: 9/30/2013 NFA ID: P087320 Form CPO-PQR - Schedule A PART 2 - INFORMATION ABOUT THE POOLS OPERATED BY THE CPO 3. POOL INFORMATION a. Pool's name MY POOL LISA 5005 b. Pool's NFA ID#: P000000 5010 c. If the Pool is operated by Co-CPOs the name of the other CPOs: 5015 d. Under the laws of what state or country is the Pool organized 5020 e. On what date does the Pool's fiscal year end: 5025 f. Is this Pool a Private Fund 5030 g. List the English name of each Foreign Financial Regulatory Authority and the country with which the Pool is registered: Foreign Financial Regulatory Authority Country Test Regulatory Authority 5080 UK 5081 h. Is this a Master Fund in a Master - Feeder Arrangement Yes 5045 If "Yes", provide the name and NFA ID# of each Feeder Fund investing in this Pool: Feeder Fund NFA ID # TEST 5082 P000000 5083 i. Is this a Feeder Fund in a Master-Feeder Arrangement Yes 5060 If "Yes", provide the name and NFA ID# of the Master Fund in which this Pool invests: Master Fund NFA ID TESTPOOL 5084 P000000 5085 j. If this Pool invests in other Pools, a) what is the maximum number of investee pool tiers 0 5075 i. What is the value of this Pool's investments in equity of other Pools or private funds 0 5087 4. POOL THIRD PARTY ADMINISTRATORS a. Does the CPO use third party administrators for the Pool No 0810 If “Yes,” provide the following information for each third party administrator: i. Name of the administrator: TESTER INVESTOR 7405 ii. NFA ID# of administrator: 0000000 7406 iii. Address of the administrator: 1285 TEST AVE LOS ANGELES CA 90015 US 7407 iv. Telephone number of the administrator: (213)255-8564 7408 v. Starting date of the relationship with the administrator: 01-MAR-2013 7409 vi. Services performed by the administrator: Page 2 of 31 Created On: 10/8/2013 1:29:06 PM
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Page 3: Form CPO-PQR - Schedule C 1. GEOGRA

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