X-17a-5 Part Ii A
Download a blank fillable X-17a-5 Part Ii A in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete X-17a-5 Part Ii A with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9OMB APPROVAL
OMB Number:
3235-0123
UNITED STATES
Expires:
May 31, 2017
SECURITIES AND EXCHANGE COMMISSION
Estimated average burden
Washington, D.C. 20549
hours per response. . . . . . 12.00
Form
FOCUS REPORT
X-17A-5
(Financial and Operational Combined Uniform Single Report)
PART IIA
12
(Please read instructions before preparing Form.)
This report is being filed pursuant to (Check Applicable Block(s)):
1) Rule 17a-5(a)
16
2) Rule 17a-5(b)
17
3) Rule 17a-11
18
4) Special request by designated examining authority
19
5) Other
26
NAME OF BROKER-DEALER
SEC FILE NO.
14
FIRM I.D. NO.
13
ADDRESS OF PRINCIPAL PLACE OF BUSINESS (Do Not Use P.O. Box No.)
15
FOR PERIOD BEGINNING (MM/DD/YY)
20
24
(No. and Street)
AND ENDING (MM/DD/YY)
21
22
23
25
(City)
(State)
(Zip Code)
NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT
(Area Code) — Telephone No.
30
31
NAME(S) OF SUBSIDIARIES OR AFFILIATES CONSOLIDATED IN THIS REPORT:
OFFICIAL USE
32
33
34
35
36
37
38
39
40
41
DOES RESPONDENT CARRY ITS OWN CUSTOMER ACCOUNTS?
YES
NO
42
CHECK HERE IF RESPONDENT IS FILING AN AUDITED REPORT
EXECUTION:
The registrant/broker or dealer submitting this Form and its attachments and the person(s) by
whom it is executed represent hereby that all information contained therein is true, correct and
complete. It is understood that all required items, statements, and schedules are considered
integral parts of this Form and that the submission of any amendment represents that all
unamended items, statements and schedules remain true, correct and complete as previously
.
submitted
Dated the _______________________________day of _________________________ 20
_____
Manual signatures of:
1)_________________________________________________________________________
___
Principal Executive Officer or Managing Partner
2) _________________________________________________________________________
___
Principal Financial Officer or Partner
3) _________________________________________________________________________
___
Principal Operations Officer or Partner
ATTENTION — Intentional misstatements or omissions of facts constitute Federal
Criminal Violations. (See 18 U.S.C. 1001 and 15 U.S.C. 78:f(a))
Persons who respond to the collection of information contained in this form
are not required to respond unless the form displays a currently valid OMB
SEC 1696 (02-03) 1 of 16
control number.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal