Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser Page 3
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9Instructions for Form ADV-W
Page 3
c.
After I withdraw from registration, two people (Persons A and B) will have custody of my books and
records, and my books and records will be kept at two locations (Locations Y and Z). Each person would
have custody of the books and records that are kept at both locations. How should I complete the Schedule
W1?
You would complete four Schedules W1. The first would list Person A and Location Y. The second
Schedule W1 would list (again) Person A, and would list Location Z. The third Schedule W1 would list
Person B and Location Y, and the fourth Schedule W1 would list Person B and Location Z. On each
Schedule W1, you should briefly describe the records that are kept at each location (e.g., business and
trading records from 1996 through 1999).
8.
Who should sign the Form ADV-W?
Copies of the Form ADV-W you file with the SEC must be executed by a person you have authorized to file the
Form. If you are a sole proprietor, you must sign the Form; if you are a partnership, a general partner must sign
the Form in the name of the partnership; if you are an unincorporated organization or association that is not a
partnership, the managing agent (an authorized person who directs or manages or who participates in the
directing or managing of its affairs) must sign the Form in the name of the organization or association; if you are
a corporation, a principal officer duly authorized must sign the Form in the name of the corporation. If an
officer of any entity is signing the Form, the officer’s title must be given.
9.
What if I need more space to provide additional information?
If you are filing electronically, add any additional information in the text box asking you to “describe the books
and records kept at this location.” If you are filing on paper, use the reverse side of Schedule W1 to provide any
additional information.
10. What if I do not follow these instructions when completing the Form ADV-W?
If you do not prepare and execute the Form ADV-W as required by these instructions, SEC staff may return the
form to you for correction. The SEC’s acceptance of the Form, however, is not a finding that you have filed the
Form ADV-W as required or that the information submitted is true, correct or complete.
PRIVACY ACT STATEMENT. Section 203(h) of the Advisers Act [15 U.S.C. §80b-3(h)] authorizes the Commission to collect the information
required by Form ADV-W. The Commission collects this information for regulatory purposes, such as reviewing an adviser’s application to
withdraw. Filing Form ADV-W is mandatory for an investment adviser to withdraw from registration. The Commission maintains the
information submitted on Form ADV-W and makes it publicly available. The Commission may return forms that do not include required
information. Intentional misstatements or omissions constitute federal criminal violations under 18 U.S.C. §1001 and 15 U.S.C. §80b-17. The
information contained in Form ADV-W is part of a system of records subject to the Privacy Act of 1974, as amended. The Commission has
published in the Federal Register the Privacy Act System of Records Notice for these records.
SEC’S COLLECTION OF INFORMATION. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid control number. Section 203(h) of the Advisers Act authorizes the Commission to collect the
information on this Form from applicants. See 15 U.S.C. §80b-3(h). Filing of this Form is mandatory for an investment adviser to withdraw from
registration. The principal purpose of this collection of information is to enable the Commission to verify that the activities of an investment
adviser seeking to withdraw from registration do not require the investment adviser to be registered and to determine whether terms and
conditions should be imposed upon a registrant’s withdrawal. By accepting a form, however, the Commission does not make a finding that it has
been completed or submitted correctly. The Commission will maintain files of the information on Form ADV-W and will make the information
publicly available. Any member of the public may direct to the Commission any comments concerning the accuracy of the burden estimate on
page one of Form ADV-W, and any suggestions for reducing this burden. This collection of information has been reviewed by the Office of
Management and Budget in accordance with the clearance requirements of 44 U.S.C. §3507.
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