Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser Page 6
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9Form ADV-W
Page 3
Item 3
Custody
Do you or a related person have custody of client assets?
Yes
No
If yes, provide the following information:
A. Number of clients for whom you have custody of cash or securities:
_________________
B. Amount of clients’ cash for which you have custody:
$ _____________ .00
C. Market value of clients’ securities for which you have custody:
$ _____________ .00
D. Market value of assets other than cash or securities for which you have custody: $ __________ .00
Item 4
Money Owed to Clients
Have you (i) received any advisory fees for investment advisory services or publications that you have not rendered or
delivered; or (ii) borrowed any money from clients that you have not repaid?
Yes
No
Do not include in your response to this Item 4 any client funds for which you have custody and that you included in
your response to Item 3.
If yes, provide the following information:
A. Amount of money owed to clients for prepaid fees or subscriptions:
$ _____________ .00
B. Amount of money owed to clients for borrowed funds:
$ _____________ .00
Item 5
Advisory Contracts
A. Have you assigned any of your investment advisory contracts to another person?
Yes
No
If yes, provide the following information:
B. Did you obtain the consent of each client prior to the assignment of the client’s contract?
Yes
No
Client consent can be obtained through an actual consent, or can be inferred through the use of a negative
consent.
If you answered “yes” to Item 5A, list on Section 5 of Schedule W1 each person to whom you have assigned any of
your investment advisory contracts. You must complete a separate Schedule W1 for each person to whom you have
assigned any of your advisory contracts.
Item 6
Judgments and Liens
Are there any unsatisfied judgments or liens against you?
Yes
No
Item 7
Statement of Financial Condition
If you answered yes to Items 3, 4, or 6, you must complete Schedule W2, disclosing the nature and amount of your assets
and liabilities and your net worth as of the last day of the month prior to the filing of this Form ADV-W.
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