Form Bd Uniform Application For Broker-Dealer Registration Page 14
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28Schedule D of FORM BD
OFFICIAL
OFFICIAL USE
USE
ONLY
Applicant Name:_____________________________________________
Page 2
Date:____________________
Firm CRD No.: _______________
Use this Schedule D Page 2 to report details for Item 10A. Report only new information or changes/updates to previously submitted
details. Do not repeat previously submitted information. Supply details for all partnerships, corporations, organizations, institutions and
individuals necessary to answer each item completely. Use additional copies of Schedule D Page 2 if necessary.
Use the “Effective Date” box to enter the Month, Day, and Year that the affiliation was effective or the date of the most recent change
in the affiliation.
This is an
INITIAL
AMENDED detail filing for Form BD Item 10A
10A. Directly or indirectly, does applicant control, is applicant controlled by, or is applicant under common control with, any
partnership, corporation, or other organization that is engaged in the securities or investment advisory business?
SECTION V
Complete this section for control issues relating to ITEM 10A only.
The details supplied relate to:
Partnership, Corporation, or Organization Name
CRD Number (if any)
1
( check only one)
This Partnership, Corporation, or Organization
controls applicant
is controlled by applicant
is under common control with applicant
Business Address (Street, City, State/Country, Zip+4/Postal Code)
Effective Date
Termination Date
MM
DD
Y YYY
MM
DD
Y YYY
/
/
/
/
Is Partnership, Corporation or
If Yes, provide country of domicile Check “Yes” or “No” for
Investment
Organization a foreign entity?
or incorporation:
activities of this partnership,
Securities
Yes
No Advisory
Yes
No
Yes
No
corporation, or organization:
Activities:
Activities:
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
Partnership, Corporation, or Organization Name
CRD Number (if any)
2
( check only one)
This Partnership, Corporation, or Organization
controls applicant
is controlled by applicant
is under common control with applicant
Business Address (Street, City, State/Country, Zip+4/Postal Code)
Effective Date
Termination Date
MM
DD
Y YYY
MM
DD
Y YYY
/
/
/
/
Is Partnership, Corporation or
If Yes, provide country of domicile Check “Yes” or “No” for
Investment
Organization a foreign entity?
or incorporation:
activities of this partnership,
Securities
Yes
No
Advisory
Yes
No
Yes
No
corporation, or organization:
Activities:
Activities:
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
Partnership, Corporation, or Organization Name
CRD Number (if any)
3
( check only one)
This Partnership, Corporation, or Organization
controls applicant
is controlled by applicant
is under common control with applicant
Business Address (Street, City, State/Country, Zip+4/Postal Code)
Effective Date
Termination Date
MM
DD
Y YYY
MM
DD
Y YYY
/
/
/
/
Is Partnership, Corporation or
If Yes, provide country of domicile Check “Yes” or “No” for
Investment
Organization a foreign entity?
or incorporation:
activities of this partnership,
Securities
Yes
No
Advisory
Yes
No
Yes
No
corporation, or organization:
Activities:
Activities:
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
If applicant has more than 3 organizations to report, complete additional Schedule D Page 2s.
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