Form Bd Uniform Application For Broker-Dealer Registration Page 15

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Schedule D of FORM BD
OFFICIAL
OFFICIAL USE
USE
ONLY
Applicant Name:_____________________________________________
Page 3
Date:____________________
Firm CRD No.: _______________
Use this Schedule D Page 3 to report details for Item 10B. 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 3 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 10B
10B. Directly or indirectly, is applicant controlled by any bank holding company, national bank, state member bank of the Federal
Reserve System, state non-member bank, savings bank or association, credit union, or foreign bank?
SECTION VI
Complete this section for control issues relating to ITEM 10B only.
Provide the details for each organization or institution that controls the applicant, including each organization or institution in the
applicant’s chain of ownership. The details supplied relate to:
Financial Institution Name
CRD Number (if applicable)
1
Institution Type (i.e., bank holding company, national bank, state member bank of the Federal Reserve System, state
Effective Date
MM DD YYYY
non-member bank, savings association, credit union, or foreign bank)
/
/
Termination Date
MM DD YYYY
/
/
Business Address (Street, City, State/Country, Zip+4/Postal Code)
If foreign, country of domicile or incorporation
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
Financial Institution Name
CRD Number (if applicable)
2
Institution Type (i.e., bank holding company, national bank, state member bank of the Federal Reserve System, state
Effective Date
MM DD YYYY
non-member bank, savings association, credit union, or foreign bank)
/
/
Termination Date
MM DD YYYY
/
/
Business Address (Street, City, State/Country, Zip+4/Postal Code)
If foreign, country of domicile or incorporation
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
Financial Institution Name
CRD Number (if applicable)
3
Institution Type (i.e., bank holding company, national bank, state member bank of the Federal Reserve System, state
Effective Date
MM DD YYYY
non-member bank, savings association, credit union, or foreign bank)
/
/
Termination Date
MM DD YYYY
/
/
Business Address (Street, City, State/Country, Zip+4/Postal Code)
If foreign, country of domicile or incorporation
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
Financial Institution Name
CRD Number (if applicable)
4
Institution Type (i.e., bank holding company, national bank, state member bank of the Federal Reserve System, state
Effective Date
MM DD YYYY
non-member bank, savings association, credit union, or foreign bank)
/
/
Termination Date
MM DD YYYY
/
/
Business Address (Street, City, State/Country, Zip+4/Postal Code)
If foreign, country of domicile or incorporation
Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary.
If applicant has more than 4 organizations/institutions to report, complete additional Schedule D page 3s.

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