Form Bd Uniform Application For Broker-Dealer Registration (Page 17 of 28) in pdf

CRIMINAL DISCLOSURE REPORTING PAGE (BD)

GENERAL INSTRUCTIONS

This Disclosure Reporting Page (DRP BD) is an

INITIAL OR

AMENDED response used to report details for affirmative responses to

Items 11A and 11B of Form BD;

; ; ; ; ;

Check

item(s) being responded to:

11A

In the past ten years has the applicant or a control affiliate:

(1)

been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign, or military court to any felony?

(2)

been charged with any felony?

11B

In the past ten years has the applicant or a control affiliate:

(1)

been convicted or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or military court to a misdemeanor involving: investments

or an investment-related business, or any fraud, false statements or omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting,

extortion, or a conspiracy to commit any of these offenses?

(2)

been charged with a misdemeanor specified in 11B(1)?

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or entity using one DRP. File with a completed Execution

Page.

Multiple counts of the same charge arising out of the same event(s) should be reported on the same DRP. Unrelated criminal actions, including separate cases arising out

of the same event, must be reported on separate DRPs. Use this DRP to report all charges arising out of the same event. One event may result in more than one affirmative

answer to the above items.

If a control affiliate is an individual or organization registered through the CRD, such control affiliate need only complete Part I of the applicant’s appropriate DRP (BD). Details

of the event must be submitted on the control affiliate’s appropriate DRP (BD) or DRP (U-4). If a control affiliate is an individual or organization not registered through the CRD,

provide complete answers to all the items on the applicant’s appropiate DRP (BD). The completion of this DRP does not relieve the control affiliate of its obligation to update

its CRD records.

Applicable court documents (i.e., criminal complaint, information or indictment as well as judgment of conviction or sentencing documents) must be provided to the CRD if

not previously submitted. Documents will not be accepted as disclosure in lieu of answering the questions on this DRP.

PART I

A. The person(s) or entity(ies) for whom this DRP is being filed is (are):

The Applicant

Applicant and one or more control affifiate(s)

One or more control affiliate(s)

If this DRP is being filed for a control affiliate, give the full name of the control affiliate below (for individuals, Last name, First name, Middle name).

If the control affiliate is registered with the CRD, provide the CRD number. If not, Indicate “non-registered’’ by checking the appropriate checkbox.

NAME OF APPLICANT

APPLICANT CRD NUMBER

BD DRP - CONTROL AFFILIATE

CRD NUMBER

This Control Affiliate is

Firm

Individual

Registered:

Yes

NAME (For individuals, Last, First, Middle)

This DRP should be removed from the BD record because the control affiliate(s) are no longer associated with the BD.