Form Bd Uniform Application For Broker-Dealer Registration (Page 18 of 28) in pdf

CRIMINAL DISCLOSURE REPORTING PAGE (BD)

(continuation)

PART II

If charge(s) were brought against an organization over which the applicant or control affiliate exercise(d) control: Enter organization name,

whether or not the organization was an investment-related business and the applicant’s or control affiliate’s position, title or relationship.

________________________________________________________________________________________________________________________

Formal Charge(s) were brought in: (include name of Federal, Military, State or Foreign Court, Location of Court - City or County and State

or Country, Docket/Case number).

_______________________________________________________________________________________________________________________

Event Disclosure Detail (Use this for both organizational and individual charges.)

A. Date First Charged (MM/DD/YYYY):

Exact

Explanation

If not exact, provide explanation: __________________________________________________________________________________________

B. Event Disclosure Detail (include Charge(s)/Charge Description(s), and for each charge provide: 1. number of counts, 2. felony or

misdemeanor, 3. plea for each charge, and 4. product type if charge is investment-related):

_______________________________________________________________________________________________________________________

C. Did any of the Charge(s) within the Event involve a Felony?

Yes

D. Current status of the Event?

Pending

On Appeal

Final

E. Event Status Date (complete unless status is Pending) (MM/DD/YYYY):

Exact

Explanation

If not exact, provide explanation: __________________________________________________________________________________________

Disposition Disclosure Detail: Include for each charge, A. Disposition Type [e.g., convicted, acquitted, dismissed, pretrial, etc.], B. Date,

C. Sentence/Penalty, D. Duration [if sentence-suspension, probation, etc.], E. Start Date of Penalty, F. Penalty/Fine Amount and G. Date Paid.

_______________________________________________________________________________________________________________________

Provide a brief summary of circumstances leading to the charge(s) as well as the disposition. Include the relevant dates when the conduct

which was the subject of the charge(s) occurred. (The information must fit within the space provided.)

_______________________________________________________________________________________________________________________

Form Bd Uniform Application For Broker-Dealer Registration Page 18