Form Bd Uniform Application For Broker-Dealer Registration Page 20
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28REGULATORY ACTION DISCLOSURE REPORTING PAGE (BD)
(continuation)
PART ll
1.
Regulatory Action initiated by:
SEC
Other Federal
State
SRO
Foreign
(Full name of regulator, foreign financial regulatory authority, federal, state or SRO)
___________________________________________________________________________________________________________________
2.
Principal Sanction: (check appropriate item)
Civil and Administrative Penalty(ies)/Fine(s)
Disgorgement
Restitution
Bar
Expulsion
Revocation
Cease and Desist
Injunction
Suspension
Censure
Prohibition
Undertaking
Denial
Reprimand
Other _____________________________
Other Sanctions:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
3.
Date Initiated (MM/DD/YYYY):
Exact
Explanation
If not exact, provide explanation: ____________________________________________________________________________________
4.
Docket/Case Number:
5.
Control Affiliate Employing Firm when activity occurred which led to the regulatory action (if applicable):
6.
Principal Product Type: (check appropriate item)
Annuity(ies) - Fixed
Derivative(s)
Investment Contract(s)
Annuity(ies) - Variable
Direct Investment(s) - DPP & LP Interest(s)
Money Market Fund(s)
CD(s)
Equity - OTC
Mutual Fund(s)
Commodity Option(s)
Equity Listed (Common & Preferred Stock)
No Product
Debt - Asset Backed
Futures - Commodity
Options
Debt - Corporate
Futures - Financial
Penny Stock(s)
Debt - Government
Index Option(s)
Unit Investment Trust(s)
Debt - Municipal
Insurance
Other ________________________________
Other Product Types:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
7.
Describe the allegations related to this regulatory action. (The information must fit within the space provided.):
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
8.
Current Status?
Pending
On Appeal
Final
9.
If on appeal, regulatory action appealed to: (SEC, SRO, Federal or State Court) and Date Appeal Filed:
____________________________________________________________________________________________________________________
(continued)
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