Form Bd Uniform Application For Broker-Dealer Registration (Page 25 of 28) in pdf

BANKRUPTCY / SIPC DISCLOSURE REPORTING PAGE (BD)

G E N E R A L I N S T R U C T I O N S

This Disclosure Reporting Page (DRP BD) is an

INITIAL OR

AMENDED response used to report details for affirmative responses to

Item 11I of Form BD;

; ; ; ; ;

Check

item(s) being responded to:

11I In the past ten years has the applicant or a control affiliate of the applicant ever been a securities firm or a control affiliate

of a securities firm that:

(1) has been the subject of a bankruptcy petition?

(2) has had a trustee appointed or a direct payment procedure initiated under the Securities Investor Protection Act?

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.

It is not a requirement that documents be provided for each event or proceeding. Should they be provided, they will not be accepted as

disclosure in lieu of answering the questions on this DRP.

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 appropriate DRP

(BD). The completion of this DRP does not relieve the control affiliate of its obligation to update its CRD records.

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 affiliate(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 affilliate(s) are no longer associated with the BD.

B. If the control affiliate is registered through the CRD, has the control affiliate submitted a DRP (with Form U-4) or BD DRP to the CRD

System for the event? If the answer is “Yes,’’ no other information on this DRP must be provided.

Yes

NOTE: The completion of this Form does not relieve the control affiliate of its obligation to update its CRD records.

PART ll

1. Action Type: (check appropriate item)

Bankruptcy

Declaration

Receivership

Compromise

Liquidated

Other ________________________

2. Action Date (MM/DD/YYYY):

Explanation

Exact

If not exact, provide explanation: ___________________________________________________________________________________________

(continued)

Form Bd Uniform Application For Broker-Dealer Registration Page 25

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