Form Bd Uniform Application For Broker-Dealer Registration (Page 8 of 28) in pdf

FORM BD

OFFICIAL

OFFICIAL USE

USE

Applicant Name:______________________________________________________________________

ONLY

PAGE 4

Date:____________________

Firm CRD No.: _______________

D. Has any other federal regulatory agency, any state regulatory agency, or foreign financial regulatory authority:

YES NO

(1) ever found the applicant or a control affiliate to have made a false statement or omission or been dishonest,

unfair, or unethical? .................................................................................................................................................

(2) ever found the applicant or a control affiliate to have been involved in a violation of investment-related

regulations or statutes? ...........................................................................................................................................

(3) ever found the applicant or a control affiliate to have been a cause of an investment-related business having

its authorization to do business denied, suspended, revoked, or restricted? ......................................................

(4) in the past ten years, entered an order against the applicant or a control affiliate in connection with an

investment-related activity? .....................................................................................................................................

(5) ever denied, suspended, or revoked the applicant’s or a control affiliate’s registration or license or otherwise,

by order, prevented it from associating with an investment-related business or restricted its activities? ..........

E. Has any self-regulatory organization or commodities exchange ever:

(1) found the applicant or a control affiliate to have made a false statement or omission? .......................................

(2) found the applicant or a control affiliate to have been involved in a violation of its rules (other than a violation

designated as a “minor rule violation’’ under a plan approved by the U.S. Securities and Exchange

Commission)? ..........................................................................................................................................................

(3) found the applicant or a control affiliate to have been the cause of an investment-related business having its

authorization to do business denied, suspended, revoked, or restricted? ...........................................................

(4) disciplined the applicant or a control affiliate by expelling or suspending it from membership, barring or

suspending its association with other members, or otherwise restricting its activities? ......................................

F. Has the applicant’s or a control affiliate’s authorization to act as an attorney, accountant, or federal contractor ever

been revoked or suspended? .........................................................................................................................................

G. Is the applicant or a control affiliate now the subject of any regulatory proceeding that could result in a “yes”

answer to any part of 11C, D, or E? ...............................................................................................................................

H. (1) Has any domestic or foreign court:

(a) in the past ten years, enjoined the applicant or a control affiliate in connection with any investment-related

activity? ..............................................................................................................................................................

(b) ever found that the applicant or a control affiliate was involved in a violation of investment-related statutes

or regulations? ..................................................................................................................................................

the applicant or control affiliate by a state or foreign financial regulatory authority? .....................................

(2) Is the applicant or a control affiliate now the subject of any civil proceeding that could result in a “yes” answer

to any part of 11H(1)? ..............................................................................................................................................

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? ...........................................................................................................................................................................

J. Has a bonding company ever denied, paid out on, or revoked a bond for the applicant? .........................................

K. Does the applicant have any unsatisfied judgments or liens against it? ......................................................................