Outside Business Activity Disclosure Form printable pdf download

FOR A COPY OF THIS DOCUMENT IN MICROSOFT WORD, PLEASE CONTACT US AT (877) 542-6759

Outside Business Activity Disclosure Form

Pursuant to FINRA Rule 3270, all registered representatives are required to disclose and receive written approval for their outside employment upon

initial employment, prior to engaging in any new employment and upon request of the firm’s Compliance Department.

The following outside business activities are not required to be disclosed:

1. Business activity with a recognized charitable, civic, religious or fraternal tax-exempt entity [501(c)(3)], for which compensation is not received.

2. Business activity which represents a passive investment or income (e.g. rental income)

I (NAME) ________________________________________________ _HAVE

INTEND TO

HAVE NOT

engage(d) in employment outside of the Firm.

(If you have not engaged in outside business activities, please leave the rest of this form blank and sign below)

If the registered Representative intends to or is already engaged in Outside Business Activity, please complete

the following. Add additional pages if necessary:

Name of Employer: _______________________________________ Date of Initial Employment: ____/_____/_____

Job Title: ______________________________ Job Location (City & State) ________________________________

# of Hrs. P/Month: _________ Method of Compensation

: ______________________________

(Salary Commissions, etc.)

Is this job securities related?

Yes

(

IF YES, COMPLETE THE PRIVATE SECURITIES DISCLOSURE FORM)

Description of Job Responsibilities: __________________________________________________________________

_________________________________________________________________________________________________

My signature below certifies that all of the information above it true and correct. Furthermore, I attest that I have

read, understand and agree to comply with FINRA Rule 3270 and the outside business activities Written

Supervisory Procedures of The Firm.

Signature of Registered Rep: ______________________________________________ Date _____/_____/_____

Compliance Department Use Only

Approved ________ Name of Approving Principal: ________________________________ Date _____/_____/_____

Has this outside employment been disclosed on the employee’s Form U4?

Yes

Has the Firm conducted a formal 3270 Analysis regarding this outside employment?

Yes

Denied ________ Name of Principal Denying Employment: _________________________ Date ____/_____/_____

Reason for Denial: _______________________________________________________________________________

______________________________________________________________________________________________

Signature of Principal ______________________________________________ Date _____/_____/_____

Thornton & Associates, LLC - 16 North Marengo Avenue, Suite 700, Pasadena, CA 91101 - Toll Free (877) 542-6759

Outside Business Activity Disclosure Form

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