Uniform Application For Securities Industry Registration Or Transfer
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1Rev. Form U4 (05/2009)
UNIFORM APPLICATION FOR SECURITIES INDUSTRY REGISTRATION OR TRANSFER
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
13. OTHER BUSINESS
Are you currently engaged in any other business either as a proprietor, partner, officer, director, employee, trustee, agent or otherwise?
(Please exclude non investment-related activity that is exclusively charitable, civic, religious or fraternal and is recognized as tax exempt.) If
YES, please provide the following details: the name of the other business, whether the business is investment-related, the address of the
other business, the nature of the other business, your position, title, or relationship with the other business, the start date of your
relationship, the approximate number of hours/month you devote to the other business, the number of hours you devote to the other
business during securities trading hours, and briefly describe your duties relating to the other business.
Yes
No
If "Yes," please enter details below.
Add
New
Revise
Business Name: ___________________________________________________
Is this an "investment-related" business?
Yes
No
Address of Other Business: __________________________________________
__________________________________________
__________________________________________
Number of Hours/Month devoted to the other business: ________________hrs/month
Number of hours/day you devote to the other business during securities trading hours: ______________hrs/day
Nature of the other business: ____________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Your Position: _______________________
Your Title or Relationship: __________________________
Start Date of your Relationship: ______/_______/_______
Describe your duties relating to the other business: _________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
Total Yearly Compensation for Other Business: $___________________ or
None
Signature: _________________________________________________________
Date: ____/_____/_______
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