Outside Business Activity And Dba Form Page 2

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Hours per month during market hours devoted to this activity: _____ Total hours per month __________
Do you sell, refer, or receive compensation from life settlement activity?:
YES
NO
Do you sell (fixed) equity indexed annuities?
YES
NO
Do you sell fixed annuities?
YES
NO
Do you use the services of an IMO, FMO or similar organization?
YES
NO
If so, please give the name: ________________________________________________________________________
Do you have a website for any of your insurance activity?
YES
NO
If so, please provide the web address:
3. OUTSIDE BUSINESS ACTIVITY INFORMATION:
4. Provide the full, legal name of the outside (non-Firm) company, entity or business venture (OBA) and the full
address and phone number of this OBA:
5. Is there a Website for this entity?
YES
NO
If YES, provide the web address of the site:
6. What date do you anticipate to be your start date with the OBA? Month _____ Year _____
7. If you are an existing Financial Advisor with First Asset, and this OBA is being disclosed after you have started,
what is the reasoning for late disclosure?
______________________________________________________________________________________________
8. Is this an investment related business?
YES
NO
(Note: Investment-related is defined by FINRA as
activity that pertains to securities, commodities, banking, insurance, investment advisery activity or real estate.)
If YES, please provide details:
______________________________________________________________________________________________
9. Are you or will you be an employee with this company?
YES
NO
If YES, have you signed or will you sign an employment contract? (If YES, attach a copy of your contract.)
10. Are you or will you be an independent contractor with this company?
YES
NO
(If YES attach your
agreement.)
11. Do/Will you serve as an Officer/Director/Partner/Trustee or act in a similar capacity with this entity?
If YES, describe the title and the functions of the position:
YES
NO
______________________________________________________________________________________________
12. Do/Will you have any ownership, beneficial interest or any control of this entity?
YES
NO
If YES, provide the following information:
a. Indicate the form of business structure/organizational documents of the entity (Single
Ownership/Partnership/LLC/Corporation/etc.) of this entity:
_______________________________________
b. Enter % of ownership, or description of beneficial interest or control you have: ______%
c. The state which the entity is/was organized: ___________________________
d. The registration or business license number of this entity: ______________________________________
e. The state(s) in which this entity is licensed to do business: _____________________________________
13. Do/Will you or an immediate family member have any ownership interest, beneficial interest or any control this
entity?
YES
NO If YES, please identify the person(s) and specify the amount invested and the date
of the investment: ___________________________________________________________________________
M:FAFSERVER DOCSFIRST ASSET FINANCIALFAF FormsRep Outsde Activity FormsOutside Business Activity Form 8-13.doc
2

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