Outside Business Activity And Dba Form (Page 4 of 5) in pdf

28. Is there any additional information, not already provided, that you believe may be important to consider in order

to complete the review of this activity?

YES

If YES, please provide the detail below:

______________________________________________________________________________________________

Outside Business Activity Disclosure Form

Registered Representative Acknowledgement:

I am aware that the Firm requires all outside business activities to be acknowledged by the Chief Compliance Officer

(CCO)

If I do not receive prior written acknowledgement, I understand that I

PRIOR to my involvement or participation.

am prohibited from having any affiliation with the company or entity identified, regardless of its activities, revenues

or purpose. I acknowledge that the Firm reserves the right to object to, or place conditions on, outside business

activities that may constitute, in the judgment of the Firm, a potential conflict of interest to my association with the

firm. I further understand that I am prohibited from using a fictitious/DBA business name and /or engaging in any

business activity outside the Firm without prior written approval from the CCO. The Firm will contact me via email

once my outside business activity and/or DBA request is approved OR disapproved. I also understand that the Firm

may subsequently object to any previously acknowledged activity at any time, for any reason, without notice. Further,

by affixing my signature to this form, I authorize the Firm to amend my U4 to report the information provided in this

disclosure and represent that the information provided is true and accurate to the best of my knowledge.

I also understand that upon ending involvement with the activity noted above, it is my responsibility to

promptly notify the CCO and amend my U4 within 30 days of terminating the activity.

Registered Representative’s:

Signature:

_____________________________________________ Date: _________________

Phone Numbers: Cell __________________ Business_______________FAX_______________

Personal Email Address Used for Personal Email::

_____________________________________________________________________________

29. DISCONTINUED BUSINESS ACTIVITY:

Please remove the following previously disclosed activity and update my Form U-4 (if necessary) with FINRA.

Name of discontinued activity:

End Date of Activity

____________________________________________________________________

__________________

Signature ______________________________________________________ Date Signed: ________

Rep # _______

M:FAFSERVER DOCSFIRST ASSET FINANCIALFAF FormsRep Outsde Activity FormsOutside Business Activity Form 8-13.doc

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