Uniform Application For Securities Industry Registration Or Transfer (Page 4 of 8) in pdf

6. REGISTRATION REQUESTS WITH AFFILIATED FIRMS

Will applicant maintain registration with firm(s) under common ownership or control with the filing firm?

If "yes", fill in the details to indicate a request for registration with additional firm(s).

Yes

No Information Filed

7. EXAMINATION REQUESTS

Scheduling or Rescheduling Examinations Complete this section only if you are scheduling or rescheduling an examination or continuing education

session. Do not select the Series 63 (S63) or Series 65 (S65) examinations in this section if you have completed Section 5 (JURISDICTION REGISTRATION)

and have selected registration in a jurisdiction. If you have completed Section 5 (JURISDICTION REGISTRATION), and requested an AG registration in a

jurisdiction that requires that you pass the S63 examination, an S63 examination will be automatically scheduled for you upon submission of this Form U4. If

you have completed Section 5 (JURISDICTION REGISTRATION), and requested an RA registration in a jurisdiction that requires that you pass the S65

examination, an S65 examination will be automatically scheduled for you upon submission of this Form U4.

S14

S28

S42

S53

S79

S16

S30

S44

S55

S82

S17

S31

S45

S56

S86

S22

S32

S46

S62

S87

S23

S33

S51

S63

S99

S24

S34

S52

S65

S101

S10

S26

S37

S66

S106

S11

S27

S38

S72

S201

S39

S501

S901

Other ________________________ (Paper Form Only)

OPTIONAL: Foreign Exam City ______________________

Date

_________

(MM/DD/YYYY)

8. PROFESSIONAL DESIGNATIONS

Select each designation you currently maintain.

Certified Financial Planner

Chartered Financial Consultant (ChFC)

Personal Financial Specialist (PFS)

Chartered Financial Analyst (CFA)

Chartered Investment Counselor (CIC)

9. IDENTIFYING INFORMATION/NAME CHANGE

First Name:

Middle Name:

Last Name:

PETER

PRATT

TWINING

Suffix:

Date of Birth

(MM/DD/YYYY)

10/20/1946

State/Province of Birth

Country of Birth

Sex

PENNSYLVANIA

USA

Male

Female

Height

Weight

(ft)

(in)

(lbs)

175

Hair Color

Eye Color

Blond or Strawberry

Blue

10. OTHER NAMES

No Information Filed

11. RESIDENTIAL HISTORY

Starting with the current address, give all addresses for the past 5 years. Report changes as they occur.

From

Street

City

State

Country

Postal Code

02/2015

PRESENT

11 BLYNMAN CIRCLE

MANCHESTER

USA

01944

10/2006

01/2015

88 NORTH RIDGE ROAD

IPSWICH

USA

01938

03/1980

09/2006

31 WOODBURY STREET

HAMILTON

USA

01982

12. EMPLOYMENT HISTORY

Provide complete employment history for the past 10 years. Include the firm(s) noted in Section 1 (GENERAL INFORMATION) and Section 6 (REGISTRATION

Uniform Application For Securities Industry Registration Or Transfer Page 4

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