Uniform Application For Securities Industry Registration Or Transfer (Page 7 of 8) in pdf

more (if no damage amount is alleged, the complaint must be reported unless the firm has made a good faith determination that the

damages from the alleged conduct would be less than $5,000), or;

(b) alleged that you were involved in forgery, theft, misappropriation or conversion of funds or securities?

Answer questions (4) and (5) below only for arbitration claims or civil litigation filed on or after 05/18/2009.

(4) Have you ever been the subject of an investmentrelated, consumerinitiated arbitration claim or civil litigation which

alleged that you were involved in one or more sales practice violations, and which:

(a) was settled for an amount of $15,000 or more, or;

(b) resulted in an arbitration award or civil judgment against any named respondent(s)/defendant(s), regardless of any amount?

(5) Within the past twenty four (24) months, have you been the subject of an investmentrelated, consumerinitiated

arbitration claim or civil litigation not otherwise reported under questions 14I(4) above, which:

(a) alleged that you were involved in one or more sales practice violations and contained a claim for compensatory damages of $5,000 or

more (if no damage amount is alleged, the arbitration claim or civil litigation, must be reported unless the firm has made a good faith

determination that the damages from the alleged conduct would be less than $5,000), or;

(b) alleged that you were involved in forgery, theft, misappropriation or conversion of funds or securities?

Termination Disclosure

14J. Have you ever voluntarily resigned, been discharged or permitted to resign after allegations were made that accused you of:

YES NO

(1) violating investmentrelated statutes, regulations, rules, or industry standards of conduct?

(2) fraud or the wrongful taking of property?

(3) failure to supervise in connection with investmentrelated statutes, regulations, rules or industry standards of conduct?

Financial Disclosure

14K. Within the past 10 years:

YES NO

(1) have you made a compromise with creditors, filed a bankruptcy petition or been the subject of an involuntary bankruptcy petition?

(2) based upon events that occurred while you exercised control over it, has an organization made a compromise with creditors, filed a

bankruptcy petition or been the subject of an involuntary bankruptcy petition?

(3) based upon events that occurred while you exercised control over it, has a broker or dealer been the subject of an involuntary bankruptcy

petition, or had a trustee appointed, or had a direct payment procedure initiated under the Securities Investor Protection Act?

14L. Has a bonding company ever denied, paid out on, or revoked a bond for you?

14M. Do you have any unsatisfied judgments or liens against you?

15. SIGNATURE SECTION

Please Read Carefully

All signatures required on this Form U4 filing must be made in this section.

A "signature" includes a manual signature or an electronically transmitted equivalent. For purposes of an electronic form filing, a signature is effected by

typing a name in the designated signature field. By typing a name in this field, the signatory acknowledges and represents that the entry constitutes in

every way, use, or aspect, his or her legally binding signature.

15A INDIVIDUAL/APPLICANT'S ACKNOWLEDGMENT AND CONSENT

This section must be completed on all initial or Temporary Registration form filings.

15B FIRM/APPROPRIATE SIGNATORY REPRESENTATIONS

This section must be completed on all initial or Temporary Registration form filings.

15C TEMPORARY REGISTRATION ACKNOWLEDGMENT

This section must be completed on Temporary Registration form filings to be able to receive Temporary Registration.

15D INDIVIDUAL/APPLICANT'S AMENDMENT ACKNOWLEDGMENT AND CONSENT

This section must be completed on any amendment filing that amends any information in Section 14 (Disclosure Questions) or any Disclosure

Reporting Page (DRP).

15E FIRM/APPROPRIATE SIGNATORY AMENDMENT REPRESENTATIONS

This section must be completed on all amendment form filings.

15F FIRM/APPROPRIATE SIGNATORY CONCURRENCE

This section must be completed to concur with a U4 filing made by another firm (IA/BD) on behalf of an individual that is also registered with that

other firm (IA/BD).

15C. TEMPORARY REGISTRATION ACKNOWLEDGMENT

If an applicant has been registered in a jurisdiction or self regulatory organization (SRO) in the 30 days prior to the date an application for registration is filed

with the Central Registration Depository or Investment Adviser Registration Depository, he or she may qualify for a Temporary Registration to conduct

securities business in that jurisdiction or SRO if this acknowledgment is executed and filed with the Form U4 at the applicant's firm.

This acknowledgment must be signed only if the applicant intends to apply for a Temporary Registration while the application for registration is under review.

I request a Temporary Registration in each jurisdiction and/or SRO requested on this Form U4, while my registration with the jurisdiction(s) and/or SRO(s)

requested is under review;

I am requesting a Temporary Registration with the firm filing on my behalf for the jurisdiction(s) and/or SRO(s) noted in Section 4 (SRO REGISTRATION)

and/or Section 5 (JURISDICTION REGISTRATION) of this Form U4;

I understand that I may request a Temporary Registration only in those jurisdiction(s) and/or SRO(s) in which I have been registered with my prior firm

within the previous 30 days;

I understand that I may not engage in any securities activities requiring registration in a jurisdiction and/or SRO until I have received notice from the CRD or

IARD that I have been granted a Temporary Registration in that jurisdiction and/or SRO;