Nrd - Request For Refund Form (Page 2 of 2) in pdf

Nrd - Request For Refund Form Page 2

Section B: Request for Refund Schedule

NAME OF FIRM: _______________________________________________________________________

For refunds on Duplicate individuals:

Under "Individual Registrant Information / NRD#", list the NRD number of the correct individual.

Under "Additional Information", list the NRD number of the duplicate individual.

For refunds on Corrective submissions:-

Under "NRD submission #", list the submission number for which you are requesting a refund. This is the corrective submission.

Under "Additional Information", list the original incorrect submission for which the corrective submission(s) was/were made.

REFUND REQUESTED

REFUND TYPE

INDIVIDUAL REGISTRANT

SUBMISSION

ADDITIONAL

JURIS-

NUMBER*

EFT

INFORMATION

DATE

INFORMATION

DICTION(S)

(see below)

IDENTIFIER

Commis-

IIROC

NRD Fee

NRD #

NAME

DD/MM/YYYY

sion

*Refund Type

Missing Individual (no tombstone data)

Duplicate Individual

Individual has already been terminated

Abandoned submission

Personal information change notice fee incorrectly charged

Proficiency information change notice fee incorrectly charged

Employment location change notice fee incorrectly charged

Annual fee incorrectly charged

Open a location fee incorrectly charged

Other (please specify)

NRD. Refund Request Form

Nrd - Request For Refund Form Page 2