Form 260.211.1 - Application For Broker-Dealer Certificate (Page 2 of 2) in pdf

Form 260.211.1 - Application For Broker-Dealer Certificate Page 2

A completed Form BD (Uniform Application for Broker-Dealer Registration, 17 C.F.R. §

249.501) and the schedules thereto.

NOTE: Social Security Numbers: In accordance with Section 7 of the Privacy Act of 1974 (PL. 93-579), the

following information is provided in connection with the disclosure of social security account numbers in Form BD

Uniform Application for Broker-Dealer Registration, 17 C.F.R. § 249.501) and the Schedules thereto.

(

Disclosure of a social security account number shall be considered a voluntary disclosure, except as provided below.

A social security account number is solicited pursuant to one or more of the following authorities:

Section 25211, Corporations Code.

Section 260.211, Title 10, California Code of Regulations.

Section 17520, Family Code.

Uses to be made of social security account numbers, solicited by Form BD and the Schedules thereto are:

For all persons disclosing social security account numbers, the number may be used, in addition to other

information provided, to conduct a background investigation of the individual by the Department of Justice's

Identification and Information Branch or by other federal, state or local law enforcement agencies. The social

security number may also be used to respond to requests for this information made by child support agencies.

The completed form, except any disclosed social security account numbers, shall become a public record and

available to members of the public pursuant to the provisions of the Public Records Act (Government Code

Sections 6250, et seq.).

Applicant's Minimum Net Capital Requirement: $_____________

Applicant's Fiscal Year Ends:

(Month/Day)

Execution:

____________________________

By ___________________________

____________________________

(Title)

Form 260.211.1 - Application For Broker-Dealer Certificate Page 2