Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 14

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Your Name _______________________________ CRD Number _______________
FORM ADV
Part 1A
Date _____________________________________ SEC 801-Number ____________
Page 14 of 16
For “yes” answers to the following questions, complete a Regulatory Action DRP:
Yes
No
C. Has the SEC or the Commodity Futures Trading Commission (CFTC) ever:
(1) found you or any advisory affiliate to have made a false statement or omission?
(2) found you or any advisory affiliate to have been involved in a violation of SEC
or CFTC regulations or statutes?
(3) found you or any advisory affiliate to have been a cause of an investment-related
business having its authorization to do business denied, suspended, revoked, or
restricted?
(4) entered an order against you or any advisory affiliate in connection with
investment-related activity?
(5) imposed a civil money penalty on you or any advisory affiliate, or ordered you
or any advisory affiliate to cease and desist from any activity?
D. Has any other federal regulatory agency, any state regulatory agency, or any foreign
financial regulatory authority:
(1) ever found you or any advisory affiliate to have made a false statement or
omission, or been dishonest, unfair, or unethical?
(2) ever found you or any advisory affiliate to have been involved in a violation of
investment-related regulations or statutes?
(3) ever found you or any advisory affiliate to have been a cause of an investment-
related business having its authorization to do business denied, suspended,
revoked, or restricted?
(4) in the past ten years, entered an order against you or any advisory affiliate in
connection with an investment-related activity?
(5) ever denied, suspended, or revoked your or any advisory affiliate’s registration or
license, or otherwise prevented you or any advisory affiliate, by order,
from associating with an investment-related business or restricted your or any
advisory affiliate’s activity?
E. Has any self-regulatory organization or commodities exchange ever:
(1) found you or any advisory affiliate to have made a false statement or omission?
(2) found you or any advisory affiliate to have been involved in a violation of its
rules (other than a violation designated as a “minor rule violation” under a plan
approved by the SEC)?

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