Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 19
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49FORM ADV
Your
Name: _________________________________
SEC File No.: ______________________
Schedule C
Date: _______________________________________
CRD No.: __________________________
Amendments to Schedules A and B
1.
Use Schedule C only to amend information requested on either Schedule A or Schedule B. Refer to Schedule A and Schedule B for specific
instructions for completing this Schedule C. Complete each column.
2.
In the Type of Amendment column, indicate “A” (addition), “D” (deletion), or “C” (change in information about the same person).
3.
Ownership codes are:
NA - less than 5%
C - 25% but less than 50%
G - Other (general partner, trustee, or
A - 5% but less than 10%
D - 50% but less than 75%
elected member)
B - 10% but less than 25%
E - 75% or more
4.
List below all changes to Schedule A (Direct Owners and Executive Officers):
FULL LEGAL NAME
Type
Title
Date Title
Owner-
CRD No.
Control
(Individuals: Last Name,
DE/FE/I
of
or
or Status
ship
If None: S.S. No. and Date
Person
First Name, Middle Name)
Amend- Status
Acquired
Code
of Birth, IRS Tax No. or
ment
MM YYYY
Employer ID No.
PR
5.
List below all changes to Schedule B (Indirect Owners):
FULL LEGAL NAME
DE/FE/I
Type
Entity in Which
Date
Owner-
CRD No.
Control
(Individuals: Last Name,
of
Interest is Owned Status
Status
ship
If None: S.S. No.
Person
First Name, Middle Name)
Amend-
Acquired
Code
and Date of Birth,
ment
IRS Tax No., or
MM YYYY
Employer ID No.
PR
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