Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 23
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49FORM ADV
Your
Name: _________________________________
SEC File No.: ______________________
Schedule D
Date: ______________________________
CRD No.: _________________________
Page 4 of 5
Use this Schedule D Page 4 to report details for items listed below. Report only new information or changes/updates to previously submitted
information. Do not repeat previously submitted information.
This is an
INITIAL or
AMENDED Schedule D Page 4.
SECTION 7.B.
Limited Partnership or Other Private Fund Participation
You must complete a separate Schedule D Page 4 for each limited partnership in which you or a related person is a general partner, each limited
liability company for which you or a related person is a manager, and each other private fund that you advise.
Check only one box:
Add
Delete
Amend
Name of Limited Partnership, Limited Liability Company, or other Private Fund: ______________________________________
Name of General Partner or Manager: _________________________________________
If you are registered or registering with the SEC, is this a “private fund” as defined under SEC rule 203(b)(3)-1?
Yes
No
Are your clients solicited to invest in the limited partnership, limited liability company, or other private fund ?
Yes
No
Approximately what percentage of your clients have invested in this limited partnership, limited liability company, or other private
fund?________%
Minimum investment commitment required of a limited partner, member, or other investor:
$________________
Current value of the total assets of the limited partnership, limited liability company, or other private fund:
$_________________________
SECTION 10 Control Persons
You must complete a separate Schedule D Page 4 for each control person not named in Item 1.A. or Schedules A, B, or C that directly or indirectly
controls your management or policies.
Check only one box:
Add
Delete
Amend
Firm or Organization Name ______________________________________________________________________________________________
CRD Number (if any) _______________________
Effective Date _________________
Termination Date _________________
mm/dd/yyyy
mm/dd/yyyy
Business Address:
_____________________________________________________________________________________________________________________
(number and street)
_____________________________________________________________________________________________________________________
(city)
(state/country)
(zip+4/postal code)
If this address is a private residence, check this box:
Individual Name (if applicable) (Last, First, Middle) ___________________________________________________________________________
CRD Number (if any) _______________________
Effective Date _________________
Termination Date _________________
mm/dd/yyyy
mm/dd/yyyy
Business Address:
_____________________________________________________________________________________________________________________
(number and street)
_____________________________________________________________________________________________________________________
(city)
(state/country)
(zip+4/postal code)
If this address is a private residence, check this box:
Briefly describe the nature of the control: ___________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
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