Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 33
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49CIVIL JUDICIAL ACTION DISCLOSURE REPORTING PAGE (ADV)
(continuation)
PART II
1.
Court Action initiated by: (Name of regulator, foreign financial regulatory authority, SRO, commodities exchange, agency,
firm, private plaintiff, etc.)
_____________________________________________________________________________________________________
2.
Principal Relief Sought (check appropriate item):
Cease and Desist
Disgorgement
Money Damages (Private/Civil Complaint)
Restraining Order
Civil Penalty(ies)/Fine(s)
Injunction
Restitution
Other _________
Other Relief Sought:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
3.
Filing Date of Court Action (MM/DD/YYYY):
Exact
Explanation
If not exact, provide explanation: _________________________________________________________________________
4.
Principal Product Type (check appropriate item):
Annuity(ies) - Fixed
Derivative(s)
Investment Contract(s)
Annuity(ies) - Variable
Direct Investment(s) - DPP & LP Interest(s)
Money Market Fund(s)
CD(s)
Equity - OTC
Mutual Fund(s)
Commodity Option(s)
Equity Listed (Common & Preferred Stock)
No Product
Debt - Asset Backed
Futures - Commodity
Options
Debt - Corporate
Futures - Financial
Penny Stock(s)
Debt - Government
Index Option(s)
Unit Investment Trust(s)
Debt - Municipal
Insurance
Other ______________
Other Product Types:
_____________________________________________________________________________________________________
5.
Formal Action was brought in (include name of Federal, State or Foreign Court, Location of Court - City or County and
State or Country, Docket/Case Number):
_____________________________________________________________________________________________________
6.
Advisory Affiliate Employing Firm when activity occurred which led to the civil judicial action (if applicable):
(continued)
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