Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 9

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Your Name _______________________________ CRD Number _______________
FORM ADV
Part 1A
Date _____________________________________ SEC 801-Number ____________
Page 9 of 16
H. If you provide financial planning services, to how many clients did you provide these services during your last
fiscal year?
0
1-10
11-25
26-50
51-100
101-250
251 – 500
More than 500
If more than 500, how many? ______ (round to the nearest 500)
I.
If you participate in a wrap fee program, do you (check all that apply):
(1) sponsor the wrap fee program?
(2) act as a portfolio manager for the wrap fee program?
If you are a portfolio manager for a wrap fee program, list the names of the programs and their sponsors in
Section 5.I(2) of Schedule D.
If your involvement in a wrap fee program is limited to recommending wrap fee programs to your clients, or
you advise a mutual fund that is offered through a wrap fee program, do not check either Item 5.I(1) or 5.I(2).
Item 6
Other Business Activities
In this Item, we request information about your other business activities.
A. You are actively engaged in business as a (check all that apply):
(1) Broker-dealer
(2) Registered representative of a broker-dealer
(3) Futures commission merchant, commodity pool operator, or commodity trading advisor
(4) Real estate broker, dealer, or agent
(5) Insurance broker or agent
(6) Bank (including a separately identifiable department or division of a bank)
(7) Other financial product salesperson (specify): _____________________________________
B. (1) Are you actively engaged in any other business not listed in Item 6.A. (other than giving investment
advice)?
Yes
No
(2) If yes, is this other business your primary business?
Yes
No
If "yes," describe this other business on Section 6.B. of Schedule D.
(3) Do you sell products or provide services other than investment advice to your advisory clients?
Yes
No

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