Form Dfi/dos/iaaa(Wi) - Wisconsin Investment Advisory Activity Of Applicant - 2012
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1§551.406(1)(b), Wis. Stats. and 5.01(2), Wis. Adm. Code
STATE OF WISCONSIN
DEPARTMENT OF FINANCIAL INSTITUTIONS
DIVISION OF SECURITIES
201 West Washington Ave. Suite 300
PO Box 1768
You can fill out this form online by clicking on the Firm Name
Madison, WI 53701-1768
line, filling in the required information, and using the TAB key to
(608) 266-2139
advance to the next question. You must then print out the
TTY: (608) 266-8818
Internet:
completed form for submission to the Division. Use the RESET
button at the bottom to clear all fields.
WISCONSIN INVESTMENT ADVISORY ACTIVITY OF APPLICANT
Pursuant to §551.403(1), Wis. Stats., it is unlawful for any person to transact business in Wisconsin as an investment
adviser unless so licensed or licensed as a broker-dealer whose activities in Wisconsin include investment advisory
services under §551, Wis. Stats., except that licensing is not required under any the following circumstances:
1.
The person effects transactions or provides investment advice in this state exclusively for the account
of persons specified in s. 551.403(2), Wis. Stats. or § DFI-Sec 5.13(1), Wis. Adm. Code.
2.
The person has no place of business in Wisconsin and in the last twelve months has had fewer than 6
clients in Wisconsin.
3.
The person is now, or was at the time of the transactions in question, a federal covered adviser and not
subject to state registration requirements.
The fact that a person may have transacted business as an investment adviser in Wisconsin in violation of
§551.403(1), Wis. Stats., does not mean that a person’s Wisconsin application for registration will automatically be
denied.
As part of the Wisconsin Investment Adviser Registration Application, the applicant must respond as to whether or
not the applicant has engaged in investment advisory business in Wisconsin without being properly registered. To
facilitate your response, please complete the questionnaire below and return the completed form to this Division.
NO, this applicant is not now transacting and has never transacted investment advisory business in
Wisconsin.
YES, this applicant has transacted investment advisory business in Wisconsin prior to this application.
(Do not include services performed during any period when the applicant was registered as a federal
covered adviser and not subject to state regulation.)
If yes, list all transactions effected in Wisconsin:
Name & Address
Date of
Description of
Date of Client
Name of
Total Advisory
of Customer
Transaction
Transaction
Agreement
IA Rep
Fees Charged
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
(Attach additional pages if space provided is insufficient.)
____________________________________________________________________________________________
Name of Applicant
_________________________________________________________
______________________________
Firm’s Authorized Signatory
Date
___________________________________________________________ Firm IARD Number______________
Typed Name and Title of Signatory
This document can be made available in alternate formats upon request to qualifying
individuals with disabilities.
Reset Form
DFI/DOS/IAAA(WI)(R11/12)
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