Form Adv-W - Notice Of Withdrawal From Registration As An Investment Adviser Page 7
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11Form ADV-W
Page 3
withdrawing?
Yes
No
If yes, provide the date you ceased conducting advisory business in the jurisdictions checked in the status
section above:
________________________________
MM / DD / YYYY
If you ceased conducting advisory business in these jurisdictions on different dates, you must submit a
different Form ADV-W for each different date on which you ceased conducting advisory business.
B. Reasons for withdrawal: ___________________________________________________
______________________________________________________________________
Item 3
Custody
Do you or a related person have custody of client assets?
Yes
No
If yes, provide the following information:
A. Number of clients for whom you have custody of cash or securities:
________________
B. Amount of clients’ cash for which you have custody:
$ ____________ .00
C. Market value of clients’ securities for which you have custody:
$ ____________ .00
D. Market value of assets other than cash or securities for which you have custody: $ ____ .00
Item 4
Money Owed to Clients
Have you (i) received any advisory fees for investment advisory services or publications that you have not
rendered or delivered; or (ii) borrowed any money from clients that you have not repaid?
Yes
No
Do not include in your response to this Item 4 any client funds for which you have custody and that you
included in your response to Item 3.
If yes, provide the following information:
A. Amount of money owed to clients for prepaid fees or subscriptions:
$ ____________ .00
B. Amount of money owed to clients for borrowed funds:
$ ____________ .00
Item 5
Advisory Contracts
A. Have you assigned any of your investment advisory contracts to another person?
Yes
No
If yes, provide the following information:
B. Did you obtain the consent of each client prior to the assignment of the client’s contract?
Yes
No
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