Application For Registration As A Municipal Securities Dealer Page 3
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13item 6, but information is required to be furnished on Schedule B for each such person.
e. Item 7 — The information required by this item must be furnished with respect to each person directly or indirectly engaged in
or controlling any of the applicant’s municipal securities dealer activities, including any employee.
f. Item 9 — This item relates to services performed by persons other than applicant with respect to applicant’s municipal securities
dealer activities. There need not be furnished in response to this item information concerning personnel, payroll and other
administrative services which are not directly related to the applicant’s municipal securities dealer activities.
M. Privacy Act Statement
Under Section 15, 15B(a), 17(a) and 23(a) of the Securities Exchange Act of 1934 and the Rules and Regulations thereunder,
the Commission is authorized to solicit the information required to be supplied by this form from applicants for registration as a
municipal securities dealer (and persons associated with applicants). Disclosure of the information specified on this form is
mandatory prior to processing of applications for registration as a municipal securities dealer, except social security numbers,
disclosure of which is voluntary. The information will be used for the principal purpose of determining whether the Commission
should grant or deny registration to the applicant; social security numbers, if furnished, will be used only to assist the Commission
in identifying applicants and, therefore, in promptly processing applications. Information supplied on this form will be included
routinely in the public files of the Commission and will be available for inspection by any interested person. A form which is not
prepared and executed in compliance with applicable requirements may be returned as not acceptable for filing. Acceptance of this
form, however, shall not constitute any finding that it has been filed as required or that the information submitted is true, current
or complete. Intentional misstatements or omissions of fact constitute federal criminal violations. [See 18 U.S.C. 1001 and 15
U.S.C. 78ff(a)].
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