Application For Registration As A Municipal Securities Dealer Page 4
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13OFFICIAL USE
APPLICATION FOR REGISTRATION AS A
FORM MSD
MUNICIPAL SECURITIES DEALER PURSUANT TO RULE 15Ba2-1
Page 1
UNDER THE SECURITIES EXCHANGE ACT OF 1934
OR AMENDMENT TO SUCH APPLICATION
GENERAL: Form MSD is to be used by a bank or a separately identifiable department or division of a bank (as defined by the
Municipal Securities Rulemaking Board) to apply for registration as a municipal securities dealer with the Securities and Ex
change Commission pursuant to section 15B(a) of the Securities Exchange Act of 1934 (the “Act”) or to amend such applica
tion. If applicant is a department or division of a bank, the application or amendment shall be deemed to have been made by the
bank on behalf of the applicant. Read all instructions before preparing the Form. If this Form is filed as an amendment, only a
completed page one, a completed and signed execution page, and those items which are being amended or which have changed
since the previous filing need to be filed. Please print or type all responses
IN COMPLIANCE WITH THE APPLICABLE SECURITIES LAWS,
THE APPLICANT HEREBY SUBMITS THE FOLLOWING INFORMATION:
1. (a) This Form is filed with the Securities and Exchange Commission as:
A new application
An amendment
A successor application
(b) Applicant is a:
Bank
Department or Division of a Bank
2. (a) Name of applicant:
Full name of applicant: _____________________________________________________________________________________
Name under which municipal securities dealer activities are conducted, if different: ________________________________
____________________________________________________________________________________________________________
If name of applicant is hereby amended, state name under which registered previously: __________________________
____________________________________________________________________________________________________________
If name under which municipal securities dealer activities are conducted is hereby amended, state name given
previously: _______________________________________________________________________________________________
(b) Address and telephone number of principal office at which applicant’s municipal securities dealer activities are
conducted:
______________________________________________________________________________________________________________________________
Address of principal office:
Number and Street
City
State
Zip Code
_ _______________________________________________________________________________________________________________________________
Mailing address if different:
Number and Street
City
State
Zip Code
Telephone Number: ___________________________________________________________
Area Code
Telephone Number
ALL OF THE ITEMS ON THIS PAGE MUST BE ANSWERED AND COMPLETED IN FULL
DO NOT WRITE BELOW THIS LINE . . . . FOR OFFICIAL USE ONLY
GEO. CODE
FILING DATE
BANK DIV.
MAIL CODE
EFFECTIVE DATE
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