Application For Registration As A Municipal Securities Dealer Page 6
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13OFFICIAL USE
FORM MSD Page 3
5. Furnish the following information for each person who is directly engaged in the management, direction or supervision of any of
the applicant’s municipal securities dealer activities:
(Place a double asterisk (**) next to the name of each person who is added to the names furnished in the most recent previous filing.)
RELATIONSHIP
Official
FULL NAME
Beginning
Use
Date
Title or Status
Only
Last
First
Middle
Mo. Yr.
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If applicant is a department or division of a bank, place an asterisk (*) next to the name of each person listed above who has been designate
d
by the board of directors of the bank as responsible for the day-to-day conduct of the bank’s municipal securities dealer activities, includin
g
the supervision of all of the bank’s employees engaged in the performance of such activities.
Complete a separate Schedule A or Form MSD-4 for each person named in response to item 5. If applicant is a department or division of a bank
,
attach as an exhibit to this Form a copy of the resolution or resolutions of the board of directors of the bank in which each person identified i
n
item 5 as having been designated by the board as responsible for the day-to-day conduct of the bank’s municipal securities dealer activities i
s
so designated. Such resolutions must be certified by an appropriate officer of the bank as having been duly adopted and as true, current, an
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complete.
If any item on this page is amended, you must answer in full all other items on this page and file with a
completed page 1, and signed execution page. No Schedule required by any item on this page need be filed
with an amended item unless the Schedule itself is amended.
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