Application For Registration As A Municipal Securities Dealer Page 8
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13OFFICIAL USE
FORM MSD Page 5
7. (a) (vi) Has been denied membership or registration with, or participation in, or has been suspended, revoked or
expelled from membership, participation in or registration with any self-regulatory organization, or has
been suspended or barred from being associated with any member of a self-regulatory YES NO
organization....................................................................................................................................
(vii) Has been denied registration (license) with, or suspended, revoked or expelled from registration (license)
with the Securities and Exchange Commission or any jurisdiction as a broker, dealer, investment adviser,
securities salesman, or municipal securities dealer, or has been barred from being associated with a YES NO
person engaged in such business ....................................................................................
(viii) Has been found to have been a cause of (1) the denial, suspension, or revocation of any person’s
membership or participation in, or registration with the Securities and Exchange Commission, any
jurisdiction, or any self-regulatory organization, (2) any bar or suspension of any person from being
associated with a broker, dealer, municipal securities dealer, or member of a self-regulatory organization, YES NO
or (3) any expulsion of any person from a self-regulatory organization ..............................................
(ix) Has willfully made or caused to be made any statement which was, at the time and in the light of the
circumstances under which it was made, false and misleading with respect to any material fact, or has
omitted to state any material fact, which was required to be stated, in any application for membership or
participation in, or to become associated with a member of, a self-regulatory organization, in any report
required to be filed with a self-regulatory organization, or in any proceeding before a self-regulatory YES NO
organization ....................................................................................................................
(x)
Has been, within the past 10 years, the subject of any cease and desist, desist and refrain, prohibition, or
similar order which was issued by the United States or any jurisdiction arising out of the conduct of the YES NO
business of a broker, dealer, municipal securities dealer or investment adviser ............................
(xi) Has been associated at any time as an officer, director, general partner, or owner of 10 percentum or more
of the voting securities, or has at any time directly or indirectly through agreement or otherwise exercised
or had the power to exercise a controlling influence over the management or policies of, a broker or dealer
or municipal securities dealer which has been adjudicated bankrupt or a broker or dealer for which a YES NO
trustee has been appointed pursuant to the Securities Investor Protection Act of 1970 .....
(xii) Has been the subject of any order, judgment, decree or other sanction of a foreign court, foreign exchange,
or foreign government or regulatory agency arising out of any securities or investment advisory activities YES NO
...........................................................................................................................
(b) State whether applicant, or any person named in response to item 5 or 6, or any other person directly engaged
in the management, direction, supervision or performance or any of the applicant’s municipal securities dealer
activities, or who directly or indirectly controls any of such activities or who is directly or indirectly controlled YES NO
by applicant in connection with any of such activities, including any employee, is presently the subject of any
proceedings in which an adverse decision would result in any of the foregoing questions in part (a) being
answered “yes”..........................................................................................................................
If the answer to any paragraph of item 7 is “yes,” explain on Schedule A.
8. Each jurisdiction with which applicant, or the bank of which applicant is a part, is licensed or registered as a
municipal securities dealer or to which application has been made should be listed in item 3. If any license or
registration listed therein is of a restricted nature or has been suspended or if any license or registration not listed
in item 3 was terminated, or withdrawn or voluntarily terminated, explain fully on Schedule C.
9. Does applicant, or the bank of which applicant is a part, have any arrangement with any other person to perform YES NO
any services for applicant or for the bank relating to applicant’s municipal securities dealer activities? .............
If “yes,” explain on Schedule C hereto, identifying each such other person, the nature of applicant’s relation, if any,
to such persons, the nature of such services, and the arrangements pursuant to which such services are performed.
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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