Form BDW 

Uniform Request 

for 

Broker-Dealer Withdrawal 

OMB Approval 

OMB Number: .....3235-0018 

Expires: August 31, 2026

Estimated average burden 

hours per response: 0.25. 

SEC 122 (04-07) Persons who respond to the collection of information contained 

in this form are not required to respond unless the form displays 

a currently valid OMB number. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM BDW INSTRUCTIONS 

A. GENERAL INSTRUCTIONS 

1. Broker-Dealers must file Form BDW to withdraw their registration from the Securities and Exchange Commission (“SEC”), 

Self-Regulatory Organizations (“SROs”), and appropriate jurisdictions. These instructions apply to filing Form BDW 

electronically with the Central Registration Depository (“CRD”) Some jurisdictions may require a separate paper filing of Form 

BDW and/or additional filing requirements. Thus, the applicant should contact the appropriate jurisdiction(s) for specific filing 

requirements. 

2. All questions must be answered and all fields requiring a response must be complete before the filing is accepted. If filing 

Form BDW on paper, enter “None” or “N/A” where appropriate. 

3. File Form BDW with the CRD, operated by the NASD. Prior to filing Form BDW, amend Form BD to update any incomplete or 

inaccurate information. 

4. A paper copy of this Form BDW (or a reproduction of this form printed off the CRD), the original manual signature(s), must be 

retained by the broker-dealer filing the Form BDW and be made available for inspection upon a regulatory request. A paper 

copy of the initial Form BD filing and amendments to Disclosure Reporting Pages (DRPs BD) also must be retained by the 

broker-dealer filing the Form BDW. 

B. FULL WITHDRAWAL (terminates registration with the SEC, all SROs, and all jurisdictions): 

1. Complete all items except Item 3. 

2. If Item 5 is answered “yes,” file with the CRD a paper copy of FOCUS Report Part II (or Part IIA for non-carrying or nonclearing firms) “Statement of Financial Condition” and “Computation of Net Capital” sections. For firms that do not file FOCUS 

Reports, file a statement of financial condition giving the type and amount of the firm’s assets and liabilities and net worth. 

This information must reflect the finances of the firm no earlier than 10 days before this Form BDW is filed. 

C. PARTIAL WITHDRAWAL (terminates registration with specific jurisdictions and SROs, but does not terminate registration with 

the SEC and at least one SRO and jurisdiction): 

1. Complete all items. 

2. Check with jurisdiction(s) where registered for additional filing requirements. 

The CRD mailing address for questions and correspondence is: 

NASAA/NASD CENTRAL REGISTRATION DEPOSITORY

P.O. BOX 9495 

GAITHERSBURG, MD 20898-9495 

EXPLANATION OF TERMS 

(The following terms are italicized throughout this form.) 

The term JURISDICTION means a state, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, 

Guam, or any subdivision or regulatory body thereof. 

The term INVESTIGATION includes: (a) grand jury investigations, (b) U.S. Securities and Exchange Commission investigations 

after the “Wells” notice has been given, (c) NASD Regulation, Inc. investigations after the “Wells” notice has been given or after a 

person associated with a member, as defined in the NASD By-Laws, has been advised by the staff that it intends to recommend 

formal disciplinary action or, (d) formal investigations by other SROs or, (e) actions or procedures designated as investigations by 

jurisdictions. The term investigation does not include subpoenas, preliminary or routine regulatory inquiries or requests for 

information, deficiency letters, “blue sheet” requests or other trading questionnaires, or examinations. 

The term INVESTMENT-RELATED pertains to securities, commodities, banking, savings association activities, credit union 

activities, insurance, or real estate (including, but not limited to, acting as or being associated with a broker-dealer, municipal 

securities dealer, government securities broker or dealer, issuer, investment company, investment adviser, futures sponsor, bank, 

savings association, credit union, insurance company, or insurance agency). (This definition is used solely for the purpose of Form 

BD.) 

FEDERAL INFORMATION LAW AND REQUIREMENTS – SEC’s Colllection of Information: 

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a 

currently valid control number. Sections 15, 15C, 17(a) and 23(a) of the Exchange Act authorize the SEC to collect the information 

on this form from registrants. See 15 U.S.C. §§78o, 78o-4, 78o-5, 78q and 78w. Filing of this Form is mandatory. The principal 

purpose of this Form is to permit the Commission to determine whether whether it is in the public interest to permit the brokerdealer to withdraw its registration. The Form also is used by broker-dealers to advise certain self-regulatory organizations and all 

of the states that they want to withdraw from registration. The Commission and the National Association of Securities Delaers, Inc. 

maintain files of the information on this Form and will make the information publicly available. Any member of the public may direct 

to the Commission any comments concerning the accuracy of the burden estimate on application facing page of this Form, and any 

suggestions for reducing this burden. This collection of information has been reviewed by the Office of Management and Budget in 

accordance with the clearance requirements of 44 U.S.C. §3507. The information contained in this form is part of a system of 

records subject to the Privacy Act of 1974, as amended. The Securities and Exchange Commission has published in the Federal 

Register the Privacy Act Systems of Records Notice for these records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________ 

__________________________________________________________________________________________________

FORM BDW Uniform Request for Withdrawal from

Broker-Dealer Registration 

Official Use 

WARNING: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE CRIMINAL VIOLATIONS. 

1. A. FULL NAME OF BROKER-DEALER (if sole proprietor, state last, first and middle name): B. IRS Emp. Ident. No.:

C. NAME UNDER WHICH BUSINESS IS CONDUCTED, IF DIFFERENT: D. Firm CRD No.:

E. SEC File No.: F. FIRM MAIN ADDRESS: Number and Street City State/Country Zip+4/Postal Code

G. MAILING ADDRESS, IF DIFFERENT: Number and Street City H. AREA CODE / TELEPHONE NO.:

2. Check One: [ ] Full Withdrawal (skip Item 3) [ ] Partial Withdrawal (Check box(es) where withdrawing in Item 3.) SEC 

[ ] SECURITIES AND EXCHANGE COMMISSION (check only if intending to conduct an intrastate business) 

[ ] FINRA 

SRO JURISDICTION 

[ ] NYSE ARCA [ ] NADAQ [ ] CBOE BYX [ ] CBOE EDGX [ ] GEMX [ ] EMERALD 

[ ] NYSE [ ] NYSE CHX [ ] C2 [ ] CBOE BZX [ ] BX [ ] MRX [ ] MIAX 

[ ] NYSE AMER [ ] NYSE NAT [ ] CBOE [ ] CBOE EDGA [ ] ISE [ ] PHLX [ ] PEARL 

[ ] Alabama 

[ ] Alaska 

[ ] Arizona 

[ ] Arkansas 

[ ] California 

[ ] Colorado 

[ ] Connecticut 

[ ] Delaware 

[ ] District of Columbia 

[ ] Florida 

[ ] Georgia 

[ ] Guam [ ] Massachusetts [ ] New York 

[ ] Hawaii [ ] Michigan [ ] North Carolina 

[ ] Idaho [ ] Minnesota [ ] North Dakota 

[ ] Illinois [ ] Mississippi [ ] Ohio 

[ ] Indiana [ ] Missouri [ ] Oklahoma 

[ ] Iowa [ ] Montana [ ] Oregon 

[ ] Kansas [ ] Nebraska [ ] Pennsylvania 

[ ] Kentucky [ ] Nevada [ ] Puerto Rico 

[ ] Louisiana [ ] New Hampshire [ ] Rhode Island 

[ ] Maine [ ] New Jersey [ ] South Carolina 

[ ] Maryland [ ] New Mexico [ ] South Dakota 

[ ] BOX 

[ ] IEX 

[ ] LTSE 

[ ] Tennessee 

[ ] Texas 

[ ] Utah 

[ ] Vermont 

[ ] Virgin Islands 

[ ] Virginia 

[ ] Washington 

[ ] West Virginia 

[ ] Wisconsin 

[ ] Wyoming 

[ ] MEMX 

[ ] OTHER 

specify

4. Date firm ceased business or withdrew from registration request (for partial

withdrawals, give the date ceased business in the jurisdictions checked in item 3):

MM 

/ 

DD 

/ 

 YY 

 Yes No 

5. Does the broker-dealer owe any money or securities to any customer or broker-dealer [ ] [ ] 

If partial withdrawal, indicate jurisdiction(s) from which you are withdrawing 

Where you owe funds or securities to customers in such jurisdiction(s) 

, , 

If full withdrawal, complete A-D below 

A. Number of customers owed funds or securities

B. Amount of money owed to: customers $ 

$ 

broker-dealers 

C. Market value of securities owed to: customers broker-dealers 

$ 

$ 

D. Describe arrangements made for payment:

If this is a full withdrawal and Item 5 is answered “yes,” file with the CRD a FOCUS REPORT Part II (or Part IIA for non-carrying or non-clearing firms) “Statement 

of Financial Condition” and “Computation of Net Capital” sections. For firms that do not file FOCUS Reports, file a statement of financial condition giving the type 

and amount of the firm’s assets and liabilities and net worth. The FOCUS Report and the statement of financial condition must reflect the finances of the firm no 

earlier than 10 days before this Form BDW is filed. 

6. Is the broker-dealer now the subject of or named in any investment-related:

- investigation

yes 

[ ]

no 

[ ] 

- consumer-initiated complaint [ ] [ ] 

NOTE: Update any incomplete or inaccurate information contained in item 11 of Form BD. 

- private civil litigation [ ] [ ] 

7. NAME AND ADDRESS OF THE PERSON WHO WILL HAVE CUSTODY OF BOOKS AND RECORDS: AREA CODE / TELEPHONE NO.: 

ADDRESS WHERE THE BOOKS AND RECORDS WILL BE LOCATED, IF DIFFERENT: NUMBER AND STREET CITY STATE/COUNTRY ZIP + 4/POSTAL CODE 

EXECUTION: The undersigned certifies that he/she has executed this form on behalf of, and with the authority of, the broker-dealer, and that all information herein, including any attachments hereto, is 

accurate, complete, and current. The undersigned and broker-dealer further certify that all the information previously submitted on Form BD is accurate and complete as of this date, and that the broker-dealer’s 

books and records will be preserved and available for inspection as required by law. 

Date (MM/DD/YYYY) Name 

By: 

Signature Print Name and Title 

Subscribed and sworn to me this ___ day of _______, ______ by ___________________________ 

Year Notary Public 

My Commission expires _______________ County of ______________________ State of ________________