Form BD 

Uniform Application 

for 

Broker-Dealer Registration 

OMB Approval 

OMB Number: 3235-0012 

Expires: April 30, 2026 

Estimated average burden hours 

per response: 2.75. 

per amendment: .33. 

SEC _____ (MM-YY) 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 BD INSTRUCTIONS 

A. GENERAL INSTRUCTIONS 

1. Form BD is the Uniform Application for Broker-Dealer Registration. Broker-dealers must file this form to register 

with the Securities and Exchange Commission, self-regulatory organizations, and jurisdictions through the Central 

Registration Depository ("CRD") system, operated by FINRA. 

2. UPDATING - By law, the applicant must promptly update Form BD information by submitting amendments 

whenever the information on file becomes inaccurate or incomplete for any reason. 

3. CONTACT EMPLOYEE - The individual listed as the contact employees must be authorized to receive all 

compliance information, communications, and mailings, and be responsible for disseminating it within the 

applicant's organization. 

4. GOVERNMENT SECURITIES ACTIVITIES 

a. Broker-dealers registered or applicants applying for registration under Section 15(b) of the Securities 

Exchange Act of 1934 (“Exchange Act”) that conduct (or intend to conduct) a government securities business 

in addition to other broker-dealer activities (if any) must file a notice on Form BD by answering "yes" to Item 

2B. 

b. Section 15C of the Exchange Act requires sole government securities broker-dealers to register with the SEC. 

To do so, answer "yes" to Item 2C if conducting only a government securities business. 

c. Broker-dealers registered under Section 15(b) of the Exchange Act that cease to conduct a government 

securities business must file notice when ceasing their activities in government securities. To do so, file an 

amendment to Form BD and answer "yes" to Item 2D. 

NOTE: Broker-dealers registered under Section 15C may register under Section 15(b) by filing an amendment to 

Form BD and answering "yes" to Items 2A and 2D. By doing so, broker-dealer expressly consents to 

withdrawal of broker-dealer's registration under Section 15C of the Exchange Act. 

5. FEDERAL INFORMATION LAW AND REQUIREMENTS 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, 15B, 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; 

however, the social security number information, which aids in identifying the applicant, is voluntary. The principal 

purpose of this Form is to permit the Commission to determine whether the applicant meets the statutory 

requirement to engage in the securities business. The form also is used by applicants to register as brokerdealers with certain self-regulatory organizations and all of the states. The Commission and the Financial Industry 

Regulatory Authority, Inc. maintain the 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. 

B. PAPER FILING INSTRUCTIONS (FIRST TIME APPLICANTS FILING WITH CRD AND WITH SOME 

JURISDICTIONS) 

1. FORMAT 

a. A full paper Form BD is required when the applicant is filing with CRD for the first time. In addition, some 

jurisdictions may require a separate paper filing of Form BD. The applicant should contact the 

appropriate jurisdiction(s) for specific filing requirements. 

b. Attach an Execution Page (Page 1) with original manual signatures to an initial Form BD filing. 

c. Type all information. 

d. Give the name of the broker-dealer and date on each page. 

e. Use only the current version of Form BD and its schedules or a reproduction of them. 

2. DISCLOSURE REPORTING PAGE (DRP) – Information concerning the applicant or control affiliate that 

relates to the occurrence of an event reportable under Item 11 must be provided on the applicant’s 

appropriate DRP (BD). If a control affiliate is an individual or organization registered through the CRD, such 

control affiliate need only complete Part 1 of the applicant’s appropriate DRP (BD). Details of the event must 

be submitted on the control affiliate’s appropriate DRP (BD) or DRP (U-4). Attach a copy of the fully 

completed DRP (BD), or DRP (U-4) previously submitted. If a control affiliate is an individual or organization 
 

 

 

 

 

 

 

 

 

 

 

 

not registered through the CRD, provide the complete answers to all of the items on the applicant’s 

appropriate DRP (BD). 

3. SCHEDULES A, B, AND C – File Schedules A and B only with initial applications for registration. Use 

Schedule C to update Schedules A and B. Individuals not required to file a Form U-4 (individual registration) 

with the CRD system who are listed on Schedules A, B, or C must attach page 2 of Form U-4. The applicant 

broker-dealer must be listed in Form U-4 Item 20 or 21. 

4. SCHEDULE D – Schedule D provides additional space for explaining answers to Item 1C(2), and “yes” 

answers to items 5, 7, 8, 9, 10, 12, and 13 of Form BD. 

C. ELECTRONIC FILING INSTRUCTIONS (APPLICANTS/REGISTERED BROKER-DEALERS FILING 

AMENDMENTS WITH CRD) 

1. FORMAT 

a. Sections 1-13 must be answered and all fields requiring a response must be completed before the filing 

will be accepted. 

b. Applicant must complete the execution screen certifying that Form BD and amendments thereto have 

been executed properly and that the information contained therein is accurate and complete. 

c. To amend information, the applicant must update the appropriate Form BD screens. 

d. A paper copy, with original signatures, of the initial Form BD filing and amendments to Disclosure 

Reporting Pages (DRPs (BD)) must be retained by the applicant and be made available for inspection 

upon a regulatory request. 

2. DISCLOSURE REPORTING PAGE (DRP) – Information concerning the applicant or control affiliate that 

relates to the occurrence of an event reportable under Item 11 must be provided on the applicant’s 

appropriate DRP (BD). If a control affiliate is an individual or organization registered through the CRD, such 

control affiliate need only complete the control affiliate name and CRD number of the applicant’s appropriate 

DRP (BD) or DRP (U-4). If a control affiliate is an individual or organization not registered through the CRD, 

provide complete answers to all of the questions and complete all fields requiring a response on the 

applicant’s appropriate DRP (BD) screen. 

3. DIRECT AND INDIRECT OWNERS - Amend the Direct Owners and Executive Officers screen and the 

Indirect Owners screen when changes in ownership occur. Control affiliates that are individuals and who are 

not required to file a Form U4 (individual registration) with CRD must complete page 2 of Form U-4 (i.e., 

submit/file the information elicited by the Personal Data Residential History, and Employment and Personal 

History sections of that Form). The applicant broker-dealer must be listed in Form U4 Item 20 or 21. 

The CRD mailing address for questions and correspondence is: 

NASAA/NASD CENTRAL REGISTRATION DEPOSITORY

P.O. BOX 9495 

GAITHERSBURG, MD 20898-9495 

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EXPLANATION OF TERMS 

(The following terms are italicized throughout this form.) 

1. GENERAL 

APPLICANT - The broker-dealer applying on or amending this form. 

CONTROL - The power, directly or indirectly, to direct the management or policies of a company, whether through 

ownership of securities, by contract, or otherwise. Any person that (i) is a director, general partner or officer exercising 

executive responsibility (or having similar status or functions); (ii) directly or indirectly has the right to vote 25% or 

more of a class of a voting security or has the power to sell or direct the sale of 25% or more of a class of voting 

securities; or (iii) in the case of a partnership, has the right to receive upon dissolution, or has contributed, 25% or 

more of the capital, is presumed to control that company. (This definition is used solely for the purpose of Form BD.) 

JURISDICTION - A state, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, Guam, 

or any subdivision or regulatory body thereof. 

PERSON - An individual, partnership, corporation, trust, or other organization. 

SELF-REGULATORY ORGANIZATION (SRO) - Any national securities or commodities exchange or registered 

securities association, or registered clearing agency. 

2. FOR THE PURPOSE OF ITEM 5 AND SCHEDULE D 

SUCCESSOR – For the purpose of Section 6 - Successions, an unregistered entity that assumes or acquires 

substantially all of the assets and liabilities, and that continues the business of, a predecessor broker-dealer that 

ceases its broker-dealer activities. [See Exchange Act Section 15(b)(2) and the associated SEC broker-dealer 

successor rules; see also Exchange Act Release No. 31661 (December 28, 1992), 58 FR 7 (January 4, 1993)] 

3. FOR THE PURPOSE OF ITEM 11 AND THE CORRESPONDING DISCLOSURE REPORTING PAGES (DRPs) 

CHARGED - Being accused of a crime in a formal complaint, information, or indictment (or equivalent formal charge). 

CONTROL AFFILIATE – For the purpose of Sections 4, 9, 10, 12, and 13 and corresponding disclosure reporting 

pages (DRPs), a person named in Sections 7, 8, 9, or 10 as a control person or any other individual or organization 

that directly or indirectly controls, is under common control with, or is controlled by, the applicant, including any 

current employee of the applicant except one performing only clerical, administrative, support or similar functions, or 

who, regardless of title, performs no executive duties or has no senior policy making authority. 

ENJOINED - Includes being subject to a mandatory injunction, prohibitory injunction, preliminary injunction, or a 

temporary restraining order. 

FELONY - For jurisdictions that do not differentiate between a felony and a misdemeanor, a felony is an offense 

punishable by a sentence of at least one year imprisonment and/or a fine of at least $1,000. The term also includes a 

general court martial. 

FOREIGN FINANCIAL REGULATORY AUTHORITY - Includes (1) a foreign securities authority; (2) other 

governmental body or foreign equivalent of a self-regulatory organization empowered by a foreign government to 

administer or enforce its laws relating to the regulation of investment or investment-related activities; and (3) a foreign 

membership organization, a function of which is to regulate the participation of its members in the activities listed 

above. 

FOUND - Includes adverse final actions, including consent decrees in which the respondent has neither admitted nor 

denied the findings, but does not include agreements, deficiency letters, examination reports, memoranda of 

understanding, letters of caution, admonishments, and similar informal resolutions of matters. 

INVESTMENT OR INVESTMENT-RELATED – Pertaining 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, 

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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.) 

INVOLVED - Doing an act or aiding, abetting, counseling, commanding, inducing, conspiring with or failing reasonably 

to supervise another in doing an act. 

MINOR RULE VIOLATION - A violation of a self-regulatory organization rule that has been designated as "minor" 

pursuant to a plan approved by the SEC. A rule violation may be designated as "minor" under a plan if the sanction 

imposed consists of a fine of $2,500 or less, and if the sanctioned person does not contest the fine. (Check with the 

appropriate self-regulatory organization to determine if a particular rule violation has been designated as "minor" for 

these purposes). 

MISDEMEANOR - For jurisdictions that do not differentiate between a felony and a misdemeanor, a misdemeanor is 

an offense punishable by a sentence of less than one year imprisonment and/or a fine of less than $1,000. The term 

also includes a special court martial. 

ORDER - A written directive issued pursuant to statutory authority and procedures, including orders of denial, 

suspension, or revocation; does not include special stipulations, undertakings or agreements relating to payments, 

limitations on activity or other restrictions unless they are included in an order. 

PROCEEDING - Includes a formal administrative or civil action initiated by a governmental agency, self-regulatory 

organization or a foreign financial regulatory authority; a felony criminal indictment or information (or equivalent formal 

charge); or a misdemeanor criminal information (or equivalent formal charge). Does not include other civil litigation, 

investigations, or arrests or similar charges effected in the absence of a formal criminal indictment or information (or 

equivalent formal charge). 

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FORM BD 

Page 1 

(Execution Page) 

Uniform Application for Broker-Dealer 

Registration 

Date:__________ SEC File No: 8-_________ Firm CRD No.:______ 

Official Use Official 

Use 

Only 

WARNING: 

Failure to keep this form current and to file accurate supplementary information on a timely basis, or the failure to keep 

accurate books and records or otherwise to comply with the provisions of law applying to the conduct of business as a 

broker-dealer would violate the Federal securities laws and the laws of the jurisdictions and may result in disciplinary, 

administrative, injunctive or criminal action. 

INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE CRIMINAL VIOLATIONS. 

[ ] APPLICATION [ ] AMENDMENT 

1. Exact name, principal business address, mailing address, if different, and telephone number of the applicant:

A. Full name of the applicant (If Sole Proprietor, provide Last, First and Middle name):

B. IRS Empl. Ident. No.:

C. (1) The business name under which the broker-dealer primarily conducts business, if different from 1A. 

(2) List on Schedule D, Page 1, Section I any other name by which the firm conducts business and where it is used.

D. If this filing makes a name change on behalf of an applicant, enter the new name and specify whether the change is to the

[ ] applicant’s name (1A) or [ ] business name (1C):

Please check above.

E. Firm Main Address: (Do not use a P.O. Box)

Number and Street 1: Number and Street 2: 

City: State: Country: Zip/Postal Code: 

Branch offices or other business locations must be reported on Schedule E. 

F. Mailing Address, if different: 

Number and Street 1: Number and Street 2: 

City: State: Country: Zip/Postal Code: 

G. Business Telephone Number:

H. Contact Employee:

Name: Title: Telephone Number: 

EXECUTION: 

For the purpose of complying with the laws of the State(s) designated in Item 2 relating to either the offer or sale of securities or commodities, the undersigned and applicant hereby certify that the 

applicant is in compliance with applicable state surety bonding requirements and irrevocably appoint the administrator of each of those State(s) or such other person designated by law, and the 

successors in such office, attorney for the applicant in said State(s), upon whom may be served any notice, process, or pleading in any action or proceeding against the applicant arising out of or in 

connection with the offer or sale of securities or commodities, or out of the violation or alleged violation of the laws of those State(s), and the applicant hereby consents that any such action or 

proceeding against the applicant may be commenced in any court of competent jurisdiction and proper venue within said State(s) by service of process upon said appointee with the same effect as if 

applicant were a resident in said State(s) and had lawfully been served with process in said State(s). 

The applicant consents that service of any civil action brought by or notice of any proceeding before the Securities and Exchange Commission or any self-regulatory organization in connection with the 

applicant’s broker-dealer activities, or of any application for a protective decree filed by the Securities Investor Protection Corporation , may be given by registered or certified mail or confirmed telegram 

to the applicant’s contact employee at the main address, or mailing address if different, given in Items 1E and 1F. 

The undersigned, being first duly sworn, deposes and says that he/she has executed this form on behalf of, and with the authority of, said applicant. The undersigned and applicant represent that the 

information and statements contained herein, including exhibits attached hereto, and other information filed herewith, all of which are made a part hereof, are current, true and complete. The 

undersigned and applicant further represent that to the extent any information previously submitted is not amended such information is currently accurate and complete. 

Date (MM/DD/YYYY) Name of Applicant 

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 ________________ 

This page must always be completed in full with original, manual signature and notarization. 

To amend, circle items being amended. Affix notary stamp or seal where applicable. 

DO NOT WRITE BELOW THIS LINE – FOR OFFICIAL USE ONLY 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM BD 

Page 2 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use

Only 

2. Indicate by checking the appropriate box(es) each government authority, organization, or jurisdiction in which the applicant 

is registered or registering as a broker-dealer. 

SECURITIES & EXCHANGE COMMISSION 

If the applicant is registered or registering with the SEC, check here and answer Items 2A through 2D below. [ ] 

YES NO 

A. Is the applicant registered or registering as a broker-dealer under Section 15(b) or Section 15B of the

Securities Exchange Act of 1934? [ ] [ ] 

B. Is the applicant registered or registering as a broker-dealer under Section 15(b) of the Securities

Exchange Act of 1934 and also acting or intending to act as a government securities broker or

dealer?

[ ] [ ] 

C. Is the applicant registered or registering solely as a government securities broker or dealer under

Section 15C of the Securities Exchange Act of 1934? [ ] [ ] 

D. Is the applicant ceasing its activities as a government securities broker-dealer? [ ] [ ] 

If the applicant answers "Yes" to Items 2A and 2D, the applicant expressly consents to the withdrawal of its registration 

as a government securities broker or dealer under Section 15C of the Securities Exchange Act of 1934. See 

“Instructions”. 

SRO 

[ ] FINRA 

[ ] NYSE 

[ ] NYSE AMER 

[ ] NYSE ARCA 

[ ] NYSE CHX 

[ ] NYSE NAT 

[ ] NADAQ 

[ ] C2 

[ ] CBOE 

[ ] CBOE BYX 

[ ] CBOE BZX 

[ ] CBOE EDGA 

[ ] CBOE EDGX 

[ ] BX 

[ ] ISE 

[ ] GEMX 

[ ] MRX 

[ ] PHLX 

[ ] EMERALD 

[ ] MIAX 

[ ] PEARL 

[ ] BOX 

[ ] IEX 

[ ] LTSE 

[ ] MEMX 

[ ] OTHER 

___________ 

specify 

JURISDICTION 

[ ] Alabama 

[ ] Alaska 

[ ] Arizona 

[ ] Arkansas 

[ ] California 

[ ] Colorado 

[ ] Connecticut 

[ ] Delaware 

[ ] District of Columbia 

[ ] Florida 

[ ] Georgia 

[ ] Guam 

[ ] Hawaii 

[ ] Idaho 

[ ] Illinois 

[ ] Indiana 

[ ] Iowa 

[ ] Kansas 

[ ] Kentucky 

[ ] Louisiana 

[ ] Maine 

[ ] Maryland 

[ ] Massachusetts 

[ ] Michigan 

[ ] Minnesota 

[ ] Mississippi 

[ ] Missouri 

[ ] Montana 

[ ] Nebraska 

[ ] Nevada 

[ ] New Hampshire 

[ ] New Jersey 

[ ] New Mexico 

[ ] New York 

[ ] North Carolina 

[ ] North Dakota 

[ ] Ohio 

[ ] Oklahoma 

[ ] Oregon 

[ ] Pennsylvania 

[ ] Puerto Rico 

[ ] Rhode Island 

[ ] South Carolina 

[ ] South Dakota 

[ ] Tennessee 

[ ] Texas 

[ ] Utah 

[ ] Vermont 

[ ] Virgin Islands 

[ ] Virginia 

[ ] Washington 

[ ] West Virginia 

[ ] Wisconsin 

[ ] Wyoming 

3. A. Indicate legal status of the applicant:

[ ] Corporation [ ]

[ ] Partnership 

 Sole Proprietorship 

[ ] Limited Liability Company 

[ ] Other (specify) 

B. Month applicant's fiscal year ends:

C. If other than a sole proprietor, indicate date and place applicant obtained its legal status (i.e., state or country

where incorporated, where partnership agreement was filed, or where applicant entity was formed):

State of formation: Country of formation: Date of formation: MM/DD/YYYY

Schedule A and, if applicable, Schedule B must be completed as part of all initial applications. Amendments to 

these schedules must be provided on Schedule C. 

4. If the applicant is a sole proprietor, state full residence address and Social Security Number. 

Social Security Number: 

(Number and Street) (City) (State/Country) (Zip + 4/Postal Code) 

YES NO 

5. Is the applicant at the time of this filing succeeding to the business of a currently registered brokerdealer? 

If “Yes,” contact CRD prior to submitting form; complete appropriate items on Schedule D, Page 1, 

Section III. 

[ ] [ ] 

6. Does the applicant hold or maintain any funds or securities or provide clearing services for any other 

broker or dealer? [ ] [ ] 

7. Does the applicant refer or introduce customers to any other broker or dealer? 

If “Yes,” complete appropriate items on Schedule D, Page 1, Section IV. [ ] [ ] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM BD 

Page 3 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

8. Does the applicant have any arrangement with any other person, firm, or organization under which:

YES NO 

A. any books or records of the applicant are kept or maintained by such other person, firm or organization? [ ] [ ] 

B. accounts, funds, or securities of the applicant are held or maintained by such other person, firm, or

organization? [ ] [ ] 

C. accounts, funds, or securities of customers of the applicant are held or maintained by such other person, [ ] [ ] firm, or organization?

For purposes of 8B and 8C, do not include a bank or satisfactory control location as defined in

paragraph (c) of Rule 15c3-3 under the Securities Exchange Act of 1934 (17 CFR 240.15c3-3).

If “Yes” to any part of Item 8, complete appropriate items on Schedule D, Page 1, Section IV.

9. Does any person not named in Sections 1, 7, 8 or 9, directly or indirectly:

A. control the management or policies of the applicant through agreement or otherwise?

B. wholly or partially finance the business of the applicant?

Do not answer “Yes” to 9B if the person finances the business of the applicant through: 1) a public

offering of securities made pursuant to the Securities Act of 1933; 2) credit extended in the ordinary

course of business by suppliers, banks, and others; or 30 a satisfactory subordination agreement, as

defined in Rule 15c3-1 under the Securities Exchange Act of 1934 (17 CFR 240.15c3-1).

If “Yes” to any part of Item 9, complete appropriate items on Schedule D, Page 1, Section IV.

[ ] [ ] 

[ ] [ ] 

10. A. Directly or indirectly, does the applicant control, is the applicant controlled by, or is the applicant under

common control with, any partnership, corporation, or other organization that is engaged in the securities 

or investment advisory business? 

If “Yes” to item 10A, complete appropriate items on Schedule D, Page 2, Section V. 

B. Directly or indirectly, is applicant controlled by any bank holding company, national bank, state member

bank of the Federal Reserve System, state non-member bank, savings bank or association, credit union, 

or foreign bank? 

If “Yes” to item 10B, complete appropriate items on Schedule D, Page 3, Section VI. 

[ ] [ ] 

[ ] [ ] 

11. Use the appropriate DRP for providing details to “yes” answers to the questions in Item 11. Refer to the

Explanation of Terms section of Form BD Instructions for explanations of italicized terms.

REGULATORY ACTION DISCLOSURE CRIMINAL DISCLOSURE 

A. In the past ten years has the applicant or a control affiliate:

(1) Been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or

military court to any felony?

(2) Been charged with a felony

B. In the past ten years has the applicant or a control affiliate:

(1) Been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or

military court to a misdemeanor involving: investments or an investment-related business, or

any fraud, false statements or omissions, wrongful taking of property, bribery, perjury, forgery,

counterfeiting, extortion, or a conspiracy to commit any of these offenses?

(2) Been charged with a misdemeanor specified in 11B(1)?

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

C. Has the U.S. Securities and Exchange Commission or the Commodity Futures Trading Commission

ever:

(1) Found the applicant or a control affiliate to have made a false statement or omission?

(2) Found the applicant or a control affiliate to have been involved in a violation of its regulations or

statutes? 

(3) Found the applicant or a control affiliate to have been a cause of an investment-related business 

having its authorization to do business denied, revoked, or restricted? 

(4) Entered an order against the applicant or a control affiliate in connection with investment-related

activity? 

(5) Imposed a civil money penalty on the applicant or a control affiliate, or ordered the applicant or a 

control affiliate to cease and desist from any activity? 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM BD 

Page 4 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

REGULATORY ACTION DISCLOSURE 

D. Has any other federal regulatory agency, state regulatory agency, or foreign financial regulatory

authority:

(1) Ever found the applicant or a control affiliate to have made a false statement or omission or been

dishonest, unfair, or unethical?

(2) Ever found the applicant or a control affiliate to have been involved in a violation of investmentrelated regulations or statutes?

(3) Ever found the applicant or a control affiliate to have been a cause of an investment-related

business having its authorization to do business denied, suspended, revoked or restricted?

(4) In the past ten years, entered an order against the applicant or a control affiliate in connection

with an investment-related activity?

(5) Ever denied, suspended, or revoked the applicant’s or a control affiliate’s registration or license

or otherwise, by order, prevented it from associating with an investment-related business or

restricted its activities?

E. Has any self-regulatory organization or commodities exchange ever:

(1) found the applicant or a control affiliate to have made a false statement or omission?

(2) found the applicant or a control affiliate to have been involved in a violation of its rules (other than 

a violation designated as a “minor rule violation” under a plan approved by the U.S. Securities 

and exchange Commission)? 

(3) found the applicant or a control affiliate to have been the cause of an investment-related 

business having its authorization to do business denied, suspended, revoked or restricted? 

YES NO 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

(4) Disciplined the applicant or a control affiliate by expelling or suspending it from membership, 

barring or suspending its association with other members, or otherwise restricting its activities? 

F. Has the applicant’s or a control affiliate’s authorization to act as an attorney, accountant, or federal

contractor ever been revoked or suspended?

G. Is the applicant or a control affiliate now the subject of any regulatory proceeding that could result in a

“yes” answer to any part of 11C, D, or E? 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

CIVIL JUDICIAL DISCLOSURE 

H. (1) Has any domestic or foreign court:

(a) In the past ten years, enjoined the applicant or a control affiliate in connection with any

investment-related activity?

(b) Ever found that the applicant or a control affiliate was involved in a violation of investmentrelated statutes or regulations? 

(c) Ever dismissed, pursuant to a settlement agreement, an investment-related civil action 

brought against the applicant or control affiliate by a state or foreign financial regulatory 

authority? 

(2) Is the applicant or a control affiliate now the subject of any civil proceeding that could result in a

“yes” answer to any part of 11H(1)?

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

FINANCIAL DISCLOSURE 

I. In the past ten years has the applicant or a control affiliate of the applicant ever been a securities firm

or a control affiliate of a securities firm that:

(1) Has been the subject of a bankruptcy petition?

(2) Has had a trustee appointed or a direct payment procedure initiated under the Securities Investor

Protection Act? 

J. Has a bonding company ever denied, paid out on, or revoked a bond for the applicant?

K. Does the applicant have any unsatisfactory judgments or liens against it?

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 

[ ] [ ] 
 

 

 

 

 

 

 

 

 

 

 

 

FORM BD 

Page 5 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

12. Check types of business engaged in (or to be engaged in, if not yet active) by the applicant. Do not check 

any category that accounts for (or is expected to account for) less than 1% of annual revenue from the 

securities or investment advisory business. 

A. Exchange member engaged in exchange commission business other than floor activities [ ] EMC 

B. Exchange member engaged in floor activities [ ] EMF 

C. Broker or dealer making inter-dealer markets in corporate securities over-the-counter [ ] IDM 

D. Broker or dealer retailing corporate equity securities over-the-counter [ ] BDR 

E. Broker or dealer selling corporate debt securities [ ] BDD 

F. Underwriter or selling group participant (corporate securities other than mutual funds) [ ] USG 

G. Mutual fund underwriter or sponsor [ ] MFU 

H. Mutual fund retailer [ ] MFR 

I. 1. U.S. government securities dealer [ ] GSD 

2. U.S. government securities broker [ ] GSB 

J. Municipal securities dealer [ ] MSD 

K. Municipal securities broker [ ] MSB 

L. Broker or dealer selling variable life insurance or annuities [ ] VLA 

M. Solicitor of time deposits in a financial institution [ ] SSL 

N. Real estate syndicator [ ] RES 

O. Broker or dealer selling oil and gas interests [ ] OGI 

P. Put and call broker or dealer or option writer [ ] PCB 

Q.. Broker or dealer selling securities of only one issuer or associate issuers (other than mutual funds) [ ] BIA 

R. Broker or dealer selling securities of non-profit organizations (e.g., churches, hospitals) [ ] NPB 

S. Investment advisory services [ ] IAD 

T. 1. Broker or dealer selling tax shelters or limited partnerships in primary distributions [ ] TAP 

2. Broker or dealer selling tax shelters or limited partnerships in the secondary market [ ] TAS 

U. Non-exchange member arranging for transactions in listed securities by exchange member [ ] NEX 

V. Trading securities for own account [ ] TRA 

W. Private placements of securities [ ] PLA 

X. Broker or dealer selling interests in mortgages or other receivables [ ] MRI 

Y. Broker or dealer involved in a networking, kiosk or similar arrangement with a 

1. Bank, savings bank or association, or credit union [ ] BNA 

2. Insurance company or agency [ ] INA 

Z. Other (give details on Schedule D, Page 1, Section II) [ ] OTH 

13. A. Does applicant effect transactions in commodity futures, commodities or commodity options as a YES NO 

broker for others or as a dealer for its own account? [ ] [ ] 

B. Does applicant engage in any other non-securities business? [ ] [ ] 

If “yes,” describe each other business briefly on Schedule D, Page 1, Section II. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule A of FORM BD 

DIRECT OWNERS AND 

EXECUTIVE OFFICERS 

(Answer for Form BD Item 3) 

Applicant Name: ___________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use 

1. Use Schedule A only in new applications to provide information on the direct owners and executive officers of the 

applicant. Use Schedule B in new applications to provide information on indirect owners. File all amendments on 

Schedule C. Complete each column. 

2. List below the names of: 

(a) Each Chief Executive Officer, Chief Financial Officer, Chief Operations Officer, Chief Legal Officer, Chief Compliance 

Officer, Director, and individuals with similar status or function; 

(b) In the case of an applicant that is a corporation, each shareholder that directly owns 5% or more of a class of a voting 

of the applicant, unless the applicant is a public reporting company (a company subject to Sections 12 or 15(d) of the 

Securities Exchange Act of 1934). 

Direct owners include any person that owns, beneficially owns, has the right to vote, or has the power to sell or direct 

the sale of, 5% or more of a class of a voting security of the applicant. For purposes of this Schedule, a person 

beneficially owns any securities (i) owned by his/her child, stepchild, grandchild, parent, stepparent, grandparent, 

spouse, sibling, mother-in-law, father-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law, sharing the 

same residence, or (ii) that he/she has the right to acquire, within 60 days, through the exercise of any option, warrant 

or right to purchase the security. 

(c) In the case of an applicant that is a partnership, all general partners, and those limited and special partners that have 

the right to receive upon dissolution, or have contributed, 5% or more of the partnership’s capital; and 

(d) In the case of a trust that directly owns 5% or more of a class of a voting security of the applicant, or that has the right 

to receive upon dissolution, or has contributed, 5% or more of the applicant’s capital, the trust and each trustee. 

(e) In the case of an applicant that is a Limited Liability Company (“LLC”), (i) those members that have the right to receive 

upon dissolution, or have contributed, 5% or more of the LLC’s capital, and (ii) if managed by elected managers, all 

elected managers. 

3. Are there any indirect owners on the applicant required to be reported on Schedule B? [ ] Yes [ ] No 

4. In the “DE/FE/I” column, enter “DE” if the owner is a domestic entity, or enter “FE” if owner is an entity incorporated or 

domiciled in a foreign country, or enter “I” if the owner is an individual. 

5. Complete the “Title or Status” column by entering board/management titles; status as partner, trustee, sole proprietor, or 

shareholder; and for shareholders, the class of securities owned (if more than one is issued). 

6. Ownership Codes are: 

NA - less than 5% B - 10% but less than 25% D - 50% but less than 75%

 A - 5% but less than 10% C - 25% but less than 50% E - 75% or more 

7. (a) In the “Control Person” column, enter “Yes” if person has control as defined in the instructions to this form, and enter 

“No” if the person does not have control. Note that under this definition most executive officers and all 25% owners, 

general partners, and trustees would be “control persons”. 

(b) In the “PR“ column, enter “PR” if the owner is a public reporting company under Sections 12 or 15(d) of the Securities 

Exchange Act of 1934. 

FULL LEGAL NAME 

(Individuals: Last Name, First Name, Middle Name) 

DE/FE/I Title or Status Date Title or 

Status Acquired 

Ownership 

Code 

Control 

Person 

CRD No. If None: 

S.S. No., IRS Tax No. or 

Employer ID 

Official 

Use 

Only MM YYYY PR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule B of FORM BD 

INDIRECT OWNERS 

(Answer for Form BD Item 3) 

Applicant Name: _________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use 

1. Use Schedule A only in new applications to provide information on the indirect owners of the applicant. Use Schedule 

A in new applications to provide information on direct owners. File all amendments on Schedule C. Complete each 

column. 

2. With respect to each owner listed on Schedule A, (except individual owners), list below: 

(a) In the case of an owner that is a corporation, each of its shareholders that beneficially owns, has the right to vote, or 

has the power to sell or direct the sale of, 25% or more of a class of a voting security of that corporation. 

For purposes of this Schedule, a person beneficially owns any securities (i) owned by his/her child, stepchild, 

grandchild, parent, stepparent, grandparent, spouse, sibling, mother-in-law, father-in-law, son-in-law, daughter-inlaw, brother-in-law, or sister-in-law, sharing the same residence, or (ii) that he/she has the right to acquire, within 60 

days, through the exercise of any option, warrant or right to purchase the security. 

(b) In the case of an owner that is a partnership, all general partners, and those limited and special partners that have 

the right to receive upon dissolution, or have contributed, 25% or more of the partnership’s capital; and 

(c) In the case of an owner that is a trust, the trust and each trustee. 

(d) In the case of an owner that is a Limited Liability Company (“LLC”), (i) those members that have the right to receive 

upon dissolution, or have contributed, 25% or more of the LLC’s capital, and (ii) if managed by elected managers, all 

elected managers. 

3. Continue up the chain of ownership listing all 25% owners at each level. Once a public company (a company subject to 

Sections 12 or 15(d) of the Securities Exchange Act of 1934) is reached, no ownership information further up the chain 

of ownership need be given. 

4. In the “DE/FE/I” column, enter “DE” if the owner is a domestic entity, or enter “FE” if owner is an entity incorporated or 

domiciled in a foreign country, or enter “I” if the owner is an individual. 

5. Complete the “Status” column by status as partner, trustee, shareholder, etc., and if shareholder, class of securities 

owned (if more than one is issued). 

6. Ownership Codes are: 

C - 25% but less than 50% D - 50% but less than 75% E - 75% or more F - Other General Partners 

7. (a) In the “Control Person” column, enter “Yes” if person has control as defined in the instructions to this form, and enter 

“No” if the person does not have control. Note that under this definition most executive officers and all 25% owners, 

general partners, and trustees would be “control persons”. 

(b) In the “PR“ column, enter “PR” if the owner is a public reporting company under Sections 12 or 15(d) of the 

Securities Exchange Act of 1934. 

FULL LEGAL NAME 

(Individuals: Last Name, First Name, Middle 

Name) 

DE/FE/I Entity in Which Interest is 

Owned 

Status Date Status 

Acquired 

Ownership 

Code 

Control 

Person 

CRD No. If None: 

S.S. No., IRS Tax No. or 

Employer ID 

Official 

Use 

Only MM YYYY PR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule C of FORM BD 

AMENDMENTS TO 

SCHEDULES A & B 

(Answer for Form BD Item 3) 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use 

1. This Schedule C is used to amend Schedules A and B of Form BD. Refer to those schedules for specific instructions for 

completing this Schedule C. Complete each column. File with a completed Execution Page (Page 1). 

2. In the Type of Amendment (“Typ. Of Amd.”) column, indicate “A” (addition), “D” (deletion), or “C” (change in information 

about the same person) 

3. Ownership Codes are: 

NA - less than 5% B - 10% but less than 25% D - 50% but less than 75%

 A - 5% but less than 10% C - 25% but less than 50% E - 75% or more 

4. List below all changes to Schedule A: (Direct Owners and Executive Officers) 

FULL LEGAL NAME 

(Individuals: Last Name, First Name, Middle Name) 

DE/FE/I Title or Status Date Title or 

Status Acquired 

Ownership 

Code 

Control 

Person 

CRD No. If None: 

S.S. No., IRS Tax No. or 

Employer ID 

Official 

Use Only 

MM YYYY PR 

5. List below all changes to Schedule B: (Indirect Owners) 

FULL LEGAL NAME 

(Individuals: Last Name, First Name, Middle 

Name) 

DE/FE/I Entity in Which Interest is 

Owned 

Status Date Status 

Acquired 

Ownership 

Code 

Control 

Person 

CRD No. If None: 

S.S. No., IRS Tax No. or 

Employer ID 

Official 

Use Only 

MM YYYY PR 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule D of FORM BD 

Page 1 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

Use this Schedule D Page 1 to report details for items listed below. Report only new information or changes/updates to 

previously submitted details. Do not repeat previously submitted information. 

This is an [ ] INITIAL [ ] AMENDED detail filing for the Form BD items checked below: 

Section I Other Business Names 

(Check if applicable) [ ] Item 1C(2) 

List each of the “other” names and the jurisdiction(s) in which they are used. 

1. Name Jurisdiction 2. Name Jurisdiction 

3. Name Jurisdiction 4. Name Jurisdiction 

Section II Other Business 

(Check one) [ ] Item 12Z [ ] Item 13B 

Applicant must complete a separate Schedule D Page 1 for each affirmative response in this section. 

Briefly describe any other business (Item 12Z); or any other non-securities business (ITEM 13B). Use reverse side of 

this sheet for additional comments if necessary. 

Section III Successions 

(Check if applicable) [ ] Item 5 

Date of Succession MM DD YYYY 

/ / 

Name of Predecessor 

Firm CRD Number IRS Employer Number (if any) SEC File Number (if any) 

Briefly describe details of the succession including any assets or liabilities not assumed by the successor. Use reverse 

side of this sheet for additional comments if necessary. 

Section IV Introducing and Clearing Arrangements / Control Persons / Financings 

(Check one) [ ] Item 7 [ ] Item 8A [ ] Item 8B [ ] Item 8C [ ] Item 9A [ ] Item 9B 

Applicant must complete a separate Schedule D Page 1 for each affirmative response in this section including any 

multiple responses to any item. Complete the “Effective Date” box with the Month, Day and Year that the arrangement 

or agreement became effective. When reporting a change or termination of an arrangement, enter the effective date of 

the change. 

Firm or Organization Name CRD Number (if any) 

Business Address (Street, City, State/Country, Zip + 4 Postal Code) Effective Date 

MM DD YYYY 

/ / 

Termination Date 

MM DD YYYY 

/ / 

Individual Name CRD Number (if any) 

Business Address (if applicable) (Street, City, State/Country, Zip + 4 Postal Code) Effective Date 

MM DD YYYY 

/ / 

Termination Date 

MM DD YYYY 

/ / 

Briefly describe the nature of reference or arrangement (ITEM 7 or ITEM 8); the nature of the control or agreement 

(ITEM 9A); or the method and amount of financing (ITEM 9B). Use reverse side of this sheet for additional comments if 

necessary. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule D of FORM BD 

Page 2 Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

Use this Schedule D Page 3 to report details for Item 10A. Report only new information or changes/updates to 

previously submitted details. Do not repeat previously submitted information. Supply details for all partnerships, 

corporations, organizations, institutions and individuals necessary to answer each item completely. Use additional 

copies of Schedule D Page 2 if necessary. 

Use the “Effective Date” box to enter the Month, Day, and Year that the affiliation was effective or the date of the most 

recent change in the affiliation. 

This is an [ ] INITIAL [ ] AMENDED detail filing for Form BD Item 10A 

[ ] 10A. Directly or indirectly, does applicant control, is applicant controlled by, or is applicant under common control 

with, any partnership, corporation, or other organization that is engaged in the securities or investment 

advisory business? 

Section V Complete this section for control issues relating to ITEM 10A only. 

The details supplied relate to: 

1. Partnership, Corporation, or Organization Name CRD Number (if any) 

(check only one) 

This Partnership, Corporation, or Organization [ ] controls applicant [ ] is controlled by applicant [ ] is under common control with applicant 

Business Address (Street, City, State/Country, Zip + 4/Postal Code) Effective Date 

MM DD YYYY 

/ / 

Termination Date 

MM DD YYYY 

/ / 

Is Partnership, Corporation or 

Organization a foreign entity” 

[ ] Yes [ ] No 

If Yes, provide country of domicile 

or incorporation” 

Check “Yes” or “No” for 

activities of this partnership ► Securities [ ] Yes [ ] No Corporation, or organization: 

Activities: 

Investment 

Advisory [ ] Yes [ ] No 

Activities: 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary. 

2. Partnership, Corporation, or Organization Name CRD Number (if any) 

(check only one) 

This Partnership, Corporation, or Organization [ ] controls applicant [ ] is controlled by applicant [ ] is under common control with applicant 

Business Address (Street, City, State/Country, Zip + 4/Postal Code) Effective Date 

MM DD YYYY 

/ / 

Termination Date 

MM DD YYYY 

/ / 

Is Partnership, Corporation or 

Organization a foreign entity” 

[ ] Yes [ ] No 

If Yes, provide country of domicile 

or incorporation” 

Check “Yes” or “No” for 

activities of this partnership ► Securities [ ] Yes [ ] No Corporation, or organization: 

Activities: 

Investment 

Advisory [ ] Yes [ ] No 

Activities: 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary. 

3. Partnership, Corporation, or Organization Name CRD Number (if any) 

(check only one) 

This Partnership, Corporation, or Organization [ ] controls applicant [ ] is controlled by applicant [ ] is under common control with applicant 

Business Address (Street, City, State/Country, Zip + 4/Postal Code) Effective Date 

MM DD YYYY 

/ / 

Termination Date 

MM DD YYYY 

/ / 

Is Partnership, Corporation or 

Organization a foreign entity” 

[ ] Yes [ ] No 

If Yes, provide country of domicile 

or incorporation” 

Check “Yes” or “No” for 

activities of this partnership ► Securities [ ] Yes [ ] No Corporation, or organization: 

Activities: 

Investment 

Advisory [ ] Yes [ ] No 

Activities: 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments if necessary. 

If applicant has more than 3 organizations to report, complete additional schedule D Page 2s. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule D of FORM BD 

Page 3 Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use Official 

Use 

Only 

Use this Schedule D Page 3 to report details for Item 10B. Report only new information or changes/updates to 

previously submitted details. Do not report previously submitted information. Supply details for all partnerships, 

corporations, organizations, institutions and individuals necessary to answer each item completely. Use additional 

copies of Schedule D Page 3 if necessary. 

Use the “Effective Date” box to enter the Month, Day, and Year that the affiliation was effective or the date of the most 

recent change in the affiliation. 

This is an [ ] INITIAL [ ] AMENDED detail filing for Form BD Item 10B 

[ ] 10B. Directly or indirectly, is applicant controlled by any bank holding company, national bank, state member 

bank of the Federal Reserve System, state non-member bank, savings bank or association, credit union, or foreign 

bank? 

Section VI Complete this section for control issues relating to ITEM 10B only. 

Provide the details for each organization or institution that controls the applicant, including each organization or 

institution in the applicant’s chain of ownership. The details supplied relate to: 

1. Financial Institution Name CRD Number (if applicable) 

Institution Type (i.e., bank holding company, national bank, state member bank of the 

Federal Reserve System, state non-member bank, savings bank or association, credit 

union, or foreign bank) 

Effective Date MM DD YYYY 

/ / 

Termination Date MM DD YYYY 

/ / 

Business Address (Street, City, State/Country, Zip + 4/Postal Code If foreign, country of domicile or incorporation 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments, if necessary. 

2. Financial Institution Name CRD Number (if applicable) 

Institution Type (i.e., bank holding company, national bank, state member bank of the 

Federal Reserve System, state non-member bank, savings bank or association, credit 

union, or foreign bank) 

Effective Date MM DD YYYY 

/ / 

Termination Date MM DD YYYY 

/ / 

Business Address (Street, City, State/Country, Zip + 4/Postal Code If foreign, country of domicile or incorporation 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments, if necessary. 

3. Financial Institution Name CRD Number (if applicable) 

Institution Type (i.e., bank holding company, national bank, state member bank of the 

Federal Reserve System, state non-member bank, savings bank or association, credit 

union, or foreign bank) 

Effective Date MM DD YYYY 

/ / 

Termination Date MM DD YYYY 

/ / 

Business Address (Street, City, State/Country, Zip + 4/Postal Code If foreign, country of domicile or incorporation 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments, if necessary. 

4. Financial Institution Name CRD Number (if applicable) 

Institution Type (i.e., bank holding company, national bank, state member bank of the 

Federal Reserve System, state non-member bank, savings bank or association, credit 

union, or foreign bank) 

Effective Date MM DD YYYY 

/ / 

Termination Date MM DD YYYY 

/ / 

Business Address (Street, City, State/Country, Zip + 4/Postal Code If foreign, country of domicile or incorporation 

Briefly describe the control relationship. Use reverse side of this sheet for additional comments, if necessary. 

If applicant has more than 4 organizations/institutions to report, complete additional Schedule D page 3s. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Schedule E of FORM BD 

Page 3 

Applicant Name: _____________________________________ 

Date:__________ Firm CRD No.: __________ 

Official Use 

INSTRUCTIONS 

General: Use this schedule to register or report branch offices or other business locations of the applicant. Repeat Items 1-12 for each branch office 

or other business location. Each item must be completed unless otherwise noted. Use additional copies of this schedule as necessary. If 

this branch office or other business location is using a name in connection with securities activities other than the applicant’s name, such 

name must be reported under Item 1C(2) on Page 1 of this Form. 

Specific: 

Item 1. Specify only one box. Check “Add” when a branch office or other business location is opened and the applicant is filing the initial notice, 

“Delete’’ when a branch office or other business location is closed, and “Amendment” to indicate any other change to previously filed 

information. 

Item 2. CRD will assign this branch number when the applicant adds a branch office or other business location as discussed in Item 1 above. If 

known, complete this item for all deletions and amendments. 

Item 3. The Billing Code is an alpha/numeric value consisting of up to eight characters. It is the responsibility of the firm to establish and maintain 

its own unique billing codes. This is not a required field. 

Item 4. Complete this item for all entries. A physical location must be included; post office box designations alone are not sufficient. 

Item 5. Complete this item only when the applicant changes the address of an existing branch office or other business location. 

Item 6. If the branch office or other business location occupies or shares space on premises within a bank, savings bank or association, credit 

union, or other financial institution, enter the name of the institution in the space provided. 

Item 7. Complete this item for all entries. Enter the name of the supervisor or registered representative in charge who is physically at this 

location. 

Item 8. Provide the CRD number for the branch office supervisor named in Item 7. 

Item 9. Complete this item for all entries. Provide the date that the branch officeor other business location was opened (ADD), closed (DELETE), or 

the effective date of the change (AMENDMENT). 

Item 10. Check “Yes” or “No” to denote whether the location will be an Office of Supervisory Jurisdiction (OSJ) as defined in FINRA rules. 

Item 11. Check “Yes” or “No” to denote whether the location is a business location that will operate pursuant to a written agreement or contract 

(other than an insurance agency agreement) with the main office and any one or more of the following will apply: the location (A) assumes 

liability for its own expenses or has its expenses paid by a party other than the applicant; (B) has primary responsibility for decisions relating 

to the employment and remuneration of its registered representatives; (C) deems 5% or more of its total registered representatives to 

be “independent contractors” for tax purposes; or (D) engages in separate market making and/or underwriting activities. 

Item 12. Check the appropriate box(es) if the branch or other business location is registering with FINRA or registering or reporting with a jurisdiction. 

1. Check only one box: [ ] Add [ ] Delete [ ] Amendment 

2. CRD Branch Number _______________________ 6. __________________________________________________ 

Institution Name (if applicable) 

3. Billing Code ________________________________________ 7. __________________________________________________ 

Supervisor Name 

4. __________________________________________________ 8. __________________________________________________ 

Street CRD Number of Supervisor 

__________________________________________________ 9. __________________________________________________ 

P.0. Box (if applicable), Suite, Floor Effective Date (MM/DD/YYYY) 

__________________________________________________ 10. OSJ [ ] Yes [ ] No 

State/Country, Zip Code + 4/Postal Code 

If applicant is changing the address, enter the new address in Item 5. 11. [ ] Yes [ ] No 

4. __________________________________________________ If Yes, indicate each Item 11 subset that applies 

Street 

__________________________________________________ A [ ] B [ ] C [ ] D [ ] 

P.0. Box (if applicable), Suite, Floor 

__________________________________________________ 12. FINRA [ ] Jurisdiction [ ] 

State/Country, Zip Code + 4/Postal Code 

1. Check only one box: [ ] Add [ ] Delete [ ] Amendment 

2. CRD Branch Number _______________________ 6. __________________________________________________ 

Institution Name (if applicable) 

3. Billing Code ______________________________________ 7. __________________________________________________ 

Supervisor Name 

4. __________________________________________________ 8. __________________________________________________ 

Street CRD Number of Supervisor 

__________________________________________________ 9. __________________________________________________ 

P.0. Box (if applicable), Suite, Floor Effective Date (MM/DD/YYYY) 

__________________________________________________ 10. OSJ [ ] Yes [ ] No 

State/Country, Zip Code + 4/Postal Code 

If applicant is changing the address, enter the new address in Item 5. 11. [ ] Yes [ ] No 

4. __________________________________________________ If Yes, indicate each Item 11 subset that applies 

Street 

__________________________________________________ A [ ] B [ ] C [ ] D [ ] 

P.0. Box (if applicable), Suite, Floor 

__________________________________________________ 12. FINRA [ ] Jurisdiction [ ] 

State/Country, Zip Code + 4/Postal Code 
 

 

 

 

 

 

 

 

 

CRIMINAL DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page [DRP (BD)] is an [ ] INITIAL OR [ ] AMENDED response to report details for 

affirmative responses to Items 11A and 11B of Form BD; 

Check [√] item(s) being responded to: 

11A. In the past ten years has the applicant or a control affiliate: 

[ ] (1) Been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or military 

court to any felony? 

[ ] (2) Been charged with a felony? 

11B. In the past ten years has the applicant or a control affiliate: 

[ ] (1) Been convicted of or pled guilty or nolo contendere (“no contest”) in a domestic, foreign or military 

court to a misdemeanor involving: investments or an investment-related business, or any fraud, false 

statements or omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion, or a 

conspiracy to commit any of these offenses? 

[ ] (2) Been charged with a misdemeanor specified in 11B(1)? 

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or 

entity using one DRP. File with a completed Execution Page. 

Multiple counts of the same charge arising out of the same event(s) should be reported on the same DRP. Unrelated 

criminal actions, including separate cases arising out of the same event, must be reported on separate DRPs. Use this 

DRP to report all charges arising out of the same event. One event may result in more than one affirmative answer to the 

above items. 

If a control affiliate is an individual or organization registered through the CRD, such control affiliate need only complete 

Part I of the applicant’s appropriate DRP (BD). Details of the event must be submitted on the control affiliate’s appropriate 

DRP (BD) or DRP (U-4). If a control affiliate is an individual or organization not registered through the CRD, provide 

complete answers to all the items on the applicant’s appropriate DRP (BD). The completion of this DRP does not relieve 

the control affiliate of its obligation to update its CRD records. 

Applicable court documents (i.e., criminal complaint, information or indictment as well as judgment of conviction or 

sentencing documents) must be provided to the CRD if not previously submitted. Documents will not be accepted as 

disclosure in lieu of answering the questions on this DRP. 

PART I 

 

 

A. The person(s) or entity(ies) for whom this DRP (BD) is being filed is (are):

[ ] The Applicant

[ ] Applicant and one or more control affiliate(s)

[ ] One or more control affiliate(s)

If this DRP is being filed for a control affiliate, give the full name of the control affiliate below (for individuals, Last

name, First name, Middle name).

If the control affiliate is registered with the CRD, provide the CRD number. If not, indicate “non-registered” by

checking the appropriate checkbox.

Name of Applicant Applicant CRD Number 

 

 

 

 

 

BD DRP – CONTROL AFFILIATE 

CRD NUMBER This Control Affiliate is [ ] Firm [ ] Individual 

Registered: [ ] Yes [ ] No 

NAME (For individuals, Last, First, Middle) 

[ ] This DRP should be removed from the BD record because the control affiliate(s) are no longer 

associated with the BD. 

B. If the control affiliate is registered through the CRD, has the control affiliate submitted a DRP (with Form U-4) or BD

DRP to the CRD System for the event? If the answer is “Yes,” no other information on this DRP must be provided.

[ ] Yes [ ] No

Note: The completion of this Form does not relieve the control affiliate of its obligation to update its CRD records.
 

 

 

 

 

 

 

 

 

___________________________________________________________________________________________ 

____________________________________________________________________________________________ 

___________________________________________________________________________________________ 

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___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

___________________________________________________________________________________________ 

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CRIMINAL DISCLOSURE REPORTING PAGE (BD)

(continuation) 

PART II 

1. If charge(s) were brought against an organization over which the applicant or control affiliate exercise(d) control: Enter 

organization name, whether or not the organization was an investment-related business and the applicant’s or control 

affiliate’s position, title or relationship. 

2. Formal Charge(s) were brought in: (include name of Federal, Military, State or Foreign Court, Location of Court – City 

or County and State or Country, Docket/Case number). 

3. Event Disclosure Detail (Use this for both organizational and individual charges.) 

A. Date First Charged (MM/DD/YYYY): [ ] Exact [ ] Explanation 

If not exact, provide explanation: _________________________________________________________________ 

B. Event Disclosure Detail (include Charge(s)/Charge Description(s), and for each charge provide: 1. number of 

counts, 2. felony or misdemeanor, 3. plea for each charge, and 4. product type if charge is investment-related): 

C. Did any of the Charge(s) within the Event involve a Felony? [ ] Yes [ ] No 

D. Current status of the Event? [ ] Pending [ ] On Appeal [ ] Final 

E. Event Status Date (complete unless status is [ ] Exact [ ] Explanation 

Pending) (MM/DD/YYYY): 

If not exact, provide explanation: _________________________________________________________________ 

4. Disposition Disclosure Detail: Include for each charge, A. Disposition Type [e.g., convicted, acquitted, dismissed, 

pretrial, etc.], B. Date, C. Sentence/Penalty, D. Duration [if sentence-suspension, probation, etc.], E. Start Date of 

Penalty, F. Penalty/Fine Amount and G. Date Paid. 

5. Provide a brief summary of the circumstances leading to the charge(s) as well as the disposition. Include the relevant 

dates when the conduct which was the subject of the char(s) occurred. (The information must fit within the space 

provided.) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REGULATORY ACTION DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page [DRP (BD)] is an [ ] INITIAL OR [ ] AMENDED response to report details for affirmative responses 

to Items 11C, 11D, 11E, 11F, or 11G of Form BD; 

Check [√] item(s) being responded to: 

11C. Has the U.S. Securities and Exchange Commission or the Commodity Futures Trading Commission ever: 

[ ] (1) Found the applicant or a control affiliate to have made a false statement or omission? 

[ ] (2) Found the applicant or a control affiliate to have been involved in a violation of its regulations or statutes? 

[ ] (3) the applicant or a control affiliate to have been a cause of an investment-related business having its authorization to do business denied, revoked, or 

restricted? 

[ ] (4) Entered an order against the applicant or a control affiliate in connection with investment-related activity? 

[ ] (5) Imposed a civil money penalty on the applicant or a control affiliate, or ordered the applicant or a control affiliate to cease and desist from any activity? 

11D. Has any other federal regulatory agency, state regulatory agency, or foreign financial regulatory authority: 

[ ] (1) Ever found the applicant or a control affiliate to have made a false statement or omission or been dishonest, unfair, or unethical? 

[ ] (2) Ever found the applicant or a control affiliate to have been involved in a violation of investment-related regulations or statutes? 

[ ] (3) Ever found the applicant or a control affiliate to have been a cause of an investment-related business having its authorization to do business denied, 

suspended, revoked or restricted? 

[ ] (4) In the past ten years, entered an order against the applicant or a control affiliate in connection with an investment-related activity? 

[ ] (5) Ever denied, suspended, or revoked the applicant’s or a control affiliate’s registration or license or otherwise, by order, prevented it from associating with an 

investment-related business or restricted its activities? 

11E. Has any self-regulatory organization or commodities exchange ever: 

[ ] (1) found the applicant or a control affiliate to have made a false statement or omission? 

[ ] (2) found the applicant or a control affiliate to have been involved in a violation of its rules (other than a violation designated as a “minor rule violation” under a plan 

approved by the U.S. Securities and exchange Commission)? 

[ ] (3) found the applicant or a control affiliate to have been the cause of an investment-related business having its authorization to do business denied, suspended, 

revoked or restricted? 

[ ] (4) Disciplined the applicant or a control affiliate by expelling or suspending it from membership, barring or suspending its association with other members, or 

otherwise restricting its activities? 

11F. [ ] Has the applicant’s or a control affiliate’s authorization to act as an attorney, accountant, or federal contractor ever been revoked or suspended? 

11G. [ ] Is the applicant or a control affiliate now the subject of any regulatory proceeding that could result in a “yes” answer to any part of 11C, D, or E? 

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or entity using one 

DRP. File with a completed Execution Page. 

One event may result in more than one affirmative answer to Items 11C, 11D, 11E, 11F or 11G. Use only one DRP to report details related to 

the same event. IF an event gives rise to actions by more than one regulator, provide details for each action on a separate DRP. 

It is not a requirement that documents be provided for each event or proceeding. Should they be provided, they will not be accepted as 

disclosure in lieu of answering the questions on this DRP. 

If a control affiliate is an individual or organization registered through the CRD, such control affiliate need only complete Part I of the 

applicant’s appropriate DRP (BD). Details of the event must be submitted on the control affiliate’s appropriate DRP (BD) or DRP (U-4). If a 

control affiliate is an individual or organization not registered through the CRD, provide complete answers to all the items on the applicant’s 

appropriate DRP (BD). The completion of this DRP does not relieve the control affiliate of its obligation to update its CRD records. 

PART I 

A. The person(s) or entity(ies) for whom this DRP is being filed is (are): 

[ ] The Applicant 

[ ] Applicant and one or more control affiliate(s) 

[ ] One or more control affiliate(s) 

If this DRP is being filed for a control affiliate, give the full name of the control affiliate below (for individuals, Last name, 

First name, Middle name). 

If the control affiliate is registered with the CRD, provide the CRD number. If not, indicate “non-registered” by checking 

the appropriate checkbox. 

Name of Applicant Applicant CRD Number 

 

 

 

BD DRP – CONTROL AFFILIATE 

CRD NUMBER This Control Affiliate is [ ] Firm [ ] Individual 

Registered: [ ] Yes [ ] No 

NAME (For individuals, Last, First, Middle) 

[ ] This DRP should be removed from the BD record because the control affiliate(s) are no longer associated 

with the BD. 

B. If the control affiliate is registered through the CRD, has the control affiliate submitted a DRP (with Form U-4) or BD 

DRP to the CRD System for the event? If the answer is “Yes,” no other information on this DRP must be provided. 

[ ] Yes [ ] No 

Note: The completion of this Form does not relieve the control affiliate of its obligation to update its CRD records. 
 

 

 

 

 

 

 

 

 

 

 

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REGULATORY ACTION DISCLOSURE REPORTING PAGE (BD)

(continuation) 

PART II 

1. Regulatory Action initiated by: 

[ ] SEC [ ] Other Federal [ ] State [ ] SRO [ ] Foreign 

(Full name of regulator, foreign financial regulatory authority, federal, state or SRO) 

2. Principal Sanction: (check appropriate item) 

[ ] Civil and Administrative Penalty(ies)/Fine(s) [ ] Disgorgement [ ] Restitution 

[ ] Bar [ ] Expulsion [ ] Revocation 

[ ] Cease and Desist [ ] Injunction [ ] Suspension 

[ ] Censure [ ] Prohibition [ ] Undertaking 

[ ] Denial [ ] Reprimand [ ] Other ____________________ 

Other Sanctions: 

3. 

3. Date Initiated (MM/DD/YYYY) [ ] Exact [ ] Explanation 

If not exact, provide explanation: __________________________________________________________________ 

4. Docket/Case Number: 

5. Control Affiliate Employing Firm when activity occurred which led to the regulatory action (if applicable): 

6. Principal Product Type: (check appropriate item) 

[ ] Annuity(ies) - Fixed 

[ ] Annuity(ies) - Variable 

[ ] CD(s) 

[ ] Commodity Option(s) 

[ ] Debt – Asset Backed 

[ ] Debt - Corporate 

[ ] Debt - Government 

[ ] Debt - Municipal 

[ ] Derivative(s) 

[ ] Direct Investment(s) – DPP & LP Interest(s) 

[ ] Equity - OTC 

[ ] Equity Listed (Common & Preferred Stock) 

[ ] Futures - Commodity 

[ ] Futures - Financial 

[ ] Index Option(s) 

[ ] Insurance 

[ ] Investment Contract(s) 

[ ] Money Market Fund(s) 

[ ] Mutual Fund(s) 

[ ] No Product 

[ ] Options 

[ ] Penny Stock(s) 

[ ] Unit Investment Trust(s) 

[ ] Other _________________ 

Other Product Types: 

7. Describe the allegations related to this regulatory action. (The information must fit within the space provided.): 

8. Current Status? [ ] Pending [ ] On Appeal [ ] Final 

9. If on appeal, regulatory action appealed to: (SEC, SRO, Federal or State Court) and Date Appeal Filed: 

2 
 

 

 

 

 

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REGULATORY ACTION DISCLOSURE REPORTING PAGE (BD)

(continuation) 

If Final or On Appeal, complete all items below. For Pending Actions, complete Item 13 only. 

10. How was matter resolved: (check appropriate item) 

[ ] Acceptance, Waiver & Consent (AWC) [ ] Consent [ ] Settled 

[ ] Decision & Order of Offer of Settlement [ ] Dismissed [ ] Stipulation and Consent 

[ ] Decision [ ] Order [ ] Vacated 3. 

11. Resolution Date (MM/DD/YYYY) [ ] Exact [ ] Explanation 

If not exact, provide explanation: 

12. A. Were any of the following Sanctions Ordered? (Check all appropriate items): 

[ ] Monetary/Fine [ ] Revocation/Expulsion/Denial [ ] Disgorgement/Restitution 

Amount $________ [ ] Censure [ ] Cease and Desist/Injunction [ ] Bar [ ] Suspension 

B. Other Sanctions Ordered: 

C. Sanction Detail: If suspended, enjoined or barred, provide duration including start date and capacities affected 

(General Securities Principal, Financial Operations Principal, etc.). If requalification, by exam/retraining was a 

condition of the sanction, provide length of time given to re-qualify/retrain, type of exam required and whether 

condition has been satisfied. If disposition resulted in a fine, penalty, restitution, disgorgement or monetary 

compensation, provide total amount, portion levied against applicant or control affiliate, date paid and if any portion 

of penalty was waived. 

13. Provide a brief summary of details related to the action status and (or) disposition and include relevant terms, 

conditions and dates. (The information must fit within the space provided.) 

3 
 

 

 

 

 

 

 

 

 

 

 

CIVIL JUDICIAL ACTION DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page [DRP (BD)] is an [ ] INITIAL OR [ ] AMENDED response to report details for 

affirmative responses to Items 11H of Form BD; 

Check [√] item(s) being responded to: 

11H(1) Has any domestic or foreign court: 

[ ] (a) in the past ten years, enjoined the applicant or a control affiliate in connection with any 

investment-related activity? 

[ ] (b) ever found that the applicant or a control affiliate was involved in a violation of investment-related 

statutes or regulations? 

[ ] (c) ever dismissed, pursuant to a settlement agreement, an investment-related civil action brought 

against the applicant or a control affiliate by a state or foreign financial regulatory authority? 

11H(2) [ ] Is the applicant or a control affiliate now the subject of any civil proceeding that could result in a 

“yes” answer to any part of 11H? 

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or entity using one 

DRP. File with a completed Execution Page. 

One event may result in more than one affirmative answer to Items 11H. Use only one DRP to report details related to the same event. 

Unrelated civil judicial actions must be reported on separate DRPs. 

It is not a requirement that documents be provided for each event or proceeding. Should they be provided, they will not be accepted as 

disclosure in lieu of answering the questions on this DRP. 

If a control affiliate is an individual or organization registered through the CRD, such control affiliate need only complete Part I of the 

applicant’s appropriate DRP (BD). Details of the event must be submitted on the control affiliate’s appropriate DRP (BD) or DRP (U-4). If a 

control affiliate is an individual or organization not registered through the CRD, provide complete answers to all the items on the applicant’s 

appropriate DRP (BD). The completion of this DRP does not relieve the control affiliate of its obligation to update its CRD records. 

PART I 

A. The person(s) or entity(ies) for whom this DRP is being filed is (are): 

[ ] The Applicant 

[ ] Applicant and one or more control affiliate(s) 

[ ] One or more control affiliate(s) 

If this DRP is being filed for a control affiliate, give the full name of the control affiliate below (for individuals, Last name, 

First name, Middle name). 

If the control affiliate is registered with the CRD, provide the CRD number. If not, indicate “non-registered” by checking 

the appropriate checkbox. 

Name of Applicant Applicant CRD Number 

BD DRP – CONTROL AFFILIATE 

CRD NUMBER This Control Affiliate is [ ] Firm [ ] Individual 

Registered: [ ] Yes [ ] No 

NAME (For individuals, Last, First, Middle) 

[ ] This DRP should be removed from the BD record because the control affiliate(s) are no longer associated 

with the BD. 

B. If the control affiliate is registered through the CRD, has the control affiliate submitted a DRP (with Form U-4) or BD 

DRP to the CRD System for the event? If the answer is “Yes,” no other information on this DRP must be provided. 

[ ] Yes [ ] No 

Note: The completion of this Form does not relieve the control affiliate of its obligation to update its CRD records. 
 

 

 

 

 

 

 

 

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CIVIL JUDICIAL ACTION DISCLOSURE REPORTING PAGE (BD)

(continuation) 

PART II 

1. Court Action initiated by: (Name of regulator, foreign financial regulatory authority, SRO, commodities exchange, 

agency, firm, private plaintiff, etc.) 

2. Principal Relief Sought: (check appropriate item) 

[ ] Cease and Desist 

[ ] Civil Penalty(ies)/Fine(s) 

[ ] Disgorgement 

[ ] Injunction 

[ ] Money Damages (Private/Civil Complaint) 

[ ] Restitution 

[ ] Restraining Order 

[ ] Other __________ 

Other Relief Sought: 

3. 

3. Filing Date of Court Action (MM/DD/YYYY) [ ] Exact [ ] Explanation 

If not exact, provide explanation: __________________________________________________________________ 

4. Principal Product Type: (check appropriate item) 

[ ] Annuity(ies) - Fixed 

[ ] Annuity(ies) - Variable 

[ ] CD(s) 

[ ] Commodity Option(s) 

[ ] Debt – Asset Backed 

[ ] Debt - Corporate 

[ ] Debt - Government 

[ ] Debt - Municipal 

[ ] Derivative(s) 

[ ] Direct Investment(s) – DPP & LP Interest(s) 

[ ] Equity - OTC 

[ ] Equity Listed (Common & Preferred Stock) 

[ ] Futures - Commodity 

[ ] Futures - Financial 

[ ] Index Option(s) 

[ ] Insurance 

[ ] Investment Contract(s) 

[ ] Money Market Fund(s) 

[ ] Mutual Fund(s) 

[ ] No Product 

[ ] Options 

[ ] Penny Stock(s) 

[ ] Unit Investment Trust(s) 

[ ] Other _________________ 

Other Product Types: 

5. Formal Action was brought in (include name of Federal, State or Foreign Court, Location of Court – City or County and 

State or Country, Docket/Case Number): 

6. Control Affiliate Employing Firm when activity occurred which led to the civil judicial action (if applicable): 

7. Describe the allegations related to this civil action. (The information must fit within the space provided.): 

8. Current Status? [ ] Pending [ ] On Appeal [ ] Final 

9. If on appeal, action action appealed to (provide name of court): Date Appeal Filed (MM/DD/YYYY): 

10. If pending, date notice/process was served (MM/DD/YYYY) [ ] Exact [ ] Explanation 

If not exact, provide explanation: 

2 
 

 

 

 

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CIVIL JUDICIAL ACTION DISCLOSURE REPORTING PAGE (BD)

(continuation) 

If Final or On Appeal, complete all items below. For Pending Actions, complete Item 13 only. 

How was matter resolved: (check appropriate item) 

[ ] Consent [ ] Judgement Rendered [ ] Settled 

[ ] Other _______________________ [ ] Dismissed [ ] Opinion [ ] Withdrawn 

Resolution Date (MM/DD/YYYY) [ ] Exact [ ] Explanation 

If not exact, provide explanation: 

Resolution Detail 

A. Were any of the following Sanctions Ordered or Relief Granted? (Check all appropriate items): 

[ ] Monetary/Fine [ ] Revocation/Expulsion/Denial [ ] Disgorgement/Restitution 

Amount $________ [ ] Censure [ ] Cease and Desist/Injunction [ ] Bar [ ] Suspension 

B. Other Sanctions: 

C. Sanction Detail: If suspended, enjoined or barred, provide duration including start date and capacities affected 

(General Securities Principal, Financial Operations Principal, etc.). If requalification, by exam/retraining was a 

condition of the sanction, provide length of time given to re-qualify/retrain, type of exam required and whether 

condition has been satisfied. If disposition resulted in a fine, penalty, restitution, disgorgement or monetary 

compensation, provide total amount, portion levied against applicant or control affiliate, date paid and if any portion 

of penalty was waived. 

Provide a brief summary of details related to action(s), allegation(s), disposition(s), and/or finding(s) disclosed above. 

(The information must fit within the space provided.) 

3 
 

 

 

 

 

 

 

 

 

 

 

 

 

BANKRUPTCY / SIPC DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page [DRP (BD)] is an an [ [ response to report details for 

affirmative responses to Questions 11I on Form BD; 

Check [√] item(s) being responded to: 

11l In the past ten years has the applicant or a control affiliate of the applicant ever been a securities firm or a 

control affiliate of a securities firm that: 

[ ] (1) has been the subject of a bankruptcy petition? 

[ ] (2) has had a trustee appointed or a direct payment procedure initiated under the Securities Investor 

Protection Act? 

 ] INITIAL OR ] AMENDED

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or 

entity using one DRP. File with a completed Execution Page. 

It is not a requirement that documents be provided for each event or proceeding. Should they be provided, they will not be 

accepted as disclosure in lieu of answering the questions on this DRP. 

If a control affiliate is an individual or organization registered through CRD, such control affiliate need only complete Part I 

of the applicant’s appropriate DRP (BD). Details of the event must be submitted on the control affiliate’s appropriate DRP 

(B) or DRP (U-4). If a control affiliate is an individual or organization not registered through the CRD, provide complete 

answers to all the items on the applicant’s appropriate DRP (BD). The completion of this DRP does not relieve the control 

affiliate of its obligation to update its CRD records. 

PART I 

A. The person or entity for whom this DRP (BD) is being filed is: 

[ ] The Applicant 

[ ] Applicant and one or more control affiliate(s) 

[ ] One or more control affiliate(s) 

If this DRP is being filed for a control affiliate, give the full name of the control affiliate below (for individuals, Last 

name, First name, Middle name). 

If the control affiliate is registered with the CRD, provide the CRD number. If not, indicate “non-registered” by 

checking the appropriate checkbox. 

Name of Applicant Applicant CRD Number 

BD DRP – CONTROL AFFILIATE 

CRD NUMBER This Control Affiliate is [ ] Firm [ ] Individual 

Registered: [ ] Yes [ ] No 

NAME (For individuals, Last, First, Middle) 

[ ] This DRP should be removed from the BD record because the control affiliate(s) are no longer 

associated with the BD. 

B. If the control affiliate is registered through the CRD, has the control affiliate submitted a DRP (with Form U-4) or BD 

DRP to the CRD System for the event? If the answer is “Yes,” no other information on this DRP must be provided. 

PART II 

[ ] Yes [ ] No 

Note: The completion of this Form does not relieve the control affiliate of its obligation to update its CRD records. 

1. Action Type: (check appropriate item) 

[ ] Bankruptcy

[ ] Compromise 

 [ ] Declaration

[ ] Liquidated

 [ ] Receivership 

 [ ] Other ____________________ 

2. Action Date (MM/DD/YYYY) ______________________ [ ] Exact [ ] Explanation 

If not exact, provide explanation: _____________________________________________________________ 

(continued) 
 

 

 

 

 

 

 

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BANKRUPTCY / SIPC DISCLOSURE REPORTING PAGE (BD)

(continuation) 

3. If the financial action relates to an organization over which the applicant or the control affiliate exercise(d) control, 

enter organization name and the applicant’s or control affiliate’s position, title or relationship: 

Was the Organization investment-related? [ ] Yes [ ] No 

4. Court action brought in (Name of Federal, State or Foreign Court), Location of Court (City or County and State or 

Country), Docket/Case Number and Bankruptcy Chapter Number (if Federal Bankruptcy Filing): 

5. Is action currently pending? [ ] Yes [ ] No 

6. If not pending, provide Disposition Type: (check appropriate item) 

[ ] Direct Payment Procedure [ ] Dismissed [ ] Satisfied/Released 

[ ] Discharged [ ] Dissolved [ ] SIPA Trustee Appointed [ ] Other _____________ 

7. Disposition Date (MM/DD/YYYY): _______________________ [ ] Exact [ ] Explanation 

If not exact, provide explanation: _____________________________________________________________ 

8. Provide a brief summary of events leading to the action and if not discharged, explain. (The information must fit 

within the space provided.): 

9. If a SIPA trustee was appointed or a direct payment procedure was begun, enter the amount paid or agreed to be 

paid by you; or the name of the trustee: 

Currently open? [ ] Yes [ ] No 

Date Direct Payment Initiated/Filed or Trustee Appointed (MM/DD/YYYY): __________ [ ] Exact [ ] Explanation

If not exact, provide explanation: _________________________________________________________________ 

10. Provide details of any status/disposition. Include details of creditors, terms, conditions, amounts due and settlement 

schedule (if applicable). (The information must fit within the space provided.) 

2 
 

 

 

 

 

 

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BOND DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page (DRP BD) is an [ ] INITIAL OR [ ] AMENDED response used to report details 

for affirmative responses to Item 11J on Form BD; 

Check [√] item(s) being responded to:

11J [ ] Has a bonding company ever denied, paid out on , or revoked a bond for the applicant? 

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one 

person or entity using one DRP. File with a completed Execution Page. 

It is not a requirement that documents be provided for each event or proceeding. Should they be provided, they 

will not be accepted as disclosure in lieu of answering the questions on this DRP. 

Name of Applicant: Applicant CRD Number: 

1. Firm Name: (Policy Holder) 

2. Bonding Company Name: 

3. Disposition Type: (check appropriate item) 

[ ] Denied [ ] Payout [ ] Revoked 

4. Disposition Date (MM/DD/YYYY): _____________________ [ ] Exact [ ] Explanation 

If not exact, provide explanation: ________________________________________________________________ 

5. If disposition resulted in Payout, list Payout amount and Date Paid: 

6. Summarize the details of circumstances leading to necessity of the bonding company action: (The information must fit 

within the space provided.) 
 

 

 

 

 

 

 

 

 

 

 

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JUDGMENT / LIEN DISCLOSURE REPORTING PAGE (BD) 

GENERAL INSTRUCTIONS 

This Disclosure Reporting Page (DRP BD) is an [ ] INITIAL or [ ] AMENDED response used to report details for affirmative 

responses to Item 11K on Form BD; 

Check [√] item(s) being responded to:

□ 11K Does the applicant have any unsatisfied judgements or liens against it? 

Use a separate DRP for each event or proceeding. An event or proceeding may be reported for more than one person or entity 

using one DRP. 

File with a completed Execution Page. 

It is not a requirement that documents be provided for each event or proceeding. Should they be provided they will not be 

accepted as disclosure in lieu of answering the questions on this DRP. 

Name of Applicant: Applicant CRD Number: 

1. Judgment/Lien Amount: 

2. Judgment/Lien Holder: 

3. Judgment/Lien Type: (check appropriate item 

[ ] [ Civil ] Default [ ] Tax 

4. Date Filed (MM/DD/YYYY): ___________________ [ ] Exact [ ] Explanation 

If not exact, provide explanation: _____________________________________________________________ 

5. Is Judgment/Lien Outstanding? [ ] Yes [ ] No 

If No, provide status date (MM/DD/YYYY): ___________________ [ ] Exact [ ] Explanation 

If not exact, provide explanation: ______________________________________________________________ 

If No, how was matter resolved (check appropriate item)

[ ] Discharged [ ] Released [ ] Removed [ ] Satisfied

6. Court (Name of Federal, State or Foreign Court), Location of Court (City or County and State or Country) and Docket/Case 

Number: 

7. Provide a brief summary of events leading to the action and any payment schedule details including current status (if 

applicable). (The information must fit within the space provided.):