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FORM MA-I per initial response. . . . . . . . . . . 3.0

per amendment. . . . . . . . . . . . . . 0.5

INFORMATION REGARDING NATURAL PERSONS WHO ENGAGE IN MUNICIPAL 

ADVISORY ACTIVITIES 

Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, 

“Specific Instructions for Form MA-I,” before completing this form. All italicized terms herein are defined or 

described in the Glossary of Terms appended to the General Instructions. 

PART I 

This form must be completed by: 

• Every municipal advisory firm applying for registration or registered as a municipal advisor on 

Form MA, to provide information regarding each natural person who is an associated person of 

the firm and engages in municipal advisory activities on the firm’s behalf (for purposes of Form 

MA-I, the “individual”); and 

• Every natural person (sole proprietor) applying for registration as a municipal advisor on Form 

MA, to provide additional personal information. 

WARNING: Complete this form truthfully. False statements or omissions may result in denial of a 

municipal advisor’s application or revocation or suspension of such registration, administrative 

or civil action, or criminal prosecution. Form MA-I must be amended promptly whenever any 

information previously provided becomes inaccurate. See General Instruction 9. 

Type of Filing: 

This is an (check the appropriate box): 

Initial Form MA-I 

Execution Pages: Before submitting this form, you must complete the Execution Page. 

Supporting Documentation: If you are required to make reportable disclosures in the Disclosure Reporting 

Pages, you must attach the supporting documentation. 

Non-Resident Individuals: If the individual is a non-resident of the United States, you must attach a completed 

Form MA-NR signed by the individual to this Form MA-I at the time of the initial filing of Form MA-I See 

the General Instructions. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Amendment to the most recent Form MA-I 

Amendment to indicate that the individual is no longer an associated person of the municipal advisory firm or 

no longer engages in municipal advisory activities on its behalf. (If you check this box, complete only Item 1-A 

and Item 7 below.) 

Item 1 Identifying Information 

Is this an amendment to change identifying information regarding the individual named in part A below? 

Yes No 
A. The Individual 

Full Legal Name: 

Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter 

NMN on that line. 

Last Name First Name Middle Name Suffix 

Individual CRD No. (if any): _______________ 

B. Municipal Advisory Firms Where the Individual Is Employed 

In providing your responses, please note that the definition of “employee” for purposes of this form includes an 

independent contractor who engages in municipal advisory activities on behalf of a municipal advisory firm. 

See Glossary of Terms. 

Is the individual employed 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________ ________________ _______________ __________ 

____________________________________________________________________________ 

_________________________________________________________________________________ 

at more than one municipal advisory firm? 

Yes No 

If the answer is “Yes,” enter the number of municipal advisory firms the individual is employed with (sole 

proprietors not employed with any other firm enter 1): ____ 

(For individuals who are employed with more than one firm, provide the information required by this Item 1-B 

for each such firm. For sole proprietors, enter the legal name under which you conduct your municipal advisorrelated activities, and skip to Item 1-B.1.) 

Full Legal Name of municipal advisory firm with which the individual is employed: 

Name under which municipal advisor-related business is primarily conducted, if different from above: 

Date that the individual’s most recent employment with this municipal advisory firm commenced 

(MM/DD/YYYY): __________ 

Does the individual have an independent contractor relationship with the above-named firm? Yes 

No 

(1) Municipal Advisory Firm’s Registration Information: 

Is the municipal advisory firm currently registered on Form MA as a municipal advisor? (Answer “Yes” if you 

have already filed Form MA and your application for registration on that form has been approved. Otherwise, 

answer “No.”) 

Yes SEC File No. _____________ 

No 

If “No,” has the municipal advisory firm filed a Form MA application? 

 Yes Form MA Filing Date: ______________ EDGAR CIK No.: ____________ 

(MM/DD/YYYY) 

No 
If “No,” please provide an explanation: 

(2) Office 

Enter the following information for each office of the municipal advisory firm where the individual is or 

will be physically located, and each office from which the individual is or will be supervised: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

__________________________ _______________ _____________ __________ 

Located At: Supervised From: 

Start Date: ____________ 

Street Address 1: ___________________________________________________________ 

Street Address 2: ___________________________________________________________ 

City: __________ State: ______ Country: ________________ Postal Code: ____________ 

If the office where the individual is or will be physically located is a private residence, check this box: 

A private residential address will not be included in publicly available versions of this form. 

Item 2 Other Names 

Enter the following information for all other names that the individual has used or is using, or by which the 

individual is known or has been known, other than the individual’s legal name, since the age of 18. This space 

should include, for example, nicknames, aliases, and names used before or after marriage. 

Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that 

line. 

Last Name First Name Middle Name Suffix 

Item 3 Residential History 

Starting with the current address, enter the following information for all the individual’s residential addresses for the 

past 5 years. Leave no gaps greater than three months between addresses. Report changes in an amendment to this 

form as they occur in the future. Private residential addresses will not be included in publicly available versions of 

this form. 

Current Address: 

From (MM/YYYY): _______________ To (MM/YYYY): ________________ 

Street Address 1: _______________________________________________________________ 

Street Address 2: _______________________________________________________________ 

City: _____________ State: _______ Country: _____________ Postal Code: _____________ 

Prior Address: 

From (MM/YYYY): _______________ To (MM/YYYY): ________________ 

Street Address 1: _______________________________________________________________ 

Street Address 2: _______________________________________________________________ 

City: _____________ State: _______ Country: _____________ Postal Code: _____________ 

Item 4 Employment History 

Provide complete employment history of the individual for the past 10 years. Include the municipal advisory firm(s) 
entered in Item 1-B. Enter the following information for each employer. Account for all time, leaving no gaps 

longer than three months. Include full- and part-time employment, self-employment, military service, and 

homemaking. Also include statuses such as unemployed, full-time education, extended travel, or other similar 

statuses. Such statuses should be entered in the space provided below for “Name of Municipal Advisory Firm or 

Company.” 

Current Employer: 

From (MM/YYYY): _______________ To (MM/YYYY): ________________ 

Name of Municipal Advisory Firm or Company: 

City: _____________ State: _____ Country: _______________ Postal Code: _____________ 

Municipal Advisor-Related Business? Yes 

City: _____________ State: _____ Country:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________________________________________ 

_________________________________________________________________________________ 

___________________________________________________________________________________ 

 _______________ Postal Code: ______________ 

Municipal Advisor-Related Business? 

No 

Investment-Related Business? Yes No 

Position Held: _____________________________________________________________________ 

Prior to the Above: 

From (MM/YYYY): _______________ To (MM/YYYY): ________________ 

Name of Municipal Advisory Firm or Company: 

Yes No 

Investment-Related Business? Yes No 

Position Held: ______________________________________________________________________ 

Item 5 Other Business 

Is the individual currently engaged in any other business either as a proprietor, partner, officer, director, employee, 

trustee, agent or otherwise? Yes 

No 

If “Yes,” please enter the following details for each other business below: 

Other Business: 

Start Date (MM/YYYY): ______________ 

Name of Business: 

Street Address 1: _______________________________________________________________ 

Street Address 2: _______________________________________________________________ 

City: _____________ State: _______ Country: _____________ Postal Code: _____________ 

Is this a municipal advisor-related business? Yes 

No 

Is this an investment-related business? Yes 

No 

Nature of Business: ______________________________________________________________ 

Position/Title/Relationship: _______________________________ 

Approximate No. of Hours / Month Devoted to This Business: _______ 

Description of Duties: ____________________________________________________________ 
Item 6 Disclosure Information 

If the answer to any of the questions in Items 6A–6J and 6M is "Yes," provide details of all events or 

proceedings on the appropriate Disclosure Reporting Pages (“DRPs”) in Part II. 

One event or proceeding may result in the requirement to answer “Yes” to more than one question below. 

Refer to the Glossary of Terms for definitions or descriptions of italicized terms. 

CRIMINAL ACTION DISCLOSURE 

If the answer is “Yes” to any question below in Item 6A or 6B, complete a Criminal Action DRP. 

Item 6A. 

(1) Has the individual ever: 

(a) been convicted of any felony, or pled guilty or nolo contendere ("no contest") to any charge of a felony in a 

domestic, foreign, or military court? 

Yes No 

(b) been charged with any felony? 

Yes No 

(2) Based upon activities that occurred while the individual exercised control over it, has an organization ever: 

(a) been convicted of or pled guilty or nolo contendere ("no contest") in a domestic or foreign court to any 

charge of a felony? 

(b) been charged with any felony? 

Yes No 

Item 6B. 

(1) Has the individual ever: 

(a) been convicted of any misdemeanor or pled guilty or nolo contendere ("no contest") in a domestic, foreign or 

military court to any charge of a misdemeanor involving: municipal advisory activities or a municipal 

advisor-related or 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? ⁪ 

Yes No 

(b) been charged with any misdemeanor of the kind described in 6B(1)(a)? 

Yes No 

(2) Based upon activities that occurred while the individual exercised control over it, has an organization ever: 

(a) been convicted of any misdemeanor or pled guilty or nolo contendere ("no contest") in a domestic or foreign 

court to any 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

charge of a misdemeanor of the kind specified in 6B(1)(a)? 

Yes 

Yes 

No 

No 

(b) been charged with any misdemeanor of the kind specified in 6B(1)(a)? 

Yes No 
REGULATORY ACTION DISCLOSURE 

If the answer is “Yes” to any question below in Items 6C-6G(1), complete a Regulatory Action DRP. 

Item 6C. 

Has the SEC or the CFTC ever: 

(1) found the individual to have made a false statement or omission? 

Yes No 

(2) found the individual to have been involved in a violation of any SEC or CFTC regulation or statute? 

Yes No 

(3) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization 

of a municipal advisor-related business or investment-related business to operate? 

Yes No 

(4) entered an order against the individual in connection with municipal advisor-related or investment-related 

activity? 

Yes No 

(5) imposed a civil money penalty on the individual, or ordered the individual to cease and desist from any 

activity? 

Yes No 

(6) found the individual to have willfully violated any provision of the Securities Act of 1933, the Securities 

Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the 

Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB, or 

found the individual to have been unable to comply with any provision of such Acts, rules or regulations? 

Yes No 

(7) found the individual to have willfully aided, abetted, counseled, commanded, induced, or procured the violation 

by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment 

Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or 

regulation under any of such Acts, or any of the rules of the MSRB? 

Yes No 

(8) found the individual to have failed reasonably to supervise another person subject to his or her supervision, with 

a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange Act of 

1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, 

or any rule or regulation under any of such Acts, or any of the rules of the MSRB? 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Yes No 

Item 6D. 
(1) Has any other federal regulatory agency or any state regulatory agency or foreign financial 

regulatory authority ever: 

(a) found the individual to have made a false statement or omission or to have been dishonest, unfair or 

unethical? 

Yes No 

(b) found the individual to have been involved in a violation of municipal advisor-related or investmentrelated regulation(s) or statute(s)? 

Yes No 

(c) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the 

authorization of a municipal advisor-related or investment-related business to operate? Yes 

No 

(d) entered an order against the individual in connection with a municipal advisor-related or investment-related 

activity? 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes No 

(e) denied, suspended, or revoked the individual’s registration or license or otherwise, by order, prevented the 

individual from associating with a municipal advisor-related or investment-related business or restricted his 

or her activities? 

Yes 

No 

(2) Has the individual ever been subject to any final order of a state securities commission (or any 

agency or office performing like functions), a state authority that supervises or examines banks, 

savings associations, or credit unions, a state insurance commission (or any agency or office 

performing like functions), a federal banking agency, or the National Credit Union Administration, 

that: 

(a) bars the individual from association with an entity regulated by such commission, authority, agency, or 

office, or from engaging in the business of securities, insurance, banking, savings association activities, or 

credit union activities; or 

Yes No 

(b) is based on violations of any laws or regulations that prohibit fraudulent, manipulative, or deceptive 

conduct? 

Yes No 

Item 6E. 

Has any self-regulatory organization or commodities exchange ever: 

(1) found the individual to have made a false statement or omission? 

Yes No 

(2) found the individual 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 SEC)? 

Yes No 
(3) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization 

of a municipal advisor-related or investment-related business to operate? 

Yes No 

(4) disciplined the individual by expelling or suspending him or her from membership, barring or suspending the 

individual’s association with its members, or restricting the individual’s activities? 

Yes No 

(5) found the individual to have willfully violated any provision of the Securities Act of 1933, the Securities 

Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the 

Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB, or 

found the individual to have been unable to comply with any provision of such Acts, rules or regulations? 

Yes No 

(6) found the individual to have willfully aided, abetted, counseled, commanded, induced, or procured the violation 

by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the 

Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any 

rule or regulation under any of such Acts, or any of the rules of the MSRB? 

Yes No 

(7) found the individual to have failed reasonably to supervise another person subject to his or her supervision, 

with a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange 

Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity 

Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB? 

Yes No 

Item 6F. 

Has the individual ever had an authorization to act as an attorney, accountant or federal contractor that was revoked 

or suspended? 

Yes 

No 

Item 6G. 

Has the individual been notified, in writing, that he or she is currently the subject of any: 

(1) regulatory complaint or proceeding that could result in a “Yes” answer to any part of 6C, D or E? 

Yes No 

INVESTIGATION DISCLOSURE 

If the answer is “Yes” to Item 6G(2) below, complete an Investigation DRP. 

(2) investigation that could result in a “Yes” answer to any part of 6A, B, C, D or E? 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Yes No 
CIVIL JUDICIAL ACTION DISCLOSURE 

If the answer is “Yes” to a question below in Item 6H, complete a Civil Judicial Action DRP. 

Item 6H. 

(1) Has any domestic or foreign court ever: 

(a) enjoined the individual in connection with any municipal advisor-related or investment-related activity? 

Yes No 

(b) found that the individual was involved in a violation of any municipal advisor-related or investment-related 

statute(s) or regulation(s)? 

Yes No 

(c) dismissed, pursuant to a settlement agreement, a municipal advisor-related or investment-related civil 

action brought against the individual by a domestic jurisdiction or foreign financial regulatory authority? 

Yes No 

(2) Is the individual named in any currently pending civil proceeding that could result in a “Yes” answer to any 

part of 6H(1)? 

CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE 

If the answer is “Yes” to a question below in Item 6I, complete a Customer Complaint / Arbitration / Civil Litigation 

DRP. 

Item 6I. 

(1) Has the individual ever been the subject of a municipal advisor-related or investment-related, customer-initiated 

(written or oral) complaint that alleged that he or she was involved in fraud, false statements, omissions, theft, 

embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, or dishonest, unfair or 

unethical practices, which: 

(a) is still pending, or; 

Yes 

Yes 

No 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No 

(b) was settled? 

Yes 

No 

(2) Has the individual ever been the subject of a municipal advisor-related or investment-related, customerinitiated arbitration or civil litigation that alleged that he or she was involved in fraud, false statements, 

omissions, theft, embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, or 

dishonest, unfair or unethical practices, which: 

(a) is still pending, or; 

Yes No 
(b) resulted in an arbitration award or civil judgment against the individual, regardless of amount, or; 

Yes 

No 

(c) was settled? 

Yes No 

TERMINATION DISCLOSURE 

If the answer is “Yes” to a question below in Item 6J, complete a Termination DRP. 

Item 6J. 

Has the individual ever voluntarily resigned, been discharged or permitted to resign after allegations were made 

that accused him or her of: 

(1) violating municipal advisor-related or investment-related statutes, regulations, rules, or industry standards of 

conduct? 

Yes 

(2) fraud or the wrongful taking of property? 

Yes No 

(3) failure to supervise in connection with municipal advisor-related or investment-related statutes, regulations, rules 

or industry standards of conduct? 

Yes 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No 

FINANCIAL DISCLOSURE 

Item 6K. 

Within the past 10 years: 

(1) has the individual made a compromise with creditors, filed a bankruptcy petition or been the subject of an 

involuntary bankruptcy petition? 

Yes No 

No 

No 

(2) based upon events that occurred while the individual exercised control over it, has an organization made a 

compromise with creditors, filed a bankruptcy petition or been the subject of an involuntary bankruptcy 

petition? 

Yes 

(3) based upon events that occurred while the individual exercised control over it, has a broker or dealer been the 

subject of an involuntary bankruptcy petition, had a trustee appointed, or had a direct payment procedure 

initiated under the Securities Investor Protection Act? 

Yes No 

Item 6L. 

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

Yes No 
 

JUDGMENT / LIEN DISCLOSURE 

If the answer is “Yes” to a question below in Item 6M, complete a Judgment/Lien DRP. 

Item 6M. Are there currently any unsatisfied judgments or liens against the individual? Yes 

No 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Item 7 Signature 

NOTE: In addition to completing Item 7, to the extent that the individual is a non-resident, a Form MA-NR completed and 

signed by the individual must be attached as an exhibit to this Form MA-I. 

Complete either Subpart A or Subpart B: 

By typing a name in the signature field, the signatory acknowledges and represents that the entry constitutes in every way, use, 

or aspect, his or her legally binding signature. 

A. For Municipal Advisory Firms filing this form: 

The municipal advisory firm has obtained and retained written consent from the individual that service of any civil 

action brought by, or notice of any proceeding before, the SEC or any self-regulatory organization in connection 

with the individual’s municipal advisory activities may be given by registered or certified mail to the individual’s 

address given in Item 1. 

I, the undersigned, sign this Form MA-I on behalf of, and with the authority of, the municipal advisory firm that is 

filing this form. The municipal advisory firm and I both certify, under penalty of perjury under the laws of the 

United States of America, that the information and statements made in this Form MA-I, including exhibits and any 

other information submitted, are true and correct, and that I am signing this Form MA-I as a free and voluntary act. 

Date: ______________________ 

By: __________________________________________ 

(signature) 

Title: _______________________________ 

B. For Natural Person Municipal Advisors (Sole Proprietors) filing this form: 

The individual named below consents that service of any civil action brought by, or notice of any proceeding 

before, the SEC or any self-regulatory organization in connection with the individual’s municipal advisory activities 

may be given by registered or certified mail to the individual’s address given in Item 1. 

I, the undersigned, certify, under penalty of perjury under the laws of the United States of America, that the 

information and statements made in this Form MA-I, including exhibits and any other information submitted, are 

true and correct, and that I am signing this Form MA-I Execution Page as a free and voluntary act. 

Date: ____________________ 

Full Legal Name of the Individual 

Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that 

line. 

______________________________ _____________________ 

Last Name 

Middle Name Suffix 

Individual CRD No. (if any):________________ 

_________________ 

First Name 

___________ 

By: __________________________________________ 

(signature) 

Warning: Intentional misstatements or omissions of fact constitute Federal criminal violations. See 18 

U.S.C. 1001 and 15 U.S.C. 78ff(a).12. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________________________________________ 

_______________________________________________________________________ 

FORM MA-I 

PART II: 

DISCLOSURE REPORTING PAGES (DRPs) 

CRIMINAL ACTION DISCLOSURE REPORTING PAGE (MA-I) 

CRIMINAL ACTION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for affirmative response(s) to Question(s) 6A and 6B on Form MA-I. 

Check the question(s) to which this DRP pertains:

 6A(1)(a) 6A(1)(b) 6A(2)(a) 6A(2)(b) 

 6B(1)(a) 6B(1)(b) 6B(2)(a) 6B(2)(b) 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report an Event or Proceeding on a Criminal Action DRP: Use a separate DRP for each event or 

proceeding. One event may result in more than one affirmative answer to Items 6A(1)(a), 6A(1)(b), 6A(2)(a), 

6A(2)(b), 6B(1)(a), 6B(1)(b), 6B(2)(a) and/or 6B(2)(b). Use this DRP to report all charges, including multiple 

counts of the same charge, arising out of the same event and filed in one criminal action. Separate cases arising out 

of the same event, and unrelated criminal actions, must be reported on separate DRPs. 

How to Provide Court Documents: Applicable court documents (i.e., criminal complaint, information or 

indictment as well as judgment of conviction or sentencing documents) must be attached as an exhibit if not 

previously submitted. 

DRP On File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 
 

 

 

 

 

 

 

 

 

 

 

 

 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or any 

municipal advisor with which the individual is associated of the obligation to 

update any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

CRIMINAL ACTION DRP – PART 2 

1. Firm or Organization 

A. Were charge(s) brought against a firm or organization over which the individual exercise(d) control? 

Yes No 

B. If “Yes,” provide the following information: 

(1) Enter the firm or organization name: __________________________________________ 

(2) Was the firm or organization engaged in a municipal advisor-related or investment-related 

business? Yes No 

(3) What was the individual’s position, title, or relationship with the firm or organization? 

2. Court Where Formal Charge(s) Were Brought: (File a separate Criminal Action DRP for charges brought 

in separate courts and/or separate cases in the same court. If brought in a foreign jurisdiction, provide all 

the information below in English.) 

Federal Court 

Military Court 

State Court

 Foreign Country Court

 International Court

 Other : ___________________________ 

A. Name of the Court:_________________________________________________________________ 

B. Location of the Court 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: ________________________ 

Postal Code: __________________ 

C. Docket/Case Name: ________________________________ 

D. 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. Details of Event: Report all charges separately. For each charge, provide the following information. 

(1) First Charge 

(a) List the charge/charge description: 

(b) Number of counts: ___ 

(c) Check the appropriate box: Felony Misdemeanor 

(d) Plea for this charge: 

(e) (i) Is the charge municipal advisor-related? Yes No 

(ii) If “Yes,” what is the product type? 

(f) (i) Is the charge investment-related? Yes No 

(ii) If “Yes,” what is the product type? 

(g) (i) Amended Charge: Indicate if the original charge was amended or reduced: 

Yes No 

(ii) If “Yes,” provide the date the charge was amended or reduced (MM/DD/YYYY): 

Report each additional charge below: 

C. Felony Charge(s): Did any of the charge(s) within the event involve a felony? Yes No 

4. Current Status of the Event: Pending On Appeal Final 

5. Event Status Date (Complete unless status is pending) (MM/DD/YYYY): ___________________ 

Exact Explanation 

If not exact, provide explanation: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________________________________________________ 

_______________________________________________________________________________ 

_______________________________________________________________________________ 

6. On Appeal – Judicial Review: If you checked “On Appeal” in Item 4, to whom was the criminal action 

appealed? (If brought in a foreign jurisdiction, provide all the information below in English.) 

Federal Court 

Military Court 

State Court

 Foreign Country Court 

International Court

 Other (specify): ___________________________ 

A. Name of the Court:_________________________________________________________________ 

B. Location of the Court 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: ________________________ 

Postal Code: __________________ 

C. Docket/Case Name: ________________________________ 

D. Docket/Case Number: ______________________________ 

E. Date Appeal filed (MM/DD/YYYY): ___________________ 

For Item 7: If you checked “Final” or “On Appeal” in Item 4, complete Item 7. 

For actions that are “Pending,” skip to Item 8. 

7. Disposition Disclosure Detail (For each charge, provide the following information): 

(a) First Charge 

(1) Disposition of the Charge: 

Check all that apply. 

Acquitted Found not guilty Pre-trial diversion/intervention 

Amended Pled guilty Reduced 

Convicted Pled nolo contendere Other (requires explanation) 

Deferred Adjudication Pled not guilty _______________________ 

Dismissed

 Appealed 

Affirmed

 Vacated & Returned For Further Action 

Vacated / Final

 Other (requires explanation) ____________________________________________ 

Explanation: If more than one disposition is checked, and/or “Other” is checked, or the above 

otherwise does not adequately summarize the disposition of the charge, provide an explanation. 

(2) Date (MM/DD/YYYY): _____________ 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(3) Sentence/Penalty: Is a sentence or other penalty ordered? Yes No 

If “Yes,” list each type (e.g., prison, jail, probation, community service, counseling, education, 

other - specify): 

(4) Was or is the individual incarcerated in connection with this sentence? Yes No 

If “Yes,” provide the following details: 

(i) Duration (length of the sentence): Days ___ Months ___ Years ___ 

(i) Start Date of Penalty (MM/DD/YYYY): _________________ Not determined. 

(ii) End Date of Penalty (MM/DD/YYYY): _________________ Not determined. 

(iv) Is the sentence to be served concurrently with any other sentence? Yes No 

If “Yes,” indicate the end date of the concurrent sentence (MM/DD/YYYY): 

(v) Explanation (Optional): 

(5) Monetary Penalty/Fine: 

(i) Was a monetary penalty/fine imposed? Yes No 

If “Yes,” provide the following details in (ii) and (iii) below: 

(ii) Total Penalty/Fine Amount: $___________ 

(iii) Was any portion suspended/reduced? 

Yes If “Yes,” how much? $___________ 

No 

(iv) Final Amount: $___________ 

(v) Was the final amount paid in full?

 Yes If “Yes,” date paid in full (MM/DD/YYYY):____________ 

No 

If “No,” indicate the amount unpaid: $___________ 

And explain the circumstances: 

Report the disposition(s) of each additional charge below: 
 

 

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_______________________________________________________________________________________ 

8. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the charge(s), as well as the current status or final disposition, if any. Include the 

relevant dates when the conduct which was the subject of the charge(s) occurred, and any other relevant 

information. The information must fit within the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_______________________________________________________________________ 

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REGULATORY ACTION DISCLOSURE REPORTING PAGE (MA-I) 

REGULATORY ACTION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for affirmative response(s) to Question(s) 6C, 6D, 6E, 6F and 6G(1) on Form MA-I. 

Check the question(s) to which this DRP pertains: 

 6C(1) 6D(1)(a) 6E(1) 6F 6G(1)

 6C(2) 6D(1)(b) 6E(2)

 6C(3) 6D(1)(c) 6E(3)

 6C(4) 6D(1)(d) 6E(4)

 6C(5) 6D(1)(e) 6E(5)

 6C(6) 6D(2)(a) 6E(6)

 6C(7) 6D(2)(b) 6E(7)

 6C(8) 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report an Event or Proceeding on a Regulatory Action DRP: Use a separate DRP for each event or 

proceeding. One event may result in more than one affirmative answer to the above items. If an event gives rise to 

actions by more than one regulator, provide details for each action on a separate DRP. 

DRP On File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 
 

 

 

 

 

 

 

 

 

 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or any 

municipal advisor with which the individual is associated of the obligation to 

update any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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REGULATORY ACTION DRP – PART 2 

1. Regulatory Action was initiated by: 

A. Select the Appropriate Item. 

Select only one box below. A separate Regulatory Action DRP is required for each such regulator or other 

authority. 

SEC State Foreign Financial Regulatory Authority 

CFTC SRO Other: _________________________ 

Federal Banking Agency 

National Credit Union Administration

 Other Federal Authority 

B. Full name of the individual regulator (if not fully identified in Item 1-A.) or other authority that 

initiated the action. For a foreign financial regulatory authority, please provide the full name in English. 

2. Sanction(s) Sought 

Select all that apply. 

Bar (Permanent) Disgorgement Rescission 

Bar (Temporary / Time Limited) Expulsion Restitution 

Cease and Desist Injunction Revocation

 Censure Prohibition Suspension 

Civil and Administrative Penalty(ies)/Fine(s) Reprimand Undertaking 

Denial Requalification 

Other Sanction(s) Sought (list each such additional sanction): 

3. Date Initiated (MM/DD/YYYY): ____________________ Exact Explanation 

If not exact, provide explanation: 

4. Regulatory Action was brought in (if brought in a foreign jurisdiction, provide all the information below in 

English): 

A. Name of the Administrative Proceeding, Commission/Agency Hearing, or Other Regulatory 

Proceeding or Forum: ________________________________________________________ 

B. Location of the Proceeding / Hearing: 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: _______________________ 

Postal Code: __________________ 

C. Docket/Case Number: __________________ 
 

 

 

 

 

 

 

 

 

 

 

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5. Employing Firm: Provide the full legal name of the individual’s employing firm, if any, when the activity 

occurred which led to the regulatory action (if there was no such employing firm at that time, enter “None”). 

Enter the employing firm’s MA and CRD registration numbers below, if any. 

A. Employing Firm: ____________________________________________________________ 

B. Municipal Advisor Registration Number, if any: ___________________ 

C. CRD Number, if any: __________________ 

6. A. Principal Product Type 

Check appropriate item. 

 No Product

 Annuity – Charitable Direct Investment – DPP & LP Interest Oil & Gas

 Annuity – Fixed Equipment Leasing Options

 Annuity – Variable Equity Listed (Common & Preferred Stock) Penny Stock

 Banking Product Equity OTC Prime Bank Instrument 

(other than CD) Futures – Commodity Promissory Note 

CD Futures – Financial Real Estate Security

 Commodity Option Index Option Security Futures 

Debt – Asset Backed Insurance Security-based Swap 

Debt – Corporate Investment Contract Swap 

Debt – Government Money Market Fund Unit Investment Trust 

Debt – Municipal Mutual Fund Viatical Settlement 

Derivative 

Other Principal Product Type (specify): 

B. Other Product Types? Yes No If “Yes,” describe each additional product type: 

7. Allegations: Describe the allegations related to this regulatory action. (The response must fit within the space 

provided.) 

8. Current Status: Pending On Appeal Final 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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9. Pending: If you checked “Pending” in Item 8, provide the following information. 

A. Date Served: The date that notice or other process was served (MM/DD/YYYY): _______________ 

Exact Explanation 

If not exact, provide explanation: 

B. Limitation or Restrictions: Are there any limitations or restrictions currently in effect? 

Yes No 

If the answer is “Yes,” provide details: 

10. On Appeal – Administrative or Judicial Review of the Regulatory Action: If the individual appealed, 

provide the following information. 

A. Name of Regulator or Court Action Appealed To: Provide the name of the US regulator (i.e., the SEC, 

an SRO, other), federal court, state court or state regulator, or a foreign or international court or regulator 

to whom the individual appealed. If brought in a foreign jurisdiction, provide all the information below in 

English. 

B. Location of the Regulator or Judicial Court to Whom the Individual Appealed: 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: _______________________ 

Postal Code: __________________ 

C. Docket/Case Name: ________________________________ 

D. Docket/Case Number: ______________________________ 

E. Date Appeal filed (MM/DD/YYYY): ______________ Exact Explanation 

If not exact, provide explanation: 

F. Appeal Details (including status): 

G. Limitation or Restrictions: Are there any limitations or restrictions currently in effect while on appeal? 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Yes No 

If the answer is “Yes,” provide details: 

If you checked “Final” or “On Appeal” in Item 8, complete Items 11 through 13, and 

consider Item 14. For actions that are “Pending,” skip to Item 14. 

11. A. Resolution: How was the matter resolved? 

Check all the applicable boxes that reflect the most recent resolution of the matter by a regulator or a 

court, whether or not any part of the resolution is on appeal. If any part of the resolution is on appeal, 

identify in Item 11-B which part is currently on appeal. 

Acceptance, Waiver & Consent (AWC) Dismissed Stipulation and Consent

 Consent Judgment Rendered Withdrawn 

Decision Order Other (requires explanation)

 Decision & Order of Offer of Settlement Settled

 Appealed 

 Affirmed 

Vacated Nunc Pro Tunc / ad initio

 Vacated & Returned For Further Action 

Vacated / Final 

Other (requires explanation) 

B. Explanation: If more than one box in Item 11-A is checked, or Other is checked, or Item 11-A otherwise 

does not adequately summarize the type of resolution, provide an explanation. For example, if the 

individual appealed all or part of a resolution by the regulator or court, indicate what is being appealed. 

C. Order: If Order is checked above in Item 11-A, does the order constitute a final order based on violations 

of any laws or regulations that prohibit fraudulent, or deceptive conduct? Yes No 

12. Resolution Date (MM/DD/YYYY):____________________ Exact Explanation 

(For a resolution that is being appealed in part, the date to be provided should be the date on which the 

regulator (reviewing a decision by an SRO or an Administrative Law Judge) or a court provided its resolution.) 

If not exact, provide explanation: 

13. Resolution Detail 

A. Sanction(s): Was/were any Sanction(s) Ordered? Yes 

 No, none were ordered. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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B. If “Yes,” check each individual sanction below that was ordered: 

Bar (Permanent) Disgorgement* Restitution* 

Bar (Temporary / Time Limited) Expulsion Requalification 

Cease and Desist Injunction Revocation

 Censure Prohibition Suspension 

Civil and Administrative Penalty(ies)/Fine(s)* Reprimand Undertaking 

Denial Rescission 

* Monetary Sanction(s): Were one or more sanctions ordered that require a monetary payment? 

Yes No 

If “Yes,” enter the total amount ordered: $_____________ 

Other Sanction(s) Ordered (list each such additional sanction): 

C. Sanction Detail (Provide the details of the following specific sanctions, if checked above in Item 13-

B.) 

(1) Barred, Enjoined, or Suspended: If you checked one or more of these sanctions in Item 13-B. above, 

check the appropriate box(es) below and provide the corresponding information. 

(a) Barred 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 

If, in the above action, the individual received one or more bars from registration capacities, 

associations, and/or other activities, and the terms specify different time periods, 

report the additional details below: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(b) Enjoined 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 

If, in the above action, the individual received one or more injunctions from registration 

capacities, associations, and/or other activities, and the terms specify different time periods, 

report the additional details below: 

(c) Suspended 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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_________________________________________________________________________ 

If, in the above action, the individual received one or more suspensions from registration 

capacities, associations, and/or other activities, and the terms specify different time periods, 

report the additional details below: 

(2) Requalification: Was requalification by examination, retraining, or other process a condition of a 

sanction? 

Yes No 

If “Yes,” provide: 

(a) Length of time given to requalify, retrain, or complete other process:

 No time period is specified. 

Time period is specified: Days ___ Months ___ Years ___ 

(b) Type of examination, retraining, or other process required: 

(c) Was the condition satisfied? Yes No 

(1) If “Yes,” provide the date (MM/DD/YYYY): ______________ 

(2) If “No,” explain the circumstances: 

If, in the above action, the individual received one or more requalifications in connection with 

registration capacities, associations, and/or other activities, and the terms specify different time 

periods, 

report the additional details below: 

(3) Monetary Sanction(s): If you indicated in Item 13-B above that one or more monetary sanctions were 

ordered, provide the following information. 

(a) Total Amount Ordered: $___________ 

(b) Portion levied against the individual: 

(i) Amount Ordered: $___________ 

(ii) Was any portion waived? 
 

 

 

 

 

 

 

 

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Yes 

No 

If “Yes,” how much? $___________ 

(iii) Final Amount: $___________ 

(iv) Was final amount paid in full? 

Yes 

No 

If “Yes,” date paid in full (MM/DD/YYYY):_______________ 

If “No,” explain the circumstances: 

14. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the action, allegation(s), finding(s) and disposition(s), if any. Include any relevant 

information on the current action status, and on any terms, conditions, and dates not already provided above, 

and any other relevant information. The information must fit within the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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INVESTIGATION DISCLOSURE REPORTING PAGE (MA-I) 

INVESTIGATION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for an affirmative response to Question 6G(2) on Form MA-I. 

Check the question(s) to which this DRP pertains: 

6G(2) Investigation that could result in a “Yes” answer to any part of: 

Check all that apply. 

6A (Criminal Action Disclosure – Felony) 

6B (Criminal Action Disclosure – Misdemeanor) 

6C (Regulatory Action Disclosure – SEC or CFTC) 

6D (Regulatory Action Disclosure – Other Federal, State, Foreign) 

6E (Regulatory Action Disclosure – SRO) 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report an Event or Investigation on an Investigation DRP: Complete this Investigation DRP only if 

you are answering “yes” to Item 6G(2), i.e., that the individual has been notified, in writing, that he or she is 

currently the subject of an investigation. (If you answered “yes” to Item 6G(1), i.e., that the individual has been 

notified in writing that he or she is currently the subject of a regulatory complaint or proceeding, complete the 

Regulatory Action DRP.) Use a separate Investigation DRP for each event or investigation. One event may result 

in more than one investigation. If an event gives rise to more than one authority investigating the individual, 

provide the details of each investigation on a separate DRP. 

Investigation Concluded Without Formal Action: If the individual has been notified that the investigation has 

been concluded without formal action, complete items 4 and 5 of this DRP to update. 

DRP on File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual 

or any municipal advisor with which the individual is associated of the 

obligation to update any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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INVESTIGATION DRP – PART 2 

1. Investigation was initiated by: 

A. Notice Received From (select appropriate item): 

Select only one box below. A separate Investigation DRP is required for each notice received from a 

regulator or other authority. 

Criminal Investigation 

Federal Military State Foreign Country International Authority

 Other: __________________________ 

 Regulatory or Other Civil Authority Investigation 

SEC State Foreign Financial Regulatory Authority 

CFTC SRO Other Foreign Authority

 Other Federal Authority

 Other: __________________________ 

B. Full name of the criminal, regulatory or other civil authority that initiated the investigation (unless 

SEC or CFTC is checked above). For a foreign investigation, please provide the full name in English. 

2. Notice Date (MM/DD/YYYY): ____________________ Exact Explanation 

If not exact, provide explanation: 

3. Description: 

A. Does the individual know the nature of the investigation? Yes No 

B. If the answer is “Yes,” describe the nature of the investigation: 

4. Product Type(s): (Select all that apply.)

 No Product

 Annuity – Charitable Direct Investment – DPP & LP Interest Oil & Gas

 Annuity – Fixed Equipment Leasing Options

 Annuity – Variable Equity Listed (Common & Preferred Stock) Penny Stock

 Banking Product Equity OTC Prime Bank Instrument 

(other than CD) Futures – Commodity Promissory Note 

CD Futures – Financial Real Estate Security

 Commodity Option Index Option Security Futures 

Debt – Asset Backed Insurance Security-based Swap 

Debt – Corporate Investment Contract Swap 

Debt – Government Money Market Fund Unit Investment Trust 

Debt – Municipal Mutual Fund Viatical Settlement 
 

 

 

 

 

 

 

 

 

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Derivative 

Other Product Type: 

5. Current Status: Is the investigation pending? Yes If “Yes,” skip to Item 7. 

No If “No,” complete Item 6. 

6. Resolution Details: 

A. Date Closed/Resolved (MM/DD/YYYY): ____________________ Exact Explanation 

If not exact, provide explanation: 

B. How was the investigation resolved? (select appropriate item):

 Closed Without Further Action Closed - Regulatory Action Initiated 

Other (Explain): 

If you checked “Closed - Regulatory Action Initiated” in Item 6-B, you must promptly complete and 

file an accurate and up-to-date Regulatory Action DRP (MA-I). 

7. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the investigation, as well as the current status or final disposition and/or finding(s), if 

any. Include any other relevant information. The information must fit within the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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TERMINATION DISCLOSURE REPORTING PAGE (MA-I) 

TERMINATION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for affirmative response(s) to Question 6J on Form MA-I; 

Check the question(s) to which this DRP pertains:

 6J(1) 6J(2) 6J(3) 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report a Termination on a Termination DRP: One termination may result in more than one affirmative 

answer to the above items. Use only one Termination DRP to report details about the same termination. Use a 

separate Termination DRP for each termination reported. 

DRP on File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 
 

 

 

 

 

 

 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or any 

municipal advisor with which the individual is associated of the obligation to 

update any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

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TERMINATION DRP – PART 2 

1. Name of Employing Firm:__________________________________________________________ 

MA Registration Number, if any: _______________ CRD Number, if any: _______________ 

2. Termination Type: Discharged Permitted to Resign Voluntary Resignation 

3. Termination Date (MM/DD/YYYY): ______________ Exact Explanation 

If not exact, provide explanation: 

4. Allegation(s): 

5. Product Type(s): (Select all that apply.) 

No Product

 Annuity – Charitable Direct Investment – DPP & LP Interest Oil & Gas

 Annuity – Fixed Equipment Leasing Options

 Annuity – Variable Equity Listed (Common & Preferred Stock) Penny Stock

 Banking Product Equity OTC Prime Bank Instrument 

(other than CD) Futures – Commodity Promissory Note 

CD Futures – Financial Real Estate Security

 Commodity Option Index Option Security Futures 

Debt – Asset Backed Insurance Security-based Swap 

Debt – Corporate Investment Contract Swap 

Debt – Government Money Market Fund Unit Investment Trust 

Debt – Municipal Mutual Fund Viatical Settlement 

Derivative 

Other Product Type: 

6. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the termination, including any relevant information. The information must fit within 

the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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JUDGMENT / LIEN DISCLOSURE REPORTING PAGE (MA-I) 

JUDGMENT / LIEN DISCLOSURE DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for an affirmative response to Question 6M on Form MA-I. 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report an Event or a Judgment/Lien on a Judgment/Lien DRP: If multiple, unrelated events result in 

the same affirmative answer, details relating to each separate event must be provided on a separate Judgment/Lien 

DRP. 

DRP on File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 
 

 

 

 

 

 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or any 

municipal advisor with which the individual is associated of the obligation to update 

any relevant Form MA or IARD or CRD records 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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JUDGMENT / LIEN DISCLOSURE DRP – PART 2 

1. Judgment/Lien Amount: $____________ 

2. Judgment/Lien Holder: _________________________________________________________ 

3. Judgment/Lien Type: Civil Tax 

4. Date Filed (MM/DD/YYYY): ____________________ Exact Explanation 

If not exact, provide explanation: 

5. Formal Action Was Brought In: (If brought in a foreign jurisdiction, provide all the information below in 

English): 

Federal Court Military Court State Court Foreign Court International Court

 Other : ___________________________ 

A. Name of the Court:______________________________________________________________ 

B. Location of the Court 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: _______________________ 

Postal Code: __________________ 

C. Docket/Case Name: _______________________________ 

D. Docket/Case Number:______________________________ 

6. Is Judgment/Lien outstanding? Yes If “Yes,” skip to item 8. 

No If “No,” complete item 7. 

7. If Judgment/Lien is not outstanding, provide: 

A. Status Date (MM/DD/YYYY): ____________________ Exact Explanation 

If not exact, provide explanation: 

B. How was matter resolved? (select appropriate item): 

Discharged Released Removed Satisfied

 Other (provide explanation): 
 

 

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8. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the action as well as the current status or final disposition. Include any other relevant 

information. The information must fit within the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CIVIL JUDICIAL ACTION DISCLOSURE REPORTING PAGE (MA-I) 

CIVIL JUDICIAL ACTION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for affirmative response(s) to Question(s) 6H on Form MA-I. 

Check the question(s) to which this DRP pertains:

 6H(1)(a) 6H(1)(b) 6H(1)(c) 6H(2) 

Is this DRP an amendment filed for the individual that seeks to remove a previously filed DRP concerning the 

individual from the record? Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report an Event or Proceeding on a Civil Judicial Action DRP: Use a separate DRP for each event or 

proceeding. One event may result in more than one affirmative answer to Item 6H. Separate cases arising out of 

the same event, and unrelated civil judicial actions, must be reported on separate DRPs; if they are later 

consolidated into a single civil judicial action, the consolidated action can be reported on one DRP. 

DRP on File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 
 

 

 

 

 

 

 

 

 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or any 

municipal advisor with which the individual is associated of the obligation to update 

any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CIVIL JUDICIAL ACTION DRP – PART 2 

1. Court Action initiated by: 

A. Select the Appropriate Item(s). 

Check all that apply. 

SEC State Foreign Financial Regulatory Authority 

CFTC SRO Municipal Advisory Firm

 Other Federal Authority Commodities Exchange Private Plaintiff 

Other: _______________________________ 

B. Plaintiff(s): Enter the full name(s) of the plaintiff(s), unless only SEC and/or CFTC is/are checked 

above. For a foreign financial regulatory authority, please provide the full name in English. 

Were all plaintiffs fully identified in the space provided? Yes No 

2. Defendant(s): 

A. Enter the full name(s) of the defendant(s). For foreign defendant(s), please provide the full name(s) in 

English: 

B. Is the individual a named defendant? Yes No If “No,” describe how this action involves the 

individual: 

3. Sanction(s) or Relief Sought: 

Check appropriate items. 

Bar (Permanent) Exemption Requalification 

Bar (Temporary / Time Limited) Expulsion Rescission 

Cease and Desist Injunction Restitution

 Censure Money Damage(s) Restraining Order 

Civil /Administrative Penalty(ies)/Fine(s) (Private/Civil Complaint) Revocation 

Denial Prohibition Suspension 

Disgorgement Reprimand Undertaking 

Other Sanction(s) or Relief Sought: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

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4. A. Filing Date of Court Action (MM/DD/YYYY): ____________________ 

Exact Explanation 

If not exact, provide explanation: 

B. Date Notice/Process was served (MM/DD/YYYY): _________________ 

Exact Explanation 

If not exact, provide explanation: 

5. Formal Action was brought in (If brought in a foreign jurisdiction, provide all the information below in 

English): 

Check the appropriate box. 

Federal Court Military Court State Court Foreign Court International Court 

Other : ___________________________ 

A. Name of the Court:__________________________________________________________ 

B. Location of the Court 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: _______________________ 

Postal Code: __________________ 

C. Docket/Case Name: _______________________________ 

D. Docket/Case Number:______________________________ 

6. Employing Firm: Provide the full legal name of the individual’s employing firm, if any, when the activity 

occurred which led to the civil judicial action. (If there was no such employing firm at that time, enter 

“None”). Enter the employing firm’s MA and CRD registration numbers below, if any. 

A. Employing Firm: ____________________________________________________________________ 

B. Municipal Advisor Registration Number, if any: ___________________ 

C. CRD Number, if any: __________________ 

7. A. Principal Product Type: 

Check appropriate item. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 No Product

 Annuity – Charitable Direct Investment – DPP & LP Interest Oil & Gas

 Annuity – Fixed Equipment Leasing Options

 Annuity – Variable Equity Listed (Common & Preferred Stock) Penny Stock

 Banking Product Equity OTC Prime Bank Instrument 

(other than CD) Futures – Commodity Promissory Note 

CD Futures – Financial Real Estate Security

 Commodity Option Index Option Security Futures 

Debt – Asset Backed Insurance Security-based Swap 

Debt – Corporate Investment Contract Swap 

Debt – Government Money Market Fund Unit Investment Trust 

Debt – Municipal Mutual Fund Viatical Settlement 

Derivative 

Other Principal Product Type (specify): 

B. Other Product Types? Yes No If “Yes,” describe each additional product type: 

8. Allegations: Describe the allegations related to this civil action. (The response must fit within the space 

provided.) 

9. Current Status: Pending On Appeal Final 

10. Pending: If you checked “Pending” in Item 9, provide the following information: 

A. Date Served: The date that notice or other process was served (MM/DD/YYYY): _______________ 

Exact Explanation 

If not exact, provide explanation: 

B. Limitation or Restrictions: Are there any limitations or restrictions currently in effect? 

Yes No 

If the answer is “Yes,” provide details: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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11. On Appeal – Judicial Review: If the individual appealed, provide the following information. 

(If brought in a foreign jurisdiction, provide all the information below in English.): 

A. Action Appealed to: (Provide the name of the federal, state, foreign, or international court to whom the 

individual appealed.): 

B. Location of the Court: 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: _________________ 

Postal Code: __________________ 

C. Docket/Case Name: _________________ 

D. Docket/Case Number: _______________ 

E. Date Appeal filed (MM/DD/YYYY): ______________ Exact Explanation 

If not exact, provide explanation: 

F. Appeal Details (including status): 

G. Limitation or Restrictions: Are there any limitations or restrictions currently in effect while on appeal? 

Yes No 

If the answer is “Yes,” provide details: 

If you checked “Final” or “On Appeal” in Item 9, complete Items 12 through 14. 

For Pending Actions, skip to Item 15. 

12. A. Resolution: How was the action resolved? 

Check all the applicable boxes that reflect the most recent resolution of the action by a court, whether or 

not any part of the resolution is on appeal. If any part of the resolution is on appeal, identify in Item 12-B 

which part is currently on appeal. 

 Consent Judgment Rendered Settled 

Decision Stipulation and Consent Withdrawn 

Decision & Order of Offer of Settlement Opinion 

Dismissed Order 

 Other: _______________________ 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 Appealed 

 Affirmed 

Vacated Nunc Pro Tunc / ad initio

 Vacated & Returned For Further Action 

Vacated / Final

 Other: _______________________ 

B. Explanation: If more than one box in Item 12-A is checked or Item 12-A otherwise does not adequately 

summarize the type of resolution, provide an explanation. For example, if the individual appealed all or 

part of a resolution by the regulator or court, indicate what is being appealed. 

C. Order: If Order is checked above in Item 12-A, does the order constitute a final order based on violations 

of any laws or regulations that prohibit fraudulent, or deceptive conduct? Yes No 

13. Resolution Date (MM/DD/YYYY):____________________ Exact Explanation 

(For a resolution that is being appealed in part, the date to be provided should be the date on which the 

regulator or court provided its resolution.) 

If not exact, provide explanation: 

14. Resolution Detail 

A. Sanctions(s): Was/were any Sanction(s) Ordered or Relief Granted? 

Yes 

 No, none were ordered or granted. 

B. If “Yes,” check each individual sanction ordered and/or relief granted below: 

Bar (Permanent) Exemption Requalification 

Bar (Temporary / Time Limited) Expulsion Rescission 

Cease and Desist Injunction Restitution*

 Censure Money Damage(s) Restraining Order 

Civil /Administrative Penalty(ies)/Fine(s)* (Private/Civil Complaint)* Revocation 

Denial Prohibition Suspension 

Disgorgement* Reprimand Undertaking 

* Monetary Sanction(s): Were one or more sanctions ordered that require a monetary payment? 

Yes No 

If “Yes,” enter the total amount ordered: $_____________ 

Other Sanctions Ordered or Relief Granted (list each such additional sanction or relief): 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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C. Sanction Detail (Provide the details of the following specific sanctions, if checked above in Item 14-B.) 

(1) Barred, Enjoined, or Suspended: If you checked one or more of these sanctions in Item 14-B. above, 

check the appropriate box(es) below and provide the corresponding information. 

(a) Barred 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 

If, in the above action, the individual received one or more bars from registration 

capacities, associations, and/or other activities, and the terms specify different time 

periods, 

report the additional details below: 

(b) Enjoined 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 

If, in the above action, the individual received one or more injunctions from registration 

capacities, associations, and/or other activities, and the terms specify different time periods, 

report the additional details below: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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(c) Suspended 

(i) Duration (length of time):

 Permanent (not limited by length of time). 

Temporary / Time Limited. Specify the: Days ___ Months ___ Years ___ 

(ii) Start Date (MM/DD/YYYY): ______________ Exact Explanation 

(iii) End Date (MM/DD/YYYY): ______________ Exact Explanation 

(iv) Description: Provide remaining details, including any explanation boxes checked above, and 

the registration capacities affected (General Securities Principal, Financial Operations 

Principal, etc.): 

If, in the above action, the individual received one or more suspensions from registration 

capacities, associations, and/or other activities, and the terms specify different time periods, 

report the additional details below: 

(2) Requalification: Was requalification by examination, retraining, or other process a condition of a 

sanction? 

Yes No 

If “Yes,” provide: 

(a) Length of time given to requalify, retrain, or complete other process:

 No time period is specified. 

Time period is specified: Days ___ Months ___ Years ___ 

(b) Type of examination, retraining, or other process required: 

(c) Was the condition satisfied? Yes No 

If “Yes,” provide the date (MM/DD/YYYY): ______________ 

If “No,” explain the circumstances: 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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If, in the above action, the individual received one or more requalifications in connection with 

registration capacities, associations, and/or other activities, and the terms specify different time 

periods, report the additional details below: 

(3) Monetary Sanction(s): If you indicated in Item 14-B above that one or more monetary sanctions were 

ordered, provide the following information. 

(a) Total Amount Ordered: $___________ 

(b) Portion levied against the individual: 

(i) Amount Ordered: $___________ 

(ii) Was any portion waived? 

Yes 

No

 If “Yes,” how much? $___________ 

(iii) Final Amount: $___________ 

(iv) Was final amount paid in full? 

Yes 

No 

If “Yes,” date paid in full (MM/DD/YYYY):________________ 

If “No,” explain the circumstances: 

15. Summary of Circumstances (Optional): You may use this space to provide a brief summary of the 

circumstances leading to the action, allegation(s), finding(s) and disposition(s), if any. Include any relevant 

information on the current action status, and on any terms, conditions, and dates not already provided above, 

and any other relevant information. The information must fit within the space provided. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION 

DISCLOSURE REPORTING PAGE (MA-I) 

CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DRP – PART 1 

This Disclosure Reporting Page (DRP MA-I) is an INITIAL or AMENDED response to report details 

for affirmative response(s) to Question(s) 6I on Form MA-I. 

Check the question(s) to which this DRP pertains: 

6I(1)(a) 6I(2)(a) 6I(2)(c) 

6I(1)(b) 6I(2)(b) 

Is this DRP an amendment that seeks to remove a previously filed DRP concerning the individual from the record? 

Yes No 

If “Yes,” the reason the DRP should be removed is: 

The event or proceeding was resolved in the individual’s favor 

The DRP was filed in error. Explain the circumstances: 

How to Report a Matter or a Proceeding on this DRP: Use a separate DRP for each matter or proceeding. One 

matter may result in more than one affirmative answer to the above items. Use a single DRP to report details 

relating to a particular matter (i.e., a customer complaint, arbitration, CFTC reparation, or civil litigation). If an 

event gives rise to separate proceedings by more than one regulator or other authority, or other plaintiff, provide 

details for each proceeding on a separate DRP. Separate cases arising out of the same matter, and unrelated civil 

judicial actions, must be reported on separate DRPs; if they are later consolidated into a single civil judicial action, 

the consolidated action can be reported on one DRP. 

DRP on File for This Event: Is an accurate and up-to-date DRP containing the information regarding the 

individual required by this DRP already on file (a) in the IARD or CRD system (with a Form ADV, BD, or U4), or 

(b) in the SEC’s EDGAR system (with a Form MA or Form MA-I)? 

Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual 

as an associated person. 

Yes 

If the answer is “Yes,” provide the applicable information indicated below that identifies where the DRP 

may be found. 

1. Form ADV, BD, or U4 Filing: For a DRP filed on the IARD or CRD system with one of these 

forms, provide the following information: 

Name on Registration: _________________________________________________ 

CRD No.: __________________ Disclosure Occurrence No.: ___________________ 

2. Form MA Filing: For a DRP filed on EDGAR with a Form MA, provide the following 

information: 

Name on Registration: _________________________________________________ 
 

 

 

 

 

 

 

 

 

 

 

MA Registration Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

3. Form MA-I Filing: For a DRP filed on EDGAR with a Form MA-I, provide the following 

information: 

Name of Individual: _________________________________________________ 

MA-I File Number: __________________ 

Date of filing that contains the DRP (MM/DD/YYYY): _________________ 

Accession number of the filing: ________________________ 

No 

If the answer is “Yes,” no other information on this DRP (other than set forth above) must be provided. 

If the answer is “No,” complete Part 2 of this DRP. 

NOTE: The completion of all or any part of this form does not relieve the individual or 

any municipal advisor with which the individual is associated of the obligation 

to update any relevant Form MA or IARD or CRD records. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DRP – PART 2 

Disclosure Instructions and the Individual’s Status: You must indicate the individual’s status in 

Items II and III below: 

I. All Matters: Items 1-6. Complete Items 1-6 for all matters, whether or not the individual is named as a 

party, including: 

A. Customer complaints, arbitrations/CFTC reparations and civil litigation in which the individual is not 

named as a party, as well as, 

B. Arbitrations/CFTC reparations and civil litigation in which the individual is named as a party. 

II. If the individual is not named as a party, check here: And complete Items 7-11. 

A. If the matter involves a customer complaint, or an arbitration/CFTC reparation or civil litigation in which 

the individual is not named as a party, complete Items 7-11 as appropriate. 

B. If a customer complaint has evolved into an arbitration/CFTC reparation or civil litigation, 

amend the existing Disclosure Form by completing Items 9 and 10. 

III. If the individual is named as a party, check here: And check the appropriate boxes below: 

A. Arbitration/CFTC Reparation: If the matter involves an arbitration/CFTC reparation in which the 

individual is a named party, check here: And complete Items 12-16, as appropriate. 

B. Civil Litigation: If the matter involves a civil litigation in which the individual is a named party, 

check here: And complete Items 17-23. 

IV. Summary of the Circumstances: Item 24. This is an optional space and applies to all event types (i.e., 

customer complaint, arbitration/CFTC reparation, civil litigation). 

Complete Items 1-6 for all matters (i.e., customer complaints, 

arbitrations/CFTC reparations, civil litigation). 

1. Customer Name(s):_______________________________________________________________________ 

2. A. Customer(s) State of Residence or domicile, if applicable: 

B. Does/do the customer(s) have other state(s) of residence or domicile, if applicable? Yes No 

If “Yes,” provide the information: 

3. Employing Firm: Provide the full legal name of the individual’s employing firm, if any, when activities 

occurred which led to the customer complaint, arbitration, CFTC reparation or civil litigation. (If there was no 

such employing firm at that time, enter “None”). Enter the employing firm’s MA and CRD registration 

numbers below, if any. 

A. Employing Firm: ____________________________________________________________________ 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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B. Municipal Advisor Registration Number, if any: ___________________ 

C. CRD Number, if any: __________________ 

4. Product Type(s): (select all that apply) 

 No Product

 Annuity – Charitable Direct Investment – DPP & LP Interest Oil & Gas

 Annuity – Fixed Equipment Leasing Options

 Annuity – Variable Equity Listed (Common & Preferred Stock) Penny Stock

 Banking Product Equity OTC Prime Bank Instrument 

(other than CD) Futures – Commodity Promissory Note 

CD Futures – Financial Real Estate Security

 Commodity Option Index Option Security Futures 

Debt – Asset Backed Insurance Security-based Swap 

Debt – Corporate Investment Contract Swap 

Debt – Government Money Market Fund Unit Investment Trust 

Debt – Municipal Mutual Fund Viatical Settlement 

Derivative 

Other Product Type? Yes No If “Yes,” describe each additional product type: 

5. Allegation(s): Describe the allegation(s) and provide a brief summary of events related to the allegation(s), 

including dates when activities leading to the allegation(s) occurred: 

6. Alleged Compensatory Damage(s) 

A. Do the allegations include any amount(s) for compensatory damage(s)? Yes No 

B. If “Yes,” indicate the amount: $__________ 

Exact Explanation 

If not exact, provide explanation: 

If the Individual Is Not a Named Party: If the matter involves a customer complaint, arbitration/CFTC 

reparation or civil litigation in which the individual is not named as a party, complete items 7-11 as 

appropriate. 

If the Individual Is a Named Party: Report in Items 12-16, or 17-23, as appropriate, only 

arbitrations/CFTC reparations or civil litigation in which the individual is named as a party. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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7. A. Is this an oral complaint? Yes No 

B. Is this a written complaint? Yes No 

C. Is this an arbitration/CFTC reparation or civil litigation? Yes No 

If “Yes,” provide: 

(1) Arbitration/reparation forum or court name: ________________________________________ 

(2) Location of the Forum or Court 

Street Address: ____________________________________________________________ 

City or County: ______________________ State/Country: ________________________ 

Postal Code: __________________ 

(3) Docket/Case Name: _______________________________ 

(4) Docket/Case Number: ______________________________ 

(5) Filing date of arbitration/CFTC reparation or civil litigation (MM/DD/YYYY):_______________ 

D. Date received by/served on firm (MM/DD/YYYY):_______________ Exact Explanation 

If not exact, provide explanation: 

8. Pending: Is the complaint, arbitration/CFTC reparation or civil litigation pending? Yes No 

If “No,” complete item 9. 

9. Final: If the complaint, arbitration/CFTC reparation or civil litigation is not pending, provide status: 

Closed/No Action Withdrawn Denied Settled 

Arbitration Award/Monetary Judgment (for claimants/plaintiffs) 

Arbitration Award/Monetary Judgment (for respondents/defendants) 

Evolved into Arbitration/CFTC reparation (individual is a named party): Complete Items 12-16. 

Evolved into Civil litigation (individual is a named party): Complete Items 17-23. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Status: 

If the Individual Is Not a Named Party: If the status is arbitration/CFTC reparation in which the 

individual is not a named party, provide details in Item 7C. 

If the Individual Is a Named Party: If the status is arbitration/CFTC reparation in which the individual 

is a named party, complete Items 12-16. If the status is civil litigation in which the individual is a named 

party, complete Items 17-23. 

10. Status Date (MM/DD/YYYY):_______________ Exact Explanation 

If not exact, provide explanation: 

11. Settlement/Award/Monetary Judgment: 

A. Is there a Settlement/Award/Monetary Judgment? Yes No 

If “Yes,” provide the details below in Item 11-B. and Item 11-C. 

B. Settlement/Award/Monetary Judgment Amount: $_________________ 

C. Was the individual required to pay any portion of the total amount? Yes No 

If “Yes,” indicate: 

(1) The individual’s contribution amount: $___________ 

(2) Was any portion waived? 

Yes 

No 

If “Yes,” how much? $___________ 

(3) Final Amount: $___________ 

(4) Was final amount paid in full? 

Yes 

No 

If “Yes,” date paid in full (MM/DD/YYYY):____________ 

If “No,” explain the circumstances: 

If the matter involves an arbitration or CFTC reparation in which the individual is a named respondent, 

complete Items 12-16, as appropriate. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

12. A. Arbitration/CFTC reparation claim filed with (FINRA, AAA, CFTC, etc.): 

B. Location of the Forum 

Street Address: ____________________________________________________________ 

City or County: ______________________ State/Region: ________________________ 

Country: ____________________________ Postal Code: __________________ 

C. Docket/Case Name: ________________________________ 

D. Docket/Case Number: ______________________________ 

E. Date notice/process was served (MM/DD/YYYY):_______________ Exact Explanation 

If not exact, provide explanation: 

13. Pending: Is arbitration/CFTC reparation pending? Yes No 

If “No,” complete Items 14 and 15. 

14. Final: If the arbitration/CFTC reparation is not pending, what was the disposition? 

Award to the Individual (Agent/Representative)

 Award to Customer 

Denied 

Dismissed

 Judgment (other than monetary)

 No Action 

Settlement that includes a monetary payment to customer

 Settlement without a monetary payment to customer

 Withdrawn 

Other:___________________________________________________________ 

15. Disposition Date (MM/DD/YYYY):_______________ Exact Explanation 

If not exact, provide explanation: 

16. Monetary Compensation Details (If you checked “Award to Customer,” or “Settlement that includes a 

monetary payment to customer” in Item 14, or otherwise a payment of money must be made to the 

customer, provide the following information.) 

A. Total Amount: $___________ 

B. The Individual’s Portion: Was the individual required to pay any portion of the total amount? 

Yes No 

C. If you answered “Yes,” to Item 16-B, indicate: 

(1) The individual’s contribution amount: $___________ 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________________________________________________________________ 

____________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

(2) Was any portion waived? 

Yes 

No 

If “Yes,” how much? $___________ 

(3) Final Amount: $___________ 

(4) Was final amount paid in full? 

Yes 

No 

If “Yes,” date paid in full (MM/DD/YYYY):____________ 

If “No,” explain the circumstances: 

If the matter involves a civil litigation in which the individual is a defendant, complete items 17-23. 

17. 

Court in which case was filed (if brought in a foreign jurisdiction, provide all the information below in 

English): 

Federal Court Military Court State Court Foreign Court International Court 

Other : ___________________________ 

A. Name of the Court:____________________________________________________________ 

B. Location of the Court 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: ________________________ 

Postal Code: __________________ 

C. Docket/Case Name: ________________________________ 

D. Docket/Case Number: ______________________________ 

18. Date received by/served on firm (MM/DD/YYYY):__________________ 

Exact Explanation 

If not exact, provide explanation: 

19. Current Status of the Civil Litigation: 

Pending (Skip to Item 24.) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________________________________________________________ 

_____________________________________________________________________________________ 

_____________________________________________________________________________________ 

_____________________________________________________________________________________ 

On Appeal (Complete Items 20-23; and consider Item 24.) 

Final (Complete Items 20-22; and Item 23 if applicable; and consider Item 24.) 

20. Resolution: 

Denied 

Dismissed

 Judgment (other than monetary)

 Monetary Judgment to the Individual (Agent/Representative)

 Monetary Judgment to Customer

 No Action 

Settlement that includes a monetary payment to customer

 Settlement without a monetary payment to customer

 Withdrawn 

Other: 

21. Disposition Date (MM/DD/YYYY):_______________ 

Exact Explanation 

If not exact, provide explanation: 

22. Monetary Compensation Details (If you checked “Monetary Judgment to Customer” or “Settlement that 

includes a monetary payment to customer” in Item 20, or otherwise a payment of money must be made to the 

customer, provide the following information.) 

A. Total Amount: $___________ 

B. Was the individual required to pay any portion of the total amount? Yes No 

C. If you answered “Yes” to Item 22-B, indicate: 

(1) The individual’s contribution amount: $___________ 

(2) Was any portion waived? 

Yes 

No 

If “Yes,” how much? $___________ 

(3) Final Amount: $___________ 

(4) Was final amount paid in full? 

Yes 

No 

If “Yes,” date paid in full (MM/DD/YYYY):____________ 
 

 

 

 

 

 

 

 

 

____________________________________________________________________________ 

____________________________________________________________________________ 

__________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

___________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

If “No,” explain the circumstances: 

23. On Appeal – Judicial Review: If the individual appealed, provide the following information. 

(If brought in a foreign jurisdiction, provide all the information below in English): 

A. Action Appealed to: (Provide the name of the federal, military, state, foreign, or international court to 

which the individual appealed.) 

B. Location of the Court: 

Street Address: ______________________________________________________________ 

City or County: ______________________ State/Country: ________________________ 

Postal Code: __________________ 

C. Docket/Case Name: ____________________ 

D. Docket/Case Number: __________________ 

E. Date Appeal filed (MM/DD/YYYY): ______________ Exact Explanation 

If not exact, provide explanation: 

F. Appeal Details (including status): 

24. Summary of the Circumstances (Optional). You may use this space to provide a brief summary of the 

circumstances leading to the customer complaint, arbitration/CFTC reparation and/or civil litigation as well as 

the current status or final disposition(s). The information must fit within the space provided.