Form SEC 2899 SEC 2899 Form MA-I

FORM MA-I
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
No

Form MA Filing Date: ______________
(MM/DD/YYYY)

EDGAR CIK 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
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:
_________________________________________________________________________________
City: _____________ State: _____ Country: _______________ Postal Code: ______________
Municipal Advisor-Related Business?
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?
Is this an investment-related business?

Yes
No
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?
Yes
No
(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
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
Item 6D.

No

(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)?
Yes
No
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

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
No
(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
(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

No

(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?
No

Yes

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
First Name
Middle Name
Suffix
Individual CRD No. (if any):________________
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
for affirmative response(s) to Question(s) 6A and 6B on Form MA-I.

AMENDED response to report details

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?
4. Current Status of the Event:

Pending

On Appeal

Yes

No

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
Amended
Convicted
Deferred Adjudication
Dismissed

Found not guilty
Pled guilty
Pled nolo contendere
Pled not guilty

Pre-trial diversion/intervention
Reduced
Other (requires explanation)
_______________________

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): _____________

(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?
If “Yes,” provide the following details:
(i) Duration (length of the sentence):

Days ___

Months ___

Yes

No

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:
_______________________________________________________
_______________________________________________________

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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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)
6C(2)
6C(3)
6C(4)
6C(5)
6C(6)
6C(7)
6C(8)

6D(1)(a)
6D(1)(b)
6D(1)(c)
6D(1)(d)
6D(1)(e)
6D(2)(a)
6D(2)(b)

6E(1)
6E(2)
6E(3)
6E(4)
6E(5)
6E(6)
6E(7)

6F

6G(1)

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.

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
CFTC
Federal Banking Agency
National Credit Union Administration
Other Federal Authority

State
SRO

Foreign Financial Regulatory Authority
Other: _________________________

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)
Bar (Temporary / Time Limited)
Cease and Desist
Censure
Civil and Administrative Penalty(ies)/Fine(s)
Denial

Disgorgement
Expulsion
Injunction
Prohibition
Reprimand
Requalification

Rescission
Restitution
Revocation
Suspension
Undertaking

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: __________________

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
Annuity – Fixed
Annuity – Variable
Banking Product
(other than CD)
CD
Commodity Option
Debt – Asset Backed
Debt – Corporate
Debt – Government
Debt – Municipal
Derivative

Direct Investment – DPP & LP Interest
Equipment Leasing
Equity Listed (Common & Preferred Stock)
Equity OTC
Futures – Commodity
Futures – Financial
Index Option
Insurance
Investment Contract
Money Market Fund
Mutual Fund

Oil & Gas
Options
Penny Stock
Prime Bank Instrument
Promissory Note
Real Estate Security
Security Futures
Security-based Swap
Swap
Unit Investment Trust
Viatical Settlement

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

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?

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)
Consent
Decision
Decision & Order of Offer of Settlement

Dismissed
Judgment Rendered
Order
Settled

Stipulation and Consent
Withdrawn
Other (requires explanation)

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.

B. If “Yes,” check each individual sanction below that was ordered:
Bar (Permanent)
Bar (Temporary / Time Limited)
Cease and Desist
Censure
Civil and Administrative Penalty(ies)/Fine(s)*
Denial

Disgorgement*
Expulsion
Injunction
Prohibition
Reprimand
Rescission

Restitution*
Requalification
Revocation
Suspension
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 Sanction(s) Ordered (list each such additional sanction):
__________________________________________________________________________________
__________________________________________________________________________________
C. Sanction Detail (Provide the details of the following specific sanctions, if checked above in Item 13B.)
(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:

______________________________________________________________________
____________________________________________________________________________

(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.):
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

_________________________________________________________________________
_________________________________________________________________________

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?

$___________

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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

INVESTIGATION DISCLOSURE REPORTING PAGE (MA-I)
INVESTIGATION DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) is an
INITIAL or
for an affirmative response to Question 6G(2) on Form MA-I.

AMENDED response to report details

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.

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
Other: __________________________

Foreign Country

International Authority

Regulatory or Other Civil Authority Investigation
SEC
State
CFTC
SRO
Other Federal Authority
Other: __________________________

Foreign Financial Regulatory Authority
Other Foreign Authority

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
Annuity – Fixed
Annuity – Variable
Banking Product
(other than CD)
CD
Commodity Option
Debt – Asset Backed
Debt – Corporate
Debt – Government
Debt – Municipal

Direct Investment – DPP & LP Interest
Equipment Leasing
Equity Listed (Common & Preferred Stock)
Equity OTC
Futures – Commodity
Futures – Financial
Index Option
Insurance
Investment Contract
Money Market Fund
Mutual Fund

Oil & Gas
Options
Penny Stock
Prime Bank Instrument
Promissory Note
Real Estate Security
Security Futures
Security-based Swap
Swap
Unit Investment Trust
Viatical Settlement

Derivative
Other Product Type:
___________________________________________________________________________________

5. Current Status: Is the investigation pending?

Yes
No

If “Yes,” skip to Item 7.
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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_________________________________________________________________________________________
_____________________________________________________________________________________

TERMINATION DISCLOSURE REPORTING PAGE (MA-I)
TERMINATION DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) is an
INITIAL or
for affirmative response(s) to Question 6J on Form MA-I;

AMENDED response to report details

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.

TERMINATION DRP – PART 2
1. Name of Employing Firm:__________________________________________________________
MA Registration Number, if any: _______________
2. Termination Type:

Discharged

CRD Number, if any: _______________

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
Annuity – Fixed
Annuity – Variable
Banking Product
(other than CD)
CD
Commodity Option
Debt – Asset Backed
Debt – Corporate
Debt – Government
Debt – Municipal
Derivative

Direct Investment – DPP & LP Interest
Equipment Leasing
Equity Listed (Common & Preferred Stock)
Equity OTC
Futures – Commodity
Futures – Financial
Index Option
Insurance
Investment Contract
Money Market Fund
Mutual Fund

Oil & Gas
Options
Penny Stock
Prime Bank Instrument
Promissory Note
Real Estate Security
Security Futures
Security-based Swap
Swap
Unit Investment Trust
Viatical Settlement

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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

JUDGMENT / LIEN DISCLOSURE REPORTING PAGE (MA-I)
JUDGMENT / LIEN DISCLOSURE DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) is an
INITIAL or
for an affirmative response to Question 6M on Form MA-I.

AMENDED response to report details

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

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
No

If “Yes,” skip to item 8.
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):
___________________________________________________________________________________
___________________________________________________________________________________

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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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

AMENDED response to report details

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.

CIVIL JUDICIAL ACTION DRP – PART 2
1. Court Action initiated by:
A. Select the Appropriate Item(s).
Check all that apply.
SEC
CFTC
Other Federal Authority

State
SRO
Commodities Exchange

Foreign Financial Regulatory Authority
Municipal Advisory Firm
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)
Bar (Temporary / Time Limited)
Cease and Desist
Censure
Civil /Administrative Penalty(ies)/Fine(s)
Denial
Disgorgement
Other Sanction(s) or Relief Sought:

Exemption
Expulsion
Injunction
Money Damage(s)
(Private/Civil Complaint)
Prohibition
Reprimand

Requalification
Rescission
Restitution
Restraining Order
Revocation
Suspension
Undertaking

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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.

No Product
Annuity – Charitable
Annuity – Fixed
Annuity – Variable
Banking Product
(other than CD)
CD
Commodity Option
Debt – Asset Backed
Debt – Corporate
Debt – Government
Debt – Municipal
Derivative

Direct Investment – DPP & LP Interest
Equipment Leasing
Equity Listed (Common & Preferred Stock)
Equity OTC
Futures – Commodity
Futures – Financial
Index Option
Insurance
Investment Contract
Money Market Fund
Mutual Fund

Oil & Gas
Options
Penny Stock
Prime Bank Instrument
Promissory Note
Real Estate Security
Security Futures
Security-based Swap
Swap
Unit Investment Trust
Viatical Settlement

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:
___________________________________________________________________________________
___________________________________________________________________________________

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
Decision
Decision & Order of Offer of Settlement
Dismissed
Other: _______________________

Judgment Rendered
Stipulation and Consent
Opinion
Order

Settled
Withdrawn

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)
Bar (Temporary / Time Limited)
Cease and Desist
Censure
Civil /Administrative Penalty(ies)/Fine(s)*
Denial
Disgorgement*

Exemption
Expulsion
Injunction
Money Damage(s)
(Private/Civil Complaint)*
Prohibition
Reprimand

Requalification
Rescission
Restitution*
Restraining Order
Revocation
Suspension
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):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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:

(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:
_________________________________________________________________________

_________________________________________________________________________
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.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

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

AMENDED response to report details

Check the question(s) to which this DRP pertains:
6I(1)(a)
6I(1)(b)

6I(2)(a)
6I(2)(b)

6I(2)(c)

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.

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: ____________________________________________________________________

B. Municipal Advisor Registration Number, if any: ___________________
C. CRD Number, if any: __________________
4. Product Type(s): (select all that apply)
No Product
Annuity – Charitable
Annuity – Fixed
Annuity – Variable
Banking Product
(other than CD)
CD
Commodity Option
Debt – Asset Backed
Debt – Corporate
Debt – Government
Debt – Municipal
Derivative

Direct Investment – DPP & LP Interest
Equipment Leasing
Equity Listed (Common & Preferred Stock)
Equity OTC
Futures – Commodity
Futures – Financial
Index Option
Insurance
Investment Contract
Money Market Fund
Mutual Fund

Oil & Gas
Options
Penny Stock
Prime Bank Instrument
Promissory Note
Real Estate Security
Security Futures
Security-based Swap
Swap
Unit Investment Trust
Viatical Settlement

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.

7. A. Is this an oral complaint?
B. Is this a written complaint?

Yes

No

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?
If “No,” complete item 9.

Yes

No

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.

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?
If “No,” complete Items 14 and 15.

Yes

No

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?
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):____________

Yes

No

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.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

______________________________________________________________________________________
______________________________________________________________________________________