Form U5 – Fill Out and Use This PDF

Form U5 is an official document which focuses on the filing requirements of corporations, limited liability companies (LLCs), and exchanges in order for them to remain compliant with the appropriate regulatory bodies. It provides organizations a reporting opportunity to identity any corporate address, security administrators, actor statuses and all other changes experienced from the point of beginning operations until each subsequent maintenance date. Form U5 outlines all required information needed to remain within lawful parameters; and therefore should be diligently examined by businesses looking to register their operations at the federal or state levels. It keeps track of contacts, financial details and filings associated with the formation and ongoing activities of various companies ranging from sole proprietorships to LLCs.

Form U5 PDF Details

Form U5 is an SEC form that must be completed by every company that has publicly traded securities. The purpose of Form U5 is to provide information about the company and its officers, directors, and shareholders. Completing Form U5 is a critical step in ensuring compliance with SEC regulations. 您的浏览器不支持 video。 Your browser does not support video. _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ __________________________________________________________________ ____ ___ __ __, / _` | '__/ _` | | |___| (_| || |___| (_| || \_____/\__,_||_.__/\__,_|| |___/ --------------------------------------------------------------------------------------------------------------- About: https://www.sec.gov/about/forms-uhc-information-reporting-requirements-uniformed-securities.pdf Englis

Question	Answer
Form Name	Form U5
Form Length	14 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	3 min 30 sec
Other names	form_u5 2004 form u5 print

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Is this a Full Termination?

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

INDIVIDUAL NAME:

INDIVIDUAL CRD #:

SSN:

FIRM CRD #:

NOTICE TO THE INDIVIDUAL WHO IS THE SUBJECT OF THIS FILING

Even if you are no longer registered you continue to be subject to the jurisdiction of regulators for at least two years after your reg- istration is terminated and may have to provide information about your activities while associated with this firm. Therefore, you must forward any residential address changes for two years following your termination date or last Form U5 amendment to:

CRD Address Changes, P.O. Box 9495, Gaithersburg, MD 20898-9495.

1. GENERAL INFORMATION

FIRST NAME:

MIDDLE NAME:

LAST NAME:

SUFFIX:

FIRM CRD #:

FIRM NAME:

FIRM NFA#:

INDIVIDUAL CRD #:

INDIVIDUAL SSN:

Individual NFA#:

FIRM Billing Code:

Office of Employment Address:

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Non-Registered				Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Non-Registered				Supervised From

OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Non-Registered				Supervised From

OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

2. CURRENT RESIDENTIAL ADDRESS

NOTICE TO THE FIRM: This is the last reported residential	FROM (MM/YYYY):	TO (MM/YYYY):
address. If this is not current, please enter the current
residential address.
ADDRESS STREET 1:	CITY:	STATE:

ADDRESS STREET 2:	COUNTRY:	POSTAL CODE:

3. FULL TERMINATION

Yes No

Note: A "Yes" response will terminate ALL registrations with all SROs and all jurisdictions.

Reason For Termination:
*Discharged	*Other	*Permitted to Resign	Deceased	Voluntary

*Provide an explanation below:

Page 1 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:
	4. DATE OF TERMINATION

Date Terminated (MM/DD/YYYY): _______________________________

A complete date of termination is required for full or partial termination. This date represents the actual date that the termination of regis- tration is effective.

Page 2 of 14

INDIVIDUAL NAME:

INDIVIDUAL CRD #:

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

SSN:

FIRM CRD #:

5. PARTIAL TERMINATION

For a partial termination, do not complete the Reason for Termination in Section 3 (FULL TERMINATION) or Section 7 (DISCLOSURE QUESTIONS). The Reason for Termination and Section 7 (DISCLOSURE QUESTIONS) should only be completed on Form U5 for full termination requests.

5A. SRO PARTIAL TERMINATION

If this is a PARTIAL TERMINATION, mark the appropriate SRO registration categories to be terminated.

REGISTRATION CATEGORY

OP - Registered Options Principal (S4)

IR - Investment Company & Variable Contracts Products Rep. (S6)

GS - Full Registration/General Securities Representative (S7)

TR - Securities Trader (S7)

TS - Trading Supervisor (S7)

SU - General Securities Sales Supervisor (S9 and S10)

BM - Branch Office Manager (S9 and S10)

SM - Securities Manager (S12)

AR - Assistant Representative/Order Processing (S11)

IE - United Kingdom-Limited General Securities Registered Representative (S17)

DR - Direct Participation Program Representative (S22)

GP - General Securities Principal (S24)

IP - Investment Company and Variable Contracts Products Principal (S26)

FA - Foreign Associate

FN - Financial and Operations Principal (S27)

FI - Introducing Broker-Dealer/Financial and Operations Principal (S28)

RS - Research Analyst (S86,S87)

RP - Research Principal

DP - Direct Participation Program Principal (S39)

OR - Operations Representative (S42)

MR - Municipal Securities Representative (S52)

MP - Municipal Securities Principal (S53)

CS - Corporate Securities Representative (S62)

RG - Government Securities Representative (S72)

PG - Government Securities Principal (S73)

SA - Supervisory Analyst (S16)

PR - Limited Representative - Private Securities Offerings (S82)

CD - Canada-Limited General Securities Registered Representative (S37)

CN - Canada-Limited General Securities Registered Representative (S38)

ET - Equity Trader (S55)

AM - Allied Member

AP - Approved Person

LE - Securities Lending Representative

LS - Securities Lending Supervisor

ME - Member Exchange

FE - Floor Employee

OF - Officer

CO - Compliance Official (S14)

CF - Compliance Official Specialist (S14A)

PM - Floor Member Conducting Public Business

PC - Floor Clerk Conducting Public Business

SC - Specialist Clerk (S21)

TA - Trading Assistant (S25)

SF - Single Stock Futures (S43)

FP - Municipal Fund (S51)

IF - In-Firm Delivery Proctor

MM- Market Maker FB - Floor Broker

MB - Market Maker Acting as Floor Broker

Other__________________________________ (Paper Form Only)

NASD NYSE AMEX BSE NSX PCX CBOE CHX PHLX ISE

Page 3 of 14

INDIVIDUAL NAME:

INDIVIDUAL CRD #:

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

SSN:

FIRM CRD #:

5B. JURISDICTION PARTIAL TERMINATION

Check appropriate jurisdiction(s) for broker-dealer agent (AG) and/or investment adviser representative (RA) termination.

JURISDICTION

Alabama

Illinois

Montana

Puerto Rico

Alaska

Indiana

Nebraska

Rhode Island

Arizona

Iowa

Nevada

South Carolina

Arkansas

Kansas

New Hampshire

South Dakota

California

Kentucky

New Jersey

Tennessee

Colorado

Louisiana

New Mexico

Texas

Connecticut

Maine

New York

Utah

Delaware

Maryland

North Carolina

Vermont

District of Columbia

Massachusetts

North Dakota

Virginia

Florida

Michigan

Ohio

Washington

Georgia

Minnesota

Oklahoma

West Virginia

Hawaii

Mississippi

Oregon

Wisconsin

Idaho

Missouri

Pennsylvania

Wyoming

AGENT OF THE ISSUER REGISTRATION (AI)

Indicate 2 letter jurisdiction code(s):___________

6. AFFILIATED FIRM TERMINATION

Is this a multiple termination with one or more firms affiliated with the filing firm?

Yes

If "yes" to the above question and the termination requests for the filing firm are identical to the termination requests of each affiliated firm, then mark the same termination request for each affiliate. If the termination requests of the affiliated firm(s) differ from those of the filing firm, complete the SRO and/or jurisdiction sections for each affiliated firm.

AFFILIATED FIRM CRD #:

AFFILIATED FIRM NAME:

AFFILIATED FIRM BILLING CODE:

Office of Employment Address:

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Registered				Located At
Non-Registered				Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Registered				Located At
Non-Registered				Supervised From

OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

Registered	CRD BRANCH #:	NYSE BRANCH CODE #:	FIRM BILLING CODE:	Located At	START DATE:	END DATE:
Registered				Located At
Non-Registered				Supervised From

OFFICE OF EMPLOYMENT ADDRESS STREET 1:			CITY:		STATE:

OFFICE OF EMPLOYMENT ADDRESS STREET 2:

COUNTRY:

POSTAL CODE:

Private Residence Check Box: If the Office of Employment address is a private residence, check this box.

Page 4 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:
	7. DISCLOSURE QUESTIONS

IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IN SECTION 7 IS 'YES', COMPLETE DETAILS OF ALL EVENTS OR PROCEEDINGS ON APPROPRIATE DRP(s). IF THE INFORMATION IN SECTION 7 HAS ALREADY BEEN REPORTED ON FORM U4 OR FORM U5, DO NOT RESUBMIT DRPs FOR THESE ITEMS. REFER TO THE EXPLANATION OF TERMS SECTION OF FORM U5 INSTRUCTIONS FOR EXPLANATION OF ITALICIZED WORDS.

Yes No

Investigation Disclosure

7A. Currently is, or at termination was, the individual the subject of an investigation or proceeding by a domestic or foreign governmental body or self-regulatory organization with jurisdiction over investment-related businesses? (Note: Provide details of an investigation on an Investigation Disclosure Reporting Page and details regarding a proceeding on a Regulatory Action Disclosure Reporting Page.)

Internal Review Disclosure

7B. Currently is, or at termination was, the individual under internal review for fraud or wrongful taking of property, or violating investment-related statutes, regulations, rules or industry standards of conduct?

Criminal Disclosure

7C. While employed by or associated with your firm, or in connection with events that occurred while the individual was employed by or associated with your firm, was the individual:

1. convicted of or did the individual plead guilty or nolo contendere ("no contest") in a domestic, foreign or military court to any felony?

2. charged with any felony?

3. convicted of or did the individual plead guilty or nolo contendere ("no contest") in a domestic, foreign or military court to a misdemeanor involving: investments or an investment-related business, or any fraud, false statements or omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion, or a conspiracy to commit any

4. charged with a misdemeanor specified in item 7(C)(3)?

Regulatory Action Disclosure

7D. While employed by or associated with your firm, or in connection with events that occurred while the individual was employed by or associated with your firm, was the individual involved in any disciplinary action by a domestic or foreign governmental body or self-regulatory organization (other than those designated as a "minor rule violation" under a plan approved by the U.S. Securities and Exchange Commission) with jurisdiction over the investment-related businesses?

Customer Complaint/Arbitration/Civil Litigation Disclosure

7E. 1. In connection with events that occurred while the individual was employed by or associated with your firm, was the individual named as a respondent/defendant in an investment-related, consumer-initiated arbitration or civil litigation which alleged that the individual was involved in one or more sales practice violations and which:

(a) is still pending, or;

(b) resulted in an arbitration award or civil judgment against the individual, regardless of amount, or;

2. In connection with events that occurred while the individual was employed by or associated with your firm, was the individual the subject of an investment-related, consumer-initiated complaint, not otherwise reported under question 7(E)(1) above, which alleged that the individual was involved in one or more sales practice violations, and which complaint was settled for an amount of $10,000 or more?

3.In connection with events that occurred while the individual was employed or associated with your firm, was the individual the subject of an investment-related, consumer-initiated, written complaint, not otherwise reported under questions 7(E)(1) or 7(E)(2) above, which:

(a) would be reportable under question 14I(3)(a) on Form U4, if the individual were still employed by your firm, but which has not previously been reported on the individual's Form U4 by your firm; or

(b) would be reportable under question 14I(3)(b) on Form U4, if the individual were still employed by your firm, but which has not previously been reported on the individual's Form U4 by your firm.

Termination Disclosure

7F. Did the individual voluntarily resign from your firm, or was the individual discharged or permitted to resign from your firm, after allegations were made that accused the individual of:

1. violating investment-related statutes, regulations, rules or industry standards of conduct?

2. fraud or the wrongful taking of property?

3. failure to supervise in connection with investment-related statutes, regulations, rules or industry standards of conduct?

Page 5 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:
	8. SIGNATURE

Please Read Carefully

All signatures required on this Form U5 filing must be made in this section.

A "Signature" includes a manual signature or an electronically transmitted equivalent. For purposes of an electronic form filing, a signature is effected by typing a name in the designated signature field. By typing a name in this field, the signatory acknowledges and represents that the entry constitutes in every way, use, or aspect, his or her legally binding signature.

8A. FIRM ACKNOWLEDGMENT

This section must be completed on all U5 form filings submitted by the firm.

8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENT

This section must be completed on amendment U5 form filings where the individual is submitting changes to Part II of the INTERNAL REVIEW DRP or changes to Section 2 (CURRENT RESIDENTIAL ADDRESS).

8A. FIRM ACKNOWLEDGMENT

I VERIFY THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED IN AND WITH THIS FORM.

__________________________________________________	_______________________________________________________
Person to contact for further information	Telephone # of person to contact
__________________________________________________	_______________________________________________________
Signature of Appropriate Signatory	Date (MM/DD/YYYY)
__________________________________________________
Type or Print Name of Appropriate Signatory

8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENT

I VERIFY THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED IN SECTION 2 (CURRENT RESIDENTIAL ADDRESS) AND/OR IN PART II OF THE INTERNAL REVIEW DRP.

__________________________________________________	_______________________________________________________
Individual Signature	Date (MM/DD/YYYY)
__________________________________________________
Type or Print Name of Individual

Page 6 of 14

INDIVIDUAL NAME:

INDIVIDUAL CRD #:

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

SSN:

FIRM CRD #:

DISCLOSURE REPORTING PAGES

U5 - CRIMINAL DRP

This Disclosure Reporting Page is an INITIAL OR AMENDED response to report details for affirmative responses to Questions

7(C)(1), 7(C)(2), 7(C)(3) and 7(C)(4) on Form U5;

Check question(s) you are responding to:

7C(1)

7C(2)

7C(3)

7C(4)

Use this DRP to report all charges arising out of the same event. One event may result in more than one affirmative answer to the above items. Multiple counts of the same charge arising out of the same event should be reported on the same DRP. Unrelated criminal actions, including separate cases arising out the same event, must be reported on separate DRPs. Applicable court documents (i.e., criminal complaint, information or indictment as well as judgment of conviction or sentencing documents) must be provided to the CRD if not previously submitted.

1.Formal Charge(s) were brought in: (include name of Federal, Military, State or Foreign Court, Location of Court - City or County and State or Country, Docket/Case number).

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

A. Date First Charged (MM/DD/YYYY):___________________________

Exact

Explanation

If not exact, provide explanation:

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

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

C. Did any of the Charge(s) within the Event involve a Felony?			Yes	No
D. Current status of the Event?	Pending	On Appeal		Final
E. Event Status Date (complete unless status is Pending) (MM/DD/YYYY):_________________					Exact	Explanation

If not exact, provide explanation:

3.Disposition Disclosure Detail

Include for each charge, A. Disposition Type [e.g., convicted, acquitted, dismissed, pretrial, etc.], B. Date, C. Sentence/Penalty, D. Duration [if sentence-suspension, probation, etc.], E. Start Date of Penalty, F. Penalty/Fine Amount and G. Date Paid.

4.Comment (Optional). You may use this field to provide a brief summary of the circumstances leading to the charge(s) as well as the current status or final disposition. Your information must fit within the space provided.

Page 7 of 14

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

INDIVIDUAL NAME:

SSN:

INDIVIDUAL CRD #:

FIRM CRD #:

U5 - CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DRP

This Disclosure Reporting Page is an INITIAL OR

AMENDED response to report details for affirmative responses to Questions

7(E)(1), 7(E)(2) and 7(E)(3) on Form U5;

Check question(s) you are responding to:

7(E)(1)(a)

7(E)(1)(b)

7(E)(1)(c)

7(E)(2)

7(E)(3)(a)

7(E)(3)(b)

One event may result in more than one affirmative answer to the above items. Use only one DRP to report details related to one customer complaint/arbitration/civil litigation. Use a separate DRP for each customer complaint/arbitration/civil litigation.

DRP Instructions:

-In all matters (i.e., customer complaints, arbitrations/CFTC reparations, civil litigations), complete items 1-6.

-If the matter involves only a customer complaint, also complete items 7-12, as appropriate.

-If the customer complaint has evolved into an arbitration/CFTC reparation or civil litigation, amend the existing DRP by completing items 9 and 10.

-If the matter involves an arbitration or CFTC reparation, complete items 13-19, as appropriate.

-If the matter involves a civil litigation, complete items 20-27.

-Item 28 is an optional field and applies to all event types (i.e., customer complaint, arbitration/CFTC reparation/civil litigation). Complete items 1-6 for all events.

1.Customer Name(s):

2.Customer(s) State of Residence:______________________________________

Other state(s) of residence/detail:

3.Employing Firm when activities occurred which led to the complaint:________________________________________

4.Allegation(s) and a brief summary of events related to the allegation(s) including dates when activities leading to the allegation(s) occurred:

5.Principal Product Type: _________________________________

Other Product Types:

6.Alleged Compensatory Damage Amount: $_________________________________

If the matter involves only a customer complaint, complete items 7-12, as appropriate.

7. Date customer complaint was received (MM/DD/YYYY):________________________________			Exact	Explanation
If not exact, provide explanation:
8. Is the customer complaint pending?	Yes	No

If the customer complaint has evolved into an arbitration/CFTC reparation or civil litigation, amend the existing DRP by completing items 9 and 10.

9.If the customer complaint is not pending, provide status: If status is settlement, complete items 11 and 12;

If status is arbitration/reparation, complete items 13-19; If status is litigation, complete items 20-27.

Closed/No Action	Withdrawn	Denied
Settled	Arbitration/Reparation	Litigation
10. Status Date (MM/DD/YYYY):________________________________		Exact	Explanation

If not exact, provide explanation:

Page 8 of 14

INDIVIDUAL NAME:

INDIVIDUAL CRD #:

Rev. Form U5 (10/2005)

UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION

SSN:

FIRM CRD #:

U5 - CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DRP (CONTINUED)

11.Settlement Amount (if settled without arbitration, litigation or reparation):________________________________

12.Individual Contribution Amount: $________________________________

If the matter involves an arbitration or CFTC reparation, complete items 13-19, as appropriate.

13. Arbitration/Reparation claim filed with (NASD, AAA, NYSE, CBOE, CFTC, etc.) and Docket/Case Number:

14.	Date notice/process was served (MM/DD/YYYY):________________________________				Exact	Explanation
	If not exact, provide explanation:

15.	Is the arbitration/reparation pending?	Yes	No

16.	If the arbitration/reparation is not pending, what was the disposition:________________________________

17.	Disposition Date (MM/DD/YYYY):________________________________			Exact	Explanation
	If not exact, provide explanation:

18.Amount of Monetary Compensation (award, settlement, reparation amount): $________________________________

19.Individual Contribution Amount: $________________________________

If the matter involves a civil litigation, complete items 20-27.

20.Court that case was filed in (include name of Federal, Military, State or Foreign Court, Location of Court - City or County and State or Country, Docket/Case number).

21.	Date notice/process was served (MM/DD/YYYY):________________________________				Exact	Explanation
	If not exact, provide explanation:

22.	Is the civil litigation pending?	Yes	No

23.	If the civil litigation is not pending, what was the disposition?________________________________

24.	Disposition Date (MM/DD/YYYY):________________________________			Exact	Explanation

If not exact, provide explanation:

25.Amount of Monetary Compensation (judgment, restitution, settlement amount): $________________________________

26.Individual Contribution Amount: $________________________________

27. If the action is currently on appeal enter date appeal filed (MM/DD/YYYY):_________________________

Exact

Explanation

If not exact, provide explanation:

28.Comment (Optional). You may use this field 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). Your information must fit within the space provided.

Page 9 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:

	U5 - INTERNAL REVIEW DRP

This Disclosure Reporting Page is an	INITIAL OR		AMENDED response to report details for affirmative response to Question 7(B)
on Form U5;
Check question you are responding to:		7(B)
Check question you are responding to:		7(B)

If the individual has been notified that the internal review has been concluded without formal action, complete items 3 and 4 of this DRP to update.

PART I

1.	Notice Received From: (Name of firm initiating the internal review):________________________________________

2.	Date internal review initiated (MM/DD/YYYY):________________________________	Exact	Explanation
	If not exact, provide explanation:

3. Describe briefly the nature of the internal review or details of the conclusion. (The information must fit within the space provided.):

4. Date internal review concluded (MM/DD/YYYY):________________________________	Exact	Explanation
If not exact, provide explanation:

PART II

INDIVIDUAL SUBJECT MAY USE THIS SPACE FOR DETAILS TO AFFIRMATIVE ANSWERS OF ITEM 7(B) ONLY

The individual who is the subject of the internal review may provide a brief summary of this event. The summary must fit within the space provided below. This summary may be submitted electronically to the CRD by the terminating firm or may be sent to:

CRD, P.O. Box 9495, Gaithersburg, MD 20898-9495.

Page 10 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:

	U5 - INVESTIGATION DRP
This Disclosure Reporting Page is an INITIAL OR		AMENDED response to report details for affirmative response to Question 7(A)
on Form U5;
Check question you are responding to:	7(A)

If the investigation has been concluded without formal action, complete items 1, 2, 3 and 4 of this DRP to update. One event may result in more than one investigation. If more than one authority is investigating, use a separate DRP to provide details.

1.	Notice Received From: (Name of Regulator, Agency, SRO, etc. initiating the investigation):_____________________________________

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

If not exact, provide explanation:

3. Describe briefly the nature of the investigation, if known, or details of the resolution. (The information must fit within the space provided.):

4. Date Resolved (MM/DD/YYYY):________________________________

Exact

Explanation

If not exact, provide explanation:

Page 11 of 14

			Rev. Form U5 (10/2005)
			UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
	INDIVIDUAL NAME:		SSN:
	INDIVIDUAL NAME:		SSN:

	INDIVIDUAL CRD #:		FIRM CRD #:

		U5 - REGULATORY ACTION DRP

This Disclosure Reporting Page is an		INITIAL OR AMENDED response to report details for affirmative responses to Questions 7(A)
and 7(D) on Form U5;

Check question you are responding to:

7(A)

7(D)

One event may result in more than one affirmative answer to the above item. Use only one DRP to report details related to the same event. If an event gives rise to actions by more than one regulator, provide details to each action on a separate DRP.

1. Regulatory Action initiated by:	SEC	Other Federal	State	SRO	Foreign
	Federal Banking Agency		National Credit		Union Administration	Other

(Full name of regulator, foreign financial regulatory authority, Federal, State, SRO, commodities exchange, or National Credit Union Administration)

2.Principal Sanction:_______________________________________

Other Sanctions:

3. Date Initiated (MM/DD/YYYY):________________________________

Exact

Explanation

If not exact, provide explanation:

4.Docket/Case Number:_______________________________________

5.Employing Firm when activity occurred which led to the regulatory action:_______________________________________

6.Principal Product Type:_______________________________________

Other Product Types:

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

8. Current status?

Pending

On Appeal

Final

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

Page 12 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:

	U5 - REGULATORY ACTION DRP (CONTINUED)

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

10.	How was matter resolved:___________________________

11.	Resolution Date (MM/DD/YYYY):________________________________	Exact	Explanation

If not exact, provide explanation:

12.Resolution Detail:

A. Were any of the following sanctions ordered? (Check all appropriate items):

Monetary/Fine	Amount: $______________________________
Revocation/Expulsion/Denial		Disgorgement/Restitution

Censure		Cease and Desist/Injunction

Bar		Suspension

B. Other sanctions ordered:

C.Sanction detail: if suspended, enjoined or barred, provide duration including start date and capacities affected (General Securities Principal, Financial Operations Principal, etc.). If requalification by exam/retraining was a condition of the sanction, provide length of time given to requalify/retrain, type of exam required and whether condition has been satisfied. If disposition resulted in a fine, penalty, restitution, disgorgement or monetary compensation, provide total amount, portion levied against the individual, date paid and if any portion of penalty was waived:

13.Comment (Optional). You may use this field to provide a brief summary of the circumstances leading to the action as well as the current status or disposition and/or finding(s). Your information must fit within the space provided.

Page 13 of 14

		Rev. Form U5 (10/2005)
		UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:		SSN:
INDIVIDUAL NAME:		SSN:

INDIVIDUAL CRD #:		FIRM CRD #:

		U5 - TERMINATION DRP

This Disclosure Reporting Page is an INITIAL OR		AMENDED response to report details for affirmative response to Questions 7(F)
on Form U5;

Check question(s) you are responding to:

7F(1)

7F(2)

7F(3)

One event may result in more than one affirmative answer to the above items. Use only one DRP to report details related to the same termination. Use a separate DRP for each termination reported.

1.Firm Name: ________________________________

2.Termination Type:________________________________

3. Termination Date(MM/DD/YYYY):________________________________

Exact

Explanation

If not exact, provide explanation:

4.Allegation(s):_______________________________________

5.Principal Product Type:_______________________________________

Other Product Types:

6.Comment (Optional). You may use this field to provide a brief summary of the circumstances leading to the termination. Your information must fit within the space provided.

Page 14 of 14

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1. The Form U5 requires certain details to be typed in. Be sure the next fields are finalized:

2. Once your current task is complete, take the next step – fill out all of these fields - NonRegistered, Supervised From, OFFICE OF EMPLOYMENT ADDRESS, OFFICE OF EMPLOYMENT ADDRESS, CITY, COUNTRY, STATE, POSTAL CODE, Private Residence Check Box If the, Registered, CRD BRANCH NYSE BRANCH CODE FIRM, Located At, START DATE, END DATE, and NonRegistered with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Form U5 conclusion process shown (portion 2)

3. Within this stage, examine Reason For Termination, Discharged Other Permitted to, Provide an explanation below, and Page of. Each one of these are required to be filled in with highest attention to detail.

Provide an explanation below, Reason For Termination, and Discharged Other Permitted to in Form U5

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4. Filling in INDIVIDUAL NAME, INDIVIDUAL CRD, Rev Form U UNIFORM TERMINATION, FIRM CRD, DATE OF TERMINATION, Date Terminated MMDDYYYY, and A complete date of termination is is vital in this fourth stage - make certain that you take your time and be attentive with each blank area!

5. Because you come close to the final parts of your document, there are actually several extra requirements that must be satisfied. Particularly, INDIVIDUAL NAME, INDIVIDUAL CRD, Rev Form U UNIFORM TERMINATION, FIRM CRD, PARTIAL TERMINATION, For a partial termination do not, If this is a PARTIAL TERMINATION, REGISTRATION CATEGORY, NASD NYSE, AMEX, BSE, NSX, PCX, CBOE, and CHX must all be filled out.

Form U5 conclusion process outlined (step 5)

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