Form X 17A 5 Fillable PDF Details

In the world of finance and securities, compliance with regulatory requirements is a cornerstone of maintaining the trust and integrity of the financial markets. The X-17A-5 Form, issued under the auspices of the United States Securities and Exchange Commission (SEC) based in Washington, D.C., serves as a critical component of this compliance framework, specifically for brokers and dealers. This form, part of the annual audited report, requires detailed information that reflects the financial health and operational integrity of the submitting entity. It encompasses a broad spectrum of data starting from basic registrant identification details to intricate financial statements and disclosures. The form is structured to ensure transparency and accountability, demanding inputs such as the complete identification of the broker-dealer, principal place of business, contact information, and the identification of the accountant responsible for the audit. Furthermore, it includes an oath or affirmation confirming the accuracy and truthfulness of the provided information and financial statements. By facilitating a comprehensive review process, including financial conditions, income or loss statements, changes in financial condition, and stockholders' equity among others, the X-17A-5 Form plays a pivotal role in enforcing adherence to Section 17 of the Securities Exchange Act of 1934 and Rule 17a-5 thereunder. It is designed not only to safeguard the interests of the investors but also to bolster the overall confidence in the United States' financial systems.

QuestionAnswer
Form NameForm X 17A 5 Fillable
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform x, x 17a 5 part iii, report form 17a, sec form x 17a 5

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UNITEDSTATES

SECURITIESANDEXCHANGECOMMISSION

Washington, D.C. 20549

ANNUAL AUDITED REPORT

FORM X-17A-5

PART III

FACING PAGE

OMB APPROVAL

OMB Number:

3235-0123

Expires: October 31, 2023 Estimated average burden

hours per response.. . . . . 12.00

SEC FILE NUMBER

8-

Information Required of Brokers and Dealers Pursuant to Section 17 of the

Securities Exchange Act of 1934 and Rule 17a-5 Thereunder

REPORT FOR THE PERIOD BEGINNING______________________________ AND ENDING______________________________

MM/DD/YY

MM/DD/YY

 

 

 

 

 

 

A. REGISTRANT IDENTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF BROKER-DEALER:

OFFICIAL USE ONLY

 

 

 

 

 

 

ADDRESS OF PRINCIPAL PLACE OF BUSINESS: (Do not use P.O. Box No.)

 

FIRM I.D. NO.

 

 

 

 

 

 

___________________________________________________________________________________________________________________

(No. and Street)

_____________________________________________________________________________________________________________________

(City)(State)(Zip Code)

NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT

_____________________________________________________________________________________________________________________

(Area Code – Telephone Number)

B. ACCOUNTANT IDENTIFICATION

INDEPENDENT PUBLIC ACCOUNTANT whose opinion is contained in this Report*

_____________________________________________________________________________________________________________________

(Name – if individual, state last, first, middle name)

_____________________________________________________________________________________________________________________

(Address)

(City)

(State)

(Zip Code)

CHECK ONE:

 

 

 

…

…

…

Certified Public Accountant

Public Accountant

Accountant not resident in United States or any of its possessions.

FOR OFFICIAL USE ONLY

*Claims for exemption from the requirement that the annual report be covered by the opinion of an independent public accountant must be supported by a statement of facts and circumstances relied on as the basis for the exemption. See Section 240.17a-5(e)(2)

 

Potential persons who are to respond to the collection of

SEC 1410 (11-05)

information contained in this form are not required to respond

unless the form displays a currently valid OMB control number.

OATH OR AFFIRMATION

I, ___________________________________________________________________________ , swear (or affirm) that, to the best of

my knowledge and belief the accompanying financial statement and supporting schedules pertaining to the firm of

_____________________________________________________________________________________________________________ , as

of _________________________________________________, 20________, are true and correct. I further swear (or affirm) that

neither the company nor any partner, proprietor, principal officer or director has any proprietary interest in any account classified solely as that of a customer, except as follows:

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________

_________________________________________

Signature

_________________________________________

Title

_________________________________________

Notary Public

This report ** contains (check all applicable boxes):

(a) Facing Page.

(b)Statement of Financial Condition.

(c)Statement of Income (Loss) or, if there is other comprehensive income in the period(s) presented, a Statement of Comprehensive Income (as defined in §210.1-02 of Regulation S-X).

(d)Statement of Changes in Financial Condition.

(e) Statement of Changes in Stockholders’ Equity or Partners’ or Sole Proprietors’ Capital.

(f) Statement of Changes in Liabilities Subordinated to Claims of Creditors.

(g) Computation of Net Capital.

(h) Computation for Determination of Reserve Requirements Pursuant to Rule 15c3-3.

(i) Information Relating to the Possession or Control Requirements Under Rule 15c3-3.

(j) A Reconciliation, including appropriate explanation of the Computation of Net Capital Under Rule 15c3-1 and the Computation for Determination of the Reserve Requirements Under Exhibit A of Rule 15c3-3.

…(k) A Reconciliation between the audited and unaudited Statements of Financial Condition with respect to methods of consolidation.

…(l) An Oath or Affirmation.

…(m) A copy of the SIPC Supplemental Report.

…(n) A report describing any material inadequacies found to exist or found to have existed since the date of the previous audit.

**For conditions of confidential treatment of certain portions of this filing, see section 240.17a-5(e)(3).

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Guidelines on how to fill out sec designation of accountant form part 1

2. Once your current task is complete, take the next step – fill out all of these fields - INDEPENDENT PUBLIC ACCOUNTANT, Name if individual state last, Address, City, State, Zip Code, CHECK ONE, Certified Public Accountant Public, Accountant not resident in United, FOR OFFICIAL USE ONLY, and Claims for exemption from the with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage # 2 of submitting sec designation of accountant form

3. This third part is pretty simple, OATH OR AFFIRMATION, ear or affirm that to the best of, my knowledge and belief the, of are true and correct I, neither the company nor any, classified solely as that of a, Signature, Title, Notary Public, This report contains check all, and a Facing Page b Statement of - each one of these fields has to be filled out here.

Filling in section 3 of sec designation of accountant form

4. This specific subsection comes with these empty form fields to complete: a Facing Page b Statement of, of Comprehensive Income as defined, d Statement of Changes in, Computation for Determination of, k A Reconciliation between the, consolidation, l An Oath or Affirmation m A copy, and For conditions of confidential.

consolidation, l An Oath or Affirmation m A copy, and a Facing Page b Statement of in sec designation of accountant form

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