©2022 Financial Industry Regulatory Authority, Inc. (FINRA). All rights reserved. Materials may not be reprinted or republished without the express permission of FINRA. This document contains FINRA Confidential and Proprietary information. FINRA provides this information to member firms only for the firms' internal assessment or use of the FINRA CRD Batch Filing and Data Download transfer program. Any other use is strictly prohibited by FINRA. FINRA reserves the right to seek all injunctive and equitable relief available to it in the event FINRA Confidential or Proprietary information is released to a third party by a member firm. A firm's use of this document demonstrates its acknowledgement that this document contains FINRA Confidential and Proprietary information, agreement that the firm will not reprint, republish or otherwise disclose this information to any third party and its agreement that FINRA may protect its rights, including but not limited to intellectual property rights. Version: Release 2022.12 (last updated on 04/07/2015) Filing Type for the Form U5 filing. Allowed values (code-description) are: FULL - Full Termination PARTIAL - Partial Termination AMENDMENT - Amendment Filing Form Version Filing Firm CRD Number Individual CRD Number Section 4 - Date Terminated Date of Termination Explanation text if amending the Date of Termination Section 3 - Full Termination Full Termination - Reason for Termination Full Termination - Termination Explanation Full Termination - Explanation text if amending the Reason for Termination and/or termination explanation Section 5A. SRO Partial Termination Collection of SRO registrations being terminated An SRO registration being terminated SRO Registrations - Regulator Code. SRO Registrations - Registration Category code Section 5B. Jurisdiction Partial Termination Collection of Jurisdiction registrations being terminated A Jurisdiction registration being terminated Jurisdiction Registrations - Regulator Code (State) Jurisdiction Registrations - Registration Category Code (AG, RA) Section 6 - Affiliated Firm Termination Flag indicating if multiple employments (with affiliates) are being terminated Collection of affiliate firm employments being terminated An affiliate employment that is being terminated Affiliate Firm CRD Number Indicates whether full termination of this affilliate is requested. Applicable only for U5 Full. Partial termination of SRO registrations with an affiliate firm. Only applicable on U5 Partial. Partial termination of State registrations with an affiliate firm. Only applicable on U5 Partial. Section 7 - Disclosure Questions Disclosure Questions - Disclosure Certification Checkbox Indicating that there is no additional information to be reported at this time and details relating to Questions 7A, 7C, 7D and 7E have been previously reported on form U4 and updated information will be provided, if needed, as it becomes available to the firm 7A. Investigation Disclosure 7B. Internal Review Disclosure 7C.(1). Criminal Disclosure 7C.(2). Criminal Disclosure 7C.(3). Criminal Disclosure 7C.(4). Criminal Disclosure 7D. Regulatory Action Disclosure 7E.(1).(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(1).(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(1).(c) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(1).(d) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(2).(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(2).(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(3).(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(3).(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(4).(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(4).(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(5).(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 7E.(5).(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 7F.(1) Termination Disclosure 7F.(2) Termination Disclosure 7F.(3) Termination Disclosure Section 2 - Current Residential Address Current Residential Address Unique number that identifies the residential address record Current Residential Address - From Date Current Residential Address - To Date Current Residential Address- Address (Street 1, Street 2, City, State, Country and Postal Code) Indication to specify if record is being Inserted/Updated/deleted Section 8 - Signatures 8A. FIRM ACKNOWLEDGMENT - Person to contact for further information 8A. FIRM ACKNOWLEDGMENT - Telephone number of person to contact 8A. FIRM ACKNOWLEDGMENT - Signature of Appropriate Signatory 8A. FIRM ACKNOWLEDGMENT - Signature Date 8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENT - Individual Signature 8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENT - Signature Date Allowed values for reason for Termination