©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 12/30/2022) Change History 12/30/2022 - Removed S101/S201 from ExamCodeType. Filing Type for the Form U4 filing. Allowed values (code-description) are: INITIAL - Initial Filing AMENDMENT - Amendment Filing P2BDINITIAL - Page 2 Initial P2BDAMEND - Page 2 Amendment DUAL - Dual RELICENSE - Relicense RELICENSEBD - Relicense BD RELICENSEIA - Relicense IA Form Version Filing Firm CRD Number Individual CRD Number Section 1 - General Information General Information - Firm Billing Code General Information - Employment Start Date with the filing firm General Information - Flag to indicate Independent Contractor relation with the filing firm. List of Registered Office of Employment Addresses (branch office locations) List of Non-Registered Office of Employment Addresses Registered Office employment location details Unique number that identifies a registered office location. This is the employment location sequence number (seqNb) that can be found on IIR. This is not the Branch CRD Number. Registered Office Location - BD Main Office Flag Registered Office Location - IA Main Office Flag Registered Office Location - Branch CRD Number Registered Office Location - Indicating whether the individual is Located at (L) or Supervised From (S) this location Registered Office Location - Employment Start Date Registered Office Location - Employment End Date Indication to specify if the regsitered employment location is being inserted or updated. Non - Registered Office employment location details Unique number that identifies a non-registered office location. This is the employment location sequence number (seqNb) that can be found on IIR. Non-Registered Office Location - Firm Billing code Non-Registered Office location - Address Non-Registered Office Location - Indication whether this location is a Private Residence. Non-Registered Office Location - Employment Start Date Non-Registered Office Location - Employment End Date Indication to specify if the non-regsitered employment location is being inserted or updated. Section 2 - Fingerprint Information Fingerprint Information - Code to indicate fingerprint requirements are satisfied or will be satisfied. Fingerprint BarCode Fingerprint Information - Flag to indicate fingerprint requirements are exempt under the Rule 17f-2(a)(1) i Fingerprint Information - Flag to indicate fingerprint requirements are exempt under the Rule 17f-2(a)(1) iii Fingerprint Information - Flag to indicate that the individual is applying as an Investment Adviser Representative Only Section 4 - SRO registrations List of SRO registrations requested SRO registration requested An SRO registration being requested SRO Registrations - Regulator Code. SRO Registrations - Registration Category Code. Section 5 - Jurisdiction registrations List of Jurisdiction registrations requested Jurisdiction registration requested An jurisdiction registration being requested Jurisdiction Registrations - Regulator Code (State) Jurisdiction Registrations - Registration Category Code (AG , RA) Section 6 - Registration Requests with Affiliated Firms Registration Requests with Affiliated Firms - Will applicant maintain registration with firm(s) under common ownership or control with the filing firm? List of Affiliated firms on the filing Registration request with an affiliated firm Affiliate Firm - Firm CRD Number Affiliate Firm - Firm Billing Code Affiliate Firm - Employment Date Affiliate Firm - Flag to indicate Independent Contractor relationship Indication to specify whether the affiliate firm record is being inserted or updated. Affiliate Firm - Registered office employment locations Affiliate Firm - Non-Registered office employment locations Affiliate Firm - Fingerprint Information Affiliate Firm - SRO Registrations Affiliate Firm - Jurisdiction Registrations Section 7- Examination Requests Examination requested Examination Requests - Exam Code. Examination previously taken Examination Requests - Previously Taken Exam Code. Examination Requests - Previously Taken Exam Date. Section 3 - Registration with Unafilliated Firms Registration with Unafilliated Firms - Will applicant maintain registration with a broker-dealer that is not affiliated with the filing firm? Registration with Unafilliated Firms - Will applicant maintain registration with an investment adviser that is not affiliated with the filing firm? Section 8 - Professional Designations Professional Designations - Certified Financial Planner(CFP) Professional Designations - Chartered Financial Consultant (ChFC) Professional Designations - Personal Financial Specialist(PFS) Professional Designations - Chartered Financial Analyst(CFA) Professional Designations - Chartered Investment Counselor(CIC) Section 9 - Identifying Information Identifying Information - First Name Identifying Information - Last Name Identifying Information - Middle Name Identifying Information - Suffix Identifying Information - Date of Birth Identifying Information - State of Birth Identifying Information - Province of Birth (outside USA) Identifying Information - Country of Birth Identifying Information - Sex Identifying Information - Height (in feet) Identifying Information - Height (in inches) Identifying Information - Weight in lbs Section 10 - Other Names (List) Other Name record Other Name Other Names - Unique number that identifies an other name record. Other Names - First Name Other Names - Last Name Other Names - Middle Name Other Names - Suffix Indication to specify if a record is being inserted or updated. Section 11 - Residential History (List) Residential History record Residential address history record Unique number that identifies the residential history record. Residential History - From Date Residential History - To Date Residential History - Address Indication to specify if a record is being inserted, updated or deleted. Section 12- Employment History (List) Employment History record Employment history record Unique number that identifies the employment history record. Indication to specify if a record is being inserted, updated or deleted. Employment History - From Date Employment History - To Date Employment History - Name of the employing firm or company Employment History - City where the employing firm is located Employment History - State where the employing firm is located Employment History - Country where the employing firm is located Employment History - Investment-Related Business Flag Employment History - Position Held with the firm Section 14 - Disclosure Questions 14A(1)(a) Criminal Disclosure 14A(1)(b) Criminal Disclosure 14A(2)(a) Criminal Disclosure 14A(2)(b) Criminal Disclosure 14B(1)(a) Criminal Disclosure 14B(1)(b) Criminal Disclosure 14B(2)(a) Criminal Disclosure 14B(2)(b) Criminal Disclosure 14C(1) Regulatory Action Disclosure 14C(2) Regulatory Action Disclosure 14C(3) Regulatory Action Disclosure 14C(4) Regulatory Action Disclosure 14C(5) Regulatory Action Disclosure 14C(6) Regulatory Action Disclosure 14C(7) Regulatory Action Disclosure 14C(8) Regulatory Action Disclosure 14D(1)(a) Regulatory Action Disclosure 14D(1)(b) Regulatory Action Disclosure 14D(1)(c) Regulatory Action Disclosure 14D(1)(d) Regulatory Action Disclosure 14D(1)(e) Regulatory Action Disclosure 14D(2)(a) Regulatory Action Disclosure 14D(2)(b) Regulatory Action Disclosure 14E(1) Regulatory Action Disclosure 14E(2) Regulatory Action Disclosure 14E(3) Regulatory Action Disclosure 14E(4) Regulatory Action Disclosure 14E(5) Regulatory Action Disclosure 14E(6) Regulatory Action Disclosure 14E(7) Regulatory Action Disclosure 14F Regulatory Action Disclosure 14G(1) Regulatory Action Disclosure 14G(2) Regulatory Action Disclosure 14H(1)(a) Civil Judicial Disclosure 14H(1)(b) Civil Judicial Disclosure 14H(1)(c) Civil Judicial Disclosure 14H(2) Civil Judicial Disclosure 14I(1)(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(1)(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(1)(c) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(1)(d) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(2)(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(2)(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(3)(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(3)(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(4)(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(4)(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(5)(a) Customer Complaint/Arbitration/Civil Litigation Disclosure 14I(5)(b) Customer Complaint/Arbitration/Civil Litigation Disclosure 14J(1) Termination Disclosure 14J(2) Termination Disclosure 14J(3) Termination Disclosure 14K(1) Financial Disclosure 14K(2) Financial Disclosure 14K(3) Financial Disclosure 14L Financial Disclosure 14M Financial Disclosure Section 13 - Other Business Other Business - Are you currently engaged in any other business either as a proprietor, partner, officer, director, employee, trustee, agent or otherwise? Other Business - Explanation details Section 15 - Signatures 15A. INDIVIDUAL/APPLICANT'S ACKNOWLEDGMENT AND CONSENT 15B. FIRM/APPROPRIATE SIGNATORY REPRESENTATIONS 15C. TEMPORARY REGISTRATION ACKNOWLEDGMENT 15D. AMENDMENT INDIVIDUAL/APPLICANT'S ACKNOWLEDGMENT AND CONSENT 15E. FIRM/APPROPRIATE SIGNATORY AMENDMENT REPRESENTATIONS Signature Signature Name Signature Date BD Page 2 Execution BD Page 2 Execution - Authorized Signatory BD Page 2 Execution - Title BD Page 2 Execution - Date Allowed values for exam request Allowed values for exam previously taken Fingerprint Barcode Available Type codes I represent that I am submitting, have submitted, or promptly will submit to the appropriate SRO a fingerprint card as required under applicable SRO rules I represent that I have been employed continuously by the filing firm since the last submission of a fingerprint card to CRD and am not required to resubmit a fingerprint card at this time I represent that I have been employed continuously by the filing firm and my fingerprints have been processed by an SRO other than FINRA. I am submitting, have submitted, or promptly will submit the processed results for posting to CRD. I affirm that I am exempt from the federal fingerprint requirement because I/filing firm currently satisfy(ies) the requirements of at least one of the permissive exemptions pursuant to Rule 17f-2 under the Securities exchange Act of 1934, including any notice or application requirements specified therein. I affirm that I am applying only as an investment adviser representative and that I am not also applying or have not also applied with this firm to become a broker-dealer representative. I am not required to submit a fingerprint card at this time because the fingerprint card submitted by the filing firm applies.