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Form ADV (Paper Version) Uniform Application For Investment Adviser Registration (Part 1A) (SEC1707) ADV - Official Federal Forms
| Form ADV (Paper Version) Uniform Application For Investment Adviser Registration (Part 1A) (SEC1707) Form. This is a national form and can be used in Securities And Exchange Commission . |
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FORM ADV (Paper Version) UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT BY EXEMPT REPORTING ADVISERS PART 1A WARNING: Complete this form truthfully. False statements or omissions may result in denial of your application, revocation of your registration, or criminal prosecution. You must keep this form updated by filing periodic amendments. See Form ADV General Instruction 4. Check the box that indicates what you would like to do (check all that apply): SEC or State Registration: Submit an initial application to register as an investment adviser with the SEC. Submit an initial application to register as an investment adviser with one or more states. Submit an annual updating amendment to your registration for your fiscal year ended _________. Submit an other-than-annual amendment to your registration. SEC or State Report by Exempt Reporting Advisers: Submit an initial report to the SEC. Submit a report to one or more state securities authorities. Submit an annual updating amendment to your report for your fiscal year ended _________. Submit an other-than-annual amendment to your report. Submit a final report. Item 1 Identifying Information Responses to this Item tell us who you are, where you are doing business, and how we can contact you. A. Your full legal name (if you are a sole proprietor, your last, first, and middle names): ___________________________________________________________ B. Name under which you primarily conduct your advisory business, if different from Item 1.A. _____________________________________________________________________________ List on Section 1.B. of Schedule D any additional names under which you conduct your advisory business. C. If this filing is reporting a change in your legal name (Item 1.A.) or primary business name (Item 1.B.), enter the new name and specify whether the name change is of your legal name or your primary business name: _____________________________________________________________________________ D. (1) If you are registered with the SEC as an investment adviser, your SEC file number: 801-___________ (2) If you report to the SEC as an exempt reporting adviser, your SEC file number: 802-___________ E. If you have a number ("CRD Number") assigned by the FINRA's CRD system or by the IARD system, your CRD number: ___________ SEC 1707 (09-11) File 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com FORM ADV Part 1A Page 2 of 19 Your Name_____________________ Date_____________________ CRD Number_____________________ SEC 801- or 802 Number_____________________ If your firm does not have a CRD number, skip this Item 1.E. Do not provide the CRD number of one of your officers, employees, or affiliates. F. Principal Office and Place of Business (1) Address (do not use a P.O. Box): ____________________________________________________________________ (number and street) ____________________________________________________________________ (city) (state/country) (zip+4/postal code) If this address is a private residence, check this box: List on Section 1.F. of Schedule D any office, other than your principal office and place of business, at which you conduct investment advisory business. If you are applying for registration, or are registered, with one or more state securities authorities, you must list all of your offices in the state or states to which you are applying for registration or with whom you are registered. If you are applying for SEC registration, if you are registered only with the SEC, or if you are reporting to the SEC as an exempt reporting adviser, list the largest five offices in terms of numbers of employees. (2) Days of week that you normally conduct business at your principal office and place of business: Monday - Friday Other: _____________________________________________ Normal business hours at this location: _______________________________________ (3) Telephone number at this location: ___________________________________________ (area code) (telephone number) (4) Facsimile number at this location: ____________________________________________ (area code) (facsimile number) G. Mailing address, if different from your principal office and place of business address: ____________________________________________________________________ (number and street) ____________________________________________________________________ (city) (state/country) (zip+4/postal code) If this address is a private residence, check this box: H. If you are a sole proprietor, state your full residence address, if different from your principal office and place of business address in Item 1.F.: ____________________________________________________________________ (number and street) ____________________________________________________________________ (city) (state/country) (zip+4/postal code) American LegalNet, Inc. www.FormsWorkFlow.com FORM ADV Part 1A Page 3 of 19 Your Name_____________________ Date_____________________ CRD Number_____________________ SEC 801- or 802 Number_____________________ I. Do you have one or more websites? Yes No If "yes," list all website addresses on Section 1.I. of Schedule D. If a website address serves as a portal through which to access other information you have published on the web, you may list the portal without listing addresses for all of the other information. Some advisers may need to list more than one portal address. Do not provide individual electronic mail (e-mail) addresses in response to this Item. J. Provide the name and contact information of your Chief Compliance Officer: If you are an exempt reporting adviser, you must provide the contact information for your Chief Compliance Officer, if you have one. If not, you must complete Item 1.K. below. ___________________________________________________________________________ (name) ____________________________________________________________________________ (other titles, if any) _____________________________________ ____________________________________ (area code) (telephone number) (area code) (facsimile number) ____________________________________________________________________ (number and street) ____________________________________________________________________ (city) (state/country) (zip+4/postal code) _________________________________________________ (electronic mail (e-mail) address, if Chief Compliance Officer has one) K. Additional Regulatory Contact Person: If a person other than the Chief Compliance Officer is author
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