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Form 17-H Risk Assessment Report For Brokers And Dealers (SEC2332) 17-H - Official Federal Forms
| Form 17-H Risk Assessment Report For Brokers And Dealers (SEC2332) Form. This is a national form and can be used in Securities And Exchange Commission . |
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United States Securities and Exchange Commission Washington, D.C. 20549 20% $33529$/ 20% 1XPEHU ([SLUHV 1RYHPEHU (VWLPDWHG DYHUDJH EXUGHQ KRXUV SHU UHVSRQVH FORM 17-H RISK ASSESSMENT REPORT FOR BROKERS AND DEALERS PART I Risk Assessment Reporting Requirements for Brokers and Dealers 12 NAME OF REPORTING BROKER-DEALER SEC FILE NO. ____________________ ____________________________________________ 14 CRD NO. _________________________ 16 _ ADDRESS OF PRINCIPAL PLACE OF BUSINESS ____________________________________________________________________________________ 18 FIRM I.D. NO. ____________________________________________ 20 FILING TYPE: (Check Appropriate Boxes) FOR PERIOD BEGINNING (MM/DD/YY) QUARTERLY ANNUAL AMENDED ______________________________________________ 22 28 30 26 AND ENDING (MM/DD/YY) ______________________________________________ 24 NAME AND TELEPHONE NUMBER OF PERSON TO CONTACT IN REGARD TO THIS REPORT ______________________________________________ 32 NAME(S) OF MATERIAL ASSOCIATED PERSONS CONTAINED IN THIS REPORT: ______________________________________________ 34 ____________________________________ 36 ______________________________________________ 38 ____________________________________ 40 42 ______________________________________________ NAME OF ASSOCIATED BROKER-DEALER(S) NOT FILING (If applicable) 44 ________________________________________________ ____________________________________ 46 ______________________________________________ 48 ____________________________________ 50 ______________________________________________ 52 ATTENTION Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. § 1001 and 15 U.S.C. § 78ff(a). Intentional misstatements or omissions of facts may also result in civil fines and other sanctions pursuant to Section 20 of the Securities Exchange Act of 1934. The person signing this report represents hereby that all information contained in this Form is true, correct and complete. It is understood that all information in this Form is considered an integral part of this Form and that the submission of any amendment represents that all unamended information remains true, correct and complete as previously filed. Pursuant to the Securities Exchange Act of 1934, the undersigned has caused this report to be signed on its behalf in the City of __________________ and State of _______________ on the ___ day of ____________, 20___. __________________________________________ (Name of Broker-Dealer) ________________________________________________________________________________________ (Signature and Title of Person Duly Authorized to Submit This Report) Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. 6(& American LegalNet, Inc. www.FormsWorkFlow.com GENERAL INSTRUCTIONS 1. This Form consists of two parts. Part I consists of the organizational, policy and legal information required by paragraphs (a)(1)(i) through (iii) of section 240.17h-1T, together with the financial statements required by paragraphs (a)(1)(iv) and (v) of section 240.17h-1T. Part II contains line items for reporting the numerical and other data required by paragraphs (a)(1)(vi) through (x) of section 240.17h-1T. 2. Report as of the last day of the fiscal quarter. This Form is to be filed within 60 calendar days of the end of each fiscal quarter by brokers and dealers concerning each Material Associated Person (as defined in Temporary Rules 17h-1T and 17h-2T). The Form for the fourth fiscal quarter shall be filed within 60 calendar days of the end of the fiscal year. The cumulative year-end financial statements required by paragraphs (a)(1)(iv) and (v) of section 240.17h-1T may be filed separately within 105 calendar days of the end of the fiscal year. 3. In the event a broker or dealer is associated with one or more other registered brokers or dealers, each broker or dealer is required to file a separate Form 17-H. The Commission may exempt from the filing requirements all brokers or dealers associated with a broker or dealer that has been designated a "Reporting Broker or Dealer." The term "Reporting Broker or Dealer" shall have the meaning set forth in Rules 17h-1T and 17h-2T. A broker or dealer seeking designation as a Reporting Broker or Dealer must apply to the Commission for an exemption pursuant to Rule 17h-2T. Pending such designation, each broker or dealer associated with the broker or dealer requesting such designation as a Reporting Broker or Dealer is required to file a separate Form 17-H. 4. The information requested in Part II of this Form shall be completed separately for each Material Associated Person, even if the financial data contained in the broker or dealer's Form X-17A-5 contains information concerning a Material Associated Person. The broker-dealer should not include information concerning its activities in the information required by Part II of this Form if such information is filed with the Commission as part of the broker-dealer's Form X-17A-5 or Form G-405. ITEM 1 ORGANIZATIONAL CHART REFLECTING ASSOCIATED PERSONS AND THE BROKER-DEALER 1. Provide a copy of the organizational chart maintained by the broker or dealer pursuant to paragraph (a)(1)(i) of section 240.17h-1T. 2. The information provided pursuant to this Item should be included in the first Form 17-H filed by the broker or dealer and in the year-end filing. Quarterly updates should be provided only where a material change in the information provided to the Commission has occurred. ITEM 2 RISK MANAGEMENT AND OTHER POLICIES 1. Provide copies of the financing, capital adequacy, and risk management and other policies, procedures or systems maintained by the broker-dealer pursuant to paragraph (a)(1)(ii) of section 240.17h-1T. 2. The information provided pursuant to this Item should be included in the first Form 17-H filed by the broker or dealer. Quarterly updates should be provided only where a material change in the information provided to the Commission has occurred. ITEM 3 LEGAL PROCEEDINGS 1. Provide the description of any material pending legal or arbitration proceedings maintained by the broker or dealer pursuant to paragraph (a)(1)(iii) of section 240.17h-1T. 2. The information provided pursuant to this Item should be included in the first Form 17-H filed with the Commission. Quarterly updates should be provided only where a m
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