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Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:NOTICE TO THE INDIVIDUAL WHO IS THE SUBJECT OF THIS FILINGEven if you are no longer registered you continue to be subject to the jurisdiction of regulators for at least two years after yourregistration is terminated and may have to provide information about your activities while associated with this firm. Therefore,youmust forward any residential address changes for two years following your termination date or last Form U5 amendment to:CRD Address Changes, P.O. Box 9495, Gaithersburg, MD 20898-9495.1. GENERAL INFORMATIONFIRST NAME:MIDDLE NAME:FIRM CRD #:FIRM NAME:INDIVIDUAL CRD #:INDIVIDUAL SSN:LAST NAME:SUFFIX:FIRM NFA#:INDIVIDUAL NFA#:FIRM Billing Code:Office of Employment Address:CRD BRANCH #:ORegisteredONon-RegisteredNYSE BRANCH CODE#: FIRM BILLING CODE:START DATE: END DATE:O Located AtO Supervised FromOFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box. CRD BRANCH #:ORegisteredONon-RegisteredNYSE BRANCH CODE#: FIRM BILLING CODE:O Located AtO Supervised FromSTART DATE: END DATE:OFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box.ORegisteredONon-RegisteredCRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE: O Located AtO Supervised FromSTART DATE: END DATE:OFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box. 2. CURRENT RESIDENTIAL ADDRESSNOTICE TO THE FIRM: This is the last reportedresidentialaddress. If this is not current, please enter the currentresidential address.ADDRESS STREET 1:FROM (MM/YYYY):TO (MM/YYYY):CITY:STATE:ADDRESS STREET 2:COUNTRY:POSTAL CODE:3. FULL TERMINATIONIs this a FULL TERMINATION? O Yes O NoNote: A "Yes" response will terminate ALL registrations with all SROs and all jurisdictions.Page 1 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:Reason For Termination:O Discharged O Other O Permitted to Resign O Deceased O VoluntaryTermination Explanation:If the Reason for Termination entered above is Permitted to Resign, Discharged or Other, provide an explanation below:If amending the Reason for Termination and/or termination explanation, provide an explanation below:4. DATE OF TERMINATIONDate Terminated (MM/DD/YYYY):A complete date of termination is required for full termination. This date represents the date the firm terminated the individual's associationwith the firm in a capacity for which registration is required.For partial termination, the date of termination is only applicable to post-dated termination requests during the renewal period.Notes: For full termination, this date is used by jurisdictions/SROs to determine whether an individual is required to requalify by examinationor obtain an appropriate waiver upon reassociating with another firm.The SRO/jurisdiction determines the effective date of termination of registration.If amending the Date of Termination, provide an explanation below:Page 2 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:5. PARTIAL TERMINATIONFor a partial termination, do not complete the Reason for Termination in Section 3 (FULL TERMINATION) or Section 7 (DISCLOSUREQUESTIONS). The Reason for Termination and Section 7 (DISCLOSURE QUESTIONS) should only be completed on Form U5 for fulltermination requests.IEXMEMXMEMXBOXBOXLTSEMIAX PEARLMIAX PEARLLTSEMIAX OPTIONSMIAX OPTIONSREGISTRATION CATEGORIESIR - Investment Company and Variable ContractsProducts Rep. (S6TO)GS - Full Registration/General Securities Representative(S7TO)DR – Direct Participation Program Representative(S22TO)MR – Municipal Securities Representative (S52TO)IEXPHLXMIAX EMERALDISE MRXISE MRXMIAX EMERALDISE GEMXISE GEMXPHLXBXISEISENQXBXCBOE EDGXCBOE BZXCBOE EDGACBOE BYXCBOECBOE SENTATIVE LEVEL REGISTRATION CATEGORIESTD – Securities Trader (S57TO)IB – Investment Banking Representative (S79TO)PR – Limited Representative – Private SecuritiesOfferings (S82TO)RS – Research Analyst (S86 and S87)OS – Operations Professional (S99TO)Other(Paper Form Only)RETIRED REGISTRATION CATEGORIESAR – Assistant Representative/Order ProcessingCD – Canada-Limited General Securities RegisteredRepresentativeCN – Canada-Limited General Securities RegisteredRepresentativeCS – Corporate Securities RepresentativeFA - Foreign AssociateIE – United Kingdom - Limited General SecuritiesRegistered RepresentativeOR – Options RepresentativeRG – Government Securities RepresentativeSU – General Securities Sales Supervisor (S9 and S10)CO – Compliance Official (S14)CR – Compliance Officer (S14)SA – Supervisory Analyst (S16)GP – General Securities Principal (S24)RP – Research Principal (S24)BP – Investment Banking Principal (S24)TP – Securities Trader Principal (S24)Page 3 of 24NQXCBOE EDGXCBOE EDGACBOE BZXCBOE BYXCBOECBOE C2NYSE-CHIREGISTRATION CATEGORIESOP – Registered Options Principal (S4)NYSE-NATNYSE-ARCANYSE-AMERNYSEFINRAPRINCIPAL LEVEL REGISTRATION CATEGORIES
Rev. Form U5 (05/2009)IEXMEMXMEMXBOXBOXLTSEMIAX PEARLMIAX PEARLLTSEMIAX OPTIONSMIAX OPTIONSREGISTRATION CATEGORIESPO – Private Securities Offerings Principal (S24)IP – Investment Company and Variable ContractsProducts Principal (S26)FN – Financial and Operations Principal (S27)FI – Introducing Broker-Dealer/Financial and OperationsPrincipal (S28)DP – Direct Participation Program Principal (S39)IEXPHLXMIAX EMERALDMIAX EMERALDISE MRXISE MRXPHLXISE GEMXISE GEMXBXISEISENQXCBOE EDGXCBOE BZXCBOE BYXCBOECBOE C2NYSE-CHINYSE-NATNYSE-ARCAFIRM CRD #:NYSEFIRM NAME:NYSE-AMERINDIVIDUAL CRD #:FINRAINDIVIDUAL NAME:CBOE EDGAUNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONFP – Municipal Fund (S51)MP – Municipal Securities Principal (S53)PG – Government Securities PrincipalOther (PaperForm Only)RETIRED REGISTRATION CATEGORIESSM – Securities ManagerAP – Approved PersonCF – Compliance Official SpecialistFE – Floor EmployeeLE – Securities Lending RepresentativeLS – Securities Lending SupervisorME - Member ExchangeMT – Market Maker Authorized Trader-EquitiesOM – Options Member (S57TO)CT – Securities Trader Compliance Officer (S14)FL – Floor Clerk – Equities (S19)Page 4 of 24BXNQXCBOE EDGXCBOE EDGACBOE BZXCBOE BYXCBOECBOE C2NYSE-CHIREGISTRATION NGE-SPECIFIC REGISTRATION CATEGORIES
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:5B. JURISDICTION PARTIAL TERMINATIONCheck appropriate jurisdiction(s) for broker-dealer agent (AG) and/or investment adviser representative (RA) termination.JURISDICTIONAG nnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdaho sissippiMissouriAG RA JURISDICTIONMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaAG RA JURISDICTIONPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAG RA AGENT OF THE ISSUER REGISTRATION (AI) Indicate 2 letter jurisdiction code(s):6. AFFILIATED FIRM TERMINATIONIs this a multiple termination with one or more firms affiliated with the filing firm?O Ye sO NoIf "yes" to the above question and the termination requests for the filing firm are identical to the termination requests of each affiliated firm, then mark the same termination request foreach affiliate. If the termination requests of the affiliated firm(s) differ from those of the filing firm, complete the SRO and/or jurisdiction sections for each affiliated firm.AFFILIATED FIRM CRD #:AFFILIATED FIRM NAME:AFFILIATED FIRM BILLING CODE:Office of Employment Address:ORegisteredONon-RegisteredCRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:START DATE: END DATE:O Located AtO Supervised FromOFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box.ORegisteredONon-RegisteredCRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE: O Located AtO Supervised FromSTART DATE: END DATE:OFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box.ORegisteredONon-RegisteredCRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE: O Located AtO Supervised FromSTART DATE: END DATE:OFFICE OF EMPLOYMENT ADDRESS STREET 1:CITY:STATE:OFFICE OF EMPLOYMENT ADDRESS STREET 2:COUNTRY:POSTAL CODE:Private Residence Check Box: If the Office of Employment address is a private residence, check this box.Page 5 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:7. DISCLOSURE QUESTIONSIF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IN SECTION 7 IS 'YES', COMPLETE DETAILS OF ALL EVENTS ORPROCEEDINGS ON APPROPRIATE DRP(s). IF THE INFORMATION IN SECTION 7 HAS ALREADY BEEN REPORTED ON FORMU4 OR FORM U5, DO NOT RESUBMIT DRPs FOR THESE ITEMS. REFER TO THE EXPLANATION OF TERMS SECTION OF FORMU5 INSTRUCTIONS FOR EXPLANATION OF ITALICIZED WORDS.Disclosure Certification Checkbox (optional): By selecting the Disclosure Certification Checkbox, the firm certifies that (1) there is no additional information to be reported at this time; (2)details relating to Questions 7A, 7C, 7D and 7E have been previously reported on behalf of the individual via Form U4 and/or amendmentsto Form U4 (if applicable); and (3) updated information will be provided, if needed, as it becomes available to the firm.Note: Use of “Disclosure Certification Checkbox” is optional.7A.7B.7C.Investigation DisclosureCurrently is, or at termination was, the individual the subject of an investigation or proceeding by a domestic or foreigngovernmental body or self-regulatory organization with jurisdiction over investment-related businesses? (Note: Providedetails of an investigation on an Investigation Disclosure Reporting Page and details regarding a proceeding on aRegulatory Action Disclosure Reporting Page.)Internal Review DisclosureCurrently is, or at termination was, the individual under internal review for fraud or wrongful taking of property, orviolating investment-related statutes, regulations, rules or industry standards of conduct?YesNoOOOOOOOOOOOOOOOOOOOOOOOOOOCriminal DisclosureWhile employed by or associated with your firm, or in connection with events that occurred while the individual wasemployed by or associated with your firm, was the individual:convicted of or did the individual plead guilty or nolo contendere ("no contest") in a domestic, foreign or military1.court to any felony?2.3.4.charged with any felony?convicted of or did the individual plead guilty or nolo contendere ("no contest") in a domestic, foreign or militarycourt to a misdemeanor involving: investments or an investment-related business, or any fraud, false statementsor omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion, or a conspiracy tocommit any of these offenses?charged with a misdemeanor specified in item 7(C)(3)?Regulatory Action Disclosure7D.While employed by or associated with your firm, or in connection with events that occurred while the individual wasemployed by or associated with your firm, was the individual involved in any disciplinary action by a domestic orforeign governmental body or self-regulatory organization (other than those designated as a "minor rule violation"under a plan approved by the U.S. Securities and Exchange Commission) with jurisdiction over the investment-relatedbusinesses?Customer Complaint/Arbitration/Civil Litigation Disclosure7E.1.2.In connection with events that occurred while the individual was employed by or associated with your firm, wasthe individual named as a respondent/defendant in an investment-related, consumer-initiated arbitration or civillitigation which alleged that the individual was involved in one or more sales practice violations and which:is still pending, or;(a)(b)resulted in an arbitration award or civil judgment against the individual, regardless of amount, or;(c)was settled, prior to 05/18/2009, for an amount of 10,000 or more, or;was settled, on or after 05/18/2009, for an amount of 15,000 or more?(d)In connection with events that occurred while the individual was employed by or associated with your firm, wasthe individual the subject of an investment-related, consumer-initiated (written or oral) complaint, which allegedthat the individual was involved in one or more sales practice violations, and whichwas settled, prior to 05/18/2009, for an amount of 10,000 or more, or;(a)(b)was settled, on or after 05/18/2009, for an amount of 15,000 or more?Page 6 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:7. DISCLOSURE QUESTIONS (CONTINUED)In connection with events that occurred while the individual was employed by or associated with your3.firm, was the individual the subject of an investment-related, consumer-initiated, written complaint, nototherwise reported under questions 7(E)(2) above, which:would be reportable under question 14I(3)(a) on Form U4, if the individual were still employed by(a)your firm, but which has not previously been reported on the individual's Form U4 by your firm; or(b) would be reportable under question 14I(3)(b) on Form U4, if the individual were still employed byyour firm, but which has not previously been reported on the individual's Form U4 by your firm.Answer questions (4) and (5) below only for arbitration claims or civil litigation filed on or after 05/18/20094.In connection with events that occurred while the individual was employed by or associated with yourfirm, was the individual the subject of an investment-related, consumer-initiated, arbitration claim or civillitigation which alleged that the individual was involved in one or more sales practice violations, andwhich:(a)was settled for an amount of 15,000 or more, or;(b)5.resulted in an arbitration award of civil judgment against any named respondent(s)/defendant(s),regardless of amount?In connection with events that occurred while the individual was employed by or associated with yourfirm, was the individual the subject of an investment-related, consumer-initiated, arbitration claim or civillitigation not otherwise reported under question 7E(4) above, which:(a)would be reportable under question 14I(5)(a) on Form U4, if the individual were still employed byyour firm, but which has not previously been reported on the individual’s Form U4 by your firm; or(b)would be reportable under question 14I(5)(b) on Form U4, if the individual were still employed byyour firm, but which has not previously been reported on the individual's Form U4 by your firm.YesNoOOOOOOOOOOOOOOOOOOTermination Disclosure7F.Did the individual voluntarily resign from your firm, or was the individual discharged or permitted to resign fromyour firm, after allegations were made that accused the individual of:violating investment-related statutes, regulations, rules or industry standards of conduct?1.2.3.fraud or the wrongful taking of property?failure to supervise in connection with investment-related statutes, regulations, rules or industrystandards of conduct?8. SIGNATUREPlease Read CarefullyAll signatures required on this Form U5 filing must be made in this section.A "Signature" includes a manual signature or an electronically transmitted equivalent. For purposes of an electronic form filing, a signatureis effected by typing a name in the designated signature field. By typing a name in this field, the signatory acknowledges and representsthat the entry constitutes in every way, use, or aspect, his or her legally binding signature.8A. FIRM ACKNOWLEDGMENTThis section must be completed on all U5 form filings submitted by the firm.8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENTThis section must be completed on amendment U5 form filings where the individual is submitting changes to Part II of the INTERNALREVIEW DRP or changes to Section 2 (CURRENT RESIDENTIAL ADDRESS).8A. FIRM ACKNOWLEDGMENTI VERIFY THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED IN AND WITH THIS FORM.Person to contact for further informationTelephone # of person to contactSignature of Appropriate SignatoryDate (MM/DD/YYYY)Type or Print Name of Appropriate SignatoryPage 7 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:8B. INDIVIDUAL ACKNOWLEDGMENT AND CONSENTI VERIFY THE ACCURACY AND COMPLETENESS OF THE INFORMATION CONTAINED IN SECTION 2 (CURRENT RESIDENTIALADDRESS) AND/OR IN PART II OF THE INTERNAL REVIEW DRP.Individual SignatureDate (MM/DD/YYYY)Type or Print Name of IndividualPage 8 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:DISCLOSURE REPORTING PAGESU5 – CRIMINAL DRPRev. DRP (05/2009)This Disclosure Reporting Page is an INITIAL or AMENDED response to report details for affirmative response to Question(s) 7C onForm U5;Check the question(s) you are responding to, regardless of whether you are answering the question(s) "yes" or amending theanswer(s) to "no": 7C(1) 7C(2) 7C(3) 7C(4)Use this DRP to report all charges arising out of the same event. One event may result in more than one affirmative answer to the aboveitems. Multiple counts of the same charge arising out of the same event should be reported on the same DRP. Unrelated criminal actions,including separate cases arising out of the same event, must be reported on separate DRPs.Applicable court documents (i.e., criminal complaint, information or indictment as well as judgment of conviction or sentencingdocuments) must be provided to the CRD if not previously submitted.1. Formal action was brought in:O Federal CourtO State CourtO Military CourtO Foreign CourtO Other:A. Name of Court (Federal, State, Military, Foreign or Other):B. Location of Court (City or County and State or Country):C. Docket/Case#:2. Event Status:A. Current status of the Event?O PendingO On AppealO FinalB. Event Status Date (complete unless status is pending) (MM/DD/YYYY):If not exact, provide explanation:O Exact O Explanation3. Event and Disposition Disclosure Detail (Use this for both organizational and individual charges.):A. Date First Charged (MM/DD/YYYY):If not exact, provide explanation:O ExactO ExplanationB. Event and Disposition Detail:Charge Details (complete every field for each charge.)Formal Charge/Description:No. of Counts:Felony or Misdemeanor:O FelonyO MisdemeanorPlea for each Charge:Disposition of Charge:O AcquittedO DismissedO Pre-trial InterventionO AmendedO Found not guiltyO ReducedO ConvictedO Pled guiltyO Other (requires explanation)O Deferred AdjudicationExplanation:O Pled not guiltyPage 9 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:Date of Amended Charge, if applicable:U5 - CRIMINAL DRP (CONTINUED)Rev. DRP (05/2009)If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):No. of Counts (for amended or reduced charge):O Felony O MisdemeanorSpecify if amended or reduced charge is a Felony or Misdemeanor:Plea for each amended or reduced charge:Disposition of amended or reduced charge:O AcquittedO AmendedO ConvictedO Deferred AdjudicationO DismissedO Found not guiltyO Pled guiltyO Pled not guiltyO Other:O Pre-trial InterventionO ReducedO Other (requires explanation)Explanation:Charge Details (complete every field for each charge.)Formal Charge/Description:No. of Counts:Felony or Misdemeanor:O FelonyO MisdemeanorPlea for each Charge:Disposition of Charge:O AcquittedO DismissedO Pre-trial InterventionO AmendedO Found not guiltyO ReducedO ConvictedO Pled guiltyO Other (requires explanation)O Deferred AdjudicationExplanation:O Pled not guiltyPage 10 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:Date of Amended Charge, if applicable:If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):No. of Counts (for amended or reduced charge):O Felony O MisdemeanorSpecify if amended or reduced charge is a Felony or Misdemeanor:Plea for each amended or reduced charge:Disposition of amended or reduced charge:O AcquittedO AmendedO ConvictedO Deferred AdjudicationO DismissedO Found not guiltyO Pled guiltyO Pled not guiltyExplanation:Page 11 of 24O Other:O Pre-trial InterventionO ReducedO Other (requires explanation)
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:U5 - CRIMINAL DRP (CONTINUED)Rev. DRP (05/2009)Charge Details (complete every field for each charge.)Formal Charge/Description:No. of Counts:Felony or Misdemeanor:O FelonyO MisdemeanorPlea for each Charge:Disposition of Charge:O AcquittedO DismissedO Pre-trial InterventionO AmendedO Found not guiltyO ReducedO ConvictedO Pled guiltyO Other (requires explanation)O Deferred AdjudicationExplanation:O Pled not guiltyDate of Amended Charge, if applicable:If original charge was amended or reduced, specify new charge (i.e., list amended charge or reduced charge):No. of Counts (for amended or reduced charge):O Felony O MisdemeanorSpecify if amended or reduced charge is a Felony or Misdemeanor:Plea for each amended or reduced charge:Disposition of amended or reduced charge:O AcquittedO AmendedO ConvictedO Deferred AdjudicationO DismissedO Found not guiltyO Pled guiltyO Pled not guiltyO Other:O Pre-trial InterventionO ReducedO Other (requires explanation)Explanation:C. Date of Disposition (MM/DD/YYYY):O ExactO ExplanationIf not exact, provide explanation:D. Sentence/Penalty; Duration (if suspension, probation, etc): Start Date of Penalty: (MM/DD/YYYY); End date of Penalty:(MM/DD/YYYY); If Monetary penalty/fine – Amount paid; Date monetary/penalty fine paid: (MM/DD/YYYY) if not exact, provideexplanation.Page 12 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:4. Comment (Optional). You may use this field to provide a brief summary of the circumstances leading to the charge(s) as well as thecurrent status or final disposition. Your information must fit within the space provided.U5 - CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DRPThis Disclosure Reporting Page is anForm U5; INITIAL orRev. DRP (05/2009) AMENDED response to report details for affirmative response to Question(s) 7E onCheck the question(s) you are responding to, regardless of whether you are answering the question(s) "yes" or amending theanswer(s) to "no": 7E(1)(a) 7E(1)(b) 7E(1)(c) 7E(1)(d) 7E(2)(a) 7E(2)(b) 7E(3)(a) 7E(3)(b) 7E(4)(a) 7E(4)(b) 7E(5)(a) 7E(5)(b)One matter may result in more than one affirmative answer to the above items. Use a single DRP to report details relating to a particularmatter (i.e., a customer complaint/arbitration/CFTC reparation/civil litigation). Use a separate DRP for each matter.DRP Instructions: Complete items 1-6 for all matters (i.e., customer complaints, arbitrations/CFTC reparations and civil litigation in which a customeralleges that the individual was involved in sales practice violations and the individual is not named as a party, as well asarbitrations/CFTC reparations and civil litigation in which the individual is named as a party). If the matter involves a customer complaint, or an arbitration/CFTC reparation or civil litigation in which a customer alleges that theindividual was involved in sales practice violations and the individual is not named as a party, complete items 7-11 as appropriate. If a customer complaint has evolved into an arbitration/CFTC reparation or civil litigation, amend the existing DRP by completingitems 9 and 10. If the matter involves an arbitration/CFTC reparation in which the individual is a named party, complete items 12-16, asappropriate. If the matter involves a civil litigation in which the individual is a named party, complete items 17-23. Item 24 is an optional field and applies to all event types (i.e., customer complaint, arbitration/CFTC reparation, civil litigation).Complete items 1-6 for all matters (i.e., customer complaints, arbitrations/CFTC reparations, civil litigation).1. Customer Name(s):2. A. Customer(s) State of Residence (select "not on list" when the customer's residence is a foreignaddress):B. Other state(s) of residence/detail:3. Employing Firm when activities occurred which led to the customer complaint, arbitration, CFTC reparation or civil litigation:4. Allegation(s) and a brief summary of events related to the allegation(s) including dates when activities leading to the allegation(s)occurred:5. Product Type(s): (select all that apply)Page 13 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #: No Product Annuity-Charitable Annuity-Fixed Annuity-Variable Banking Product (other than CD) CD Commodity Option Debt-Asset Backed Debt-Corporate Debt-Government Debt-Municipal Derivative Direct Investment-DPP & LP Interest Equipment Leasing Equity Listed (Common & Preferred Stock) Equity-OTC Futures Commodity Futures-Financial Index Option Insurance Investment Contract Money Market Fund Mutual Fund Oil & Gas Options Penny Stock Prime Bank Instrument Promissory Note Real Estate Security Security Futures Unit Investment Trust Viatical Settlement Other:6. Alleged Compensatory Damage Amount: O ExactOExplanation (If no damage amount is alleged, the complaint must be reported unless the firm has made a good faithdetermination that the damages from the alleged conduct would be less than 5,000):U5 - CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DRP (CONTINUED)Rev. DRP (05/2009)If the matter involves a customer complaint, arbitration/CFTC reparation or civil litigation in which a customer alleges that theindividual was involved in sales practice violations and the individual is not named as a party, complete items 7-11 asappropriate.7. A. Is this an oral complaint?B. Is this an written complaint?O YesO YesO NoO NoO YesO NoC. Is this an arbitration/CFTC reparation or civil litigation?If yes, provide:i. Arbitration/reparation forum or court name and location:ii. Docket/Case#:iii. Filing date of arbitration/CFTC reparation or civil litigation (MM/DD/YYYY):D. Date received by/served on firm (MM/DD/YYYY):O ExactO ExplanationIf not exact, provide explanation:8. Is the complaint, arbitration/CFTC reparation or civil litigation pending? Yes NoIf "No", complete item 9.9. If the complaint, arbitration/CFTC reparation or civil litigation is not pending, provide status: Closed/No Action Withdrawn Denied Arbitration Award/Monetary Judgment (for claimants/plaintiffs) Arbitration Award/Monetary Judgment (for respondents/defendants) Evolved into Arbitration/CFTC reparation (the individual is a named party) Evolved into Civil Litigation (the individual is a named party) Closed/No Action SettledIf status is arbitration/CFTC reparation in which the individual is not a named party, provide details in item 7C.If status is arbitration/CFTC reparation in which the individual is a named party, complete items 12-16.If status is civil litigation in which the individual is a named party, complete items 17-23.10. Status Date (MM/DD/YYYY):If not exact, provide explanation:O ExactO Explanation11. Settlement/Award/Monetary Judgment:A. Settlement/Award/Monetary Judgment amount: Page 14 of 24
Rev. Form U5 (05/2009)UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATIONINDIVIDUAL NAME:INDIVIDUAL CRD #:FIRM NAME:FIRM CRD #:B. Individual Contribution Amount: If the matter involves arbitration or CFTC reparation in which the individual is a named respondent, complete items 12-16, asappropriate.12. A. Arbitration/CFTC reparation claim filed with (FINRA, AAA, CFTC, etc.):B. Docket/Case#:O Exact O ExplanationC. Date notice/process was served (MM/DD/YYYY):If not exact, provide explanation:13. Is arbitration/ CFTC reparation pending?If "No", complete item 14.O Yes O No14. If the complaint, arbitration/CFTC reparation or civil litigation is not pending, provide status: Award to Applicant (Agent/Representative) Award to Customer Denied Judgment (other than monetary) Other:15. Disposition Date (MM/DD/YYYY):If not exact, provide explanation: No ActionO Exact Settled Dismissed WithdrawnO ExplanationU5 - CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DRP (CONTINUED)Rev. DRP (05/2009)16. Monetary Compensation Details (award, set
or obtain an appropriate waiver upon reassociating with another firm. The SRO/jurisdiction determines the effective date of termination of registration. If amending the Date of Termination, provide an explanation below: Rev. Form U5 (05/2009) UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
