SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
APPLICATION FOR MUNICIPAL ADVISOR REGISTRATION FOR NATURAL PERSONS
OMB Number: 3235-0681
Estimated average burden hours per response: 3.0
Form MA-I Applicant's Information
Submission Contact Information
Notification Information
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
Please read the General Instructions for this form and other forms in the MA series, as well as its subsection, "Specific Instructions for Form MA-I," before completing this form. All italicized terms herein are defined or described in the Glossary of Terms appended to the General Instructions.
PART 1
Every municipal advisory firm applying for registration or registered as a municipal advisor on Form MA, to provide information regarding each natural person who is an associated person of the firm and engages in municipal advisory activities on the firm's behalf (for purposes of Form MA-I, the "individual"); and
Every natural person (sole proprietor) applying for registration as a municipal advisor on Form MA, to provide additional personal information.
WARNING
Complete this form truthfully. False statements or omissions may result in denial of a municipal advisor's application, revocation or suspension of such registration, or criminal prosecution. Form MA-I must be amended promptly whenever any information previously provided becomes inaccurate. See General Instruction 9.
Type of Filing:
This is an (check the appropriate box):![checkbox checked](/img/sec/box-checked.jpg)
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Item 1 Identifying Information
A. The Individual
B. Municipal Advisory Firms Where the Individual Is Employed
In providing your responses, please note that the definition of "employee" for purposes of this form includes an independent contractor who engages in municipal advisory activities on behalf of a municipal advisory firm. See Glossary of Terms.
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(For individuals who are employed with more than one firm, provide the information required by this Item 1-B for each such firm. For sole proprietors, enter the legal name under which you conduct your municipal advisor-related activities, and skip to Item 1-B.1.)
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(1) Municipal Advisory Firm's Registration Information:
Notification will automatically be sent to the Login CIK, Submission Contact, and Primary Issuers. Specify additional addresses below.
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(2) Office
Enter the requested information for each office of the municipal advisory firm where the individual is or will be physically located, and each office from which the individual is or will be supervised:
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A private residential address will not be included in publicly available versions of this registration form.
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A private residential address will not be included in publicly available versions of this registration form.
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Item 2 Other Names
Enter the following information for all other names that the individual has used or is using, or by which the individual is known or has been known, other than the individual´s legal name, since the age of 18.
This space should include, for example, nicknames, aliases, and names used before or after marriage.
Item 3 Residential History
Starting with the current address, enter the following information for all the individual´s residential addresses for the past 5 years. Leave no gaps greater than three months between addresses. Report changes in an amendment to this form as they occur in the future. Private residential addresses will not be included in publicly available versions of this form.
Current Address
Item 4 Employment History
Provide complete employment history of the individual for the past 10 years. Include the municipal advisory firm(s) entered in Item 1-B. Enter the following information for each employer. Account for all time, leaving no gaps longer than three months. Include full- and part-time employment, self-employment, military service, and homemaking. Also include statuses such as unemployed, full-time education, extended travel, or other similar statuses. Such statuses should be entered in the space provided below for "Name of Municipal Advisory Firm or Company."
Current Employer
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Item 5 Other Business
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Item 6 Disclosure Information
IF THE ANSWER TO ANY OF THE QUESTIONS IN ITEMS 6A – 6J AND 6M IS "YES," PROVIDE DETAILS OF ALL EVENTS OR PROCEEDINGS ON THE APPROPRIATE DISCLOSURE REPORTING PAGES (DRPs).
One event or proceeding may result in the requirement to answer "Yes" to more than one question below.
Refer to the Glossary of Terms for definitions or descriptions of italicized terms.
CRIMINAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6A or 6B, complete a Criminal Action DRP.
Item 6A.
(1) Has the individual ever:
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(2) Based upon activities that occurred while the individual exercised control over it, has an organization ever:
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Item 6B.
(1) Has the individual ever:
(a) been convicted of any misdemeanor or pled guilty or nolo contendere ("no contest") in a domestic, foreign or military court to any charge of a misdemeanor involving: municipal advisory activities or a municipal advisor-related or investment-related business or any fraud, false statements or omissions, wrongful taking of property, bribery, perjury, forgery, counterfeiting, extortion, or a conspiracy to commit any of these offenses?
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(b) been charged with any misdemeanor of the kind described in 6B(1)(a)?
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REGULATORY ACTION DISCLOSURE
If the answer is "Yes" to any question below in Items 6C-6G(1), complete a Regulatory Action DRP.
Item 6C.
Has the SEC or the CFTC ever:
(1) found the individual to have made a false statement or omission?
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(2) found the individual to have been involved in a violation of any SEC or CFTC regulation or statute?
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(3) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related business or investment-related business to operate?
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(4) entered an order against the individual in connection with municipal advisor-related or investment-related activity?
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(5) imposed a civil money penalty on the individual, or ordered the individual to cease and desist from any activity?
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(6) found the individual to have willfully violated any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB, or found the individal to have been unable to comply with any provision of such Acts, rules or regulations?
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(7) found the individual to have willfully aided, abetted, counseled, commanded, induced, or procured the violation by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB?
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(8) found the individual to have failed reasonably to supervise another person subject to his or her supervision, with a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB?
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Item 6D.
(1) Has any other federal regulatory agency or any state regulatory agency or foreign financial regulatory authority ever:
(a) found the individual to have made a false statement or omission or to have been dishonest, unfair or unethical?
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(b) found the individual to have been involved in a violation of municipal advisor-related or investment-related regulation(s) or statute(s)?
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(c) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related or investment-related business to operate?
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(d) entered an order against the individual in connection with a municipal advisor-related or investment-related activity?
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(e) denied, suspended, or revoked the individual's registration or license or otherwise, by order, prevented the individual from associating with a municipal advisor-related or investment-related business or restricted his or her activities?
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(2) Has the individual ever been subject to any final order of a state securities commission (or any agency or office performing like functions), a state authority that supervises or examines banks, savings associations, or credit unions, a state insurance commission (or any agency or office performing like functions), a federal banking agency, or the National Credit Union Administration, that:
(a) bars the individual from association with an entity regulated by such commission, authority, agency, or office, or from engaging in the business of securities, insurance, banking, savings association activities, or credit union activities; or
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(b) is based on violations of any laws or regulations that prohibit fraudulent, manipulative, or deceptive conduct?
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Item 6E.
Has any self-regulatory organization or commodities exchange ever:
(1) found the individual to have made a false statement or omission?
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(2) found the individual to have been involved in a violation of its rules (other than a violation designated as a "minor rule violation" under a plan approved by the SEC)?
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(3) found the individual to have been a cause of a denial, suspension, revocation, or restriction of the authorization of a municipal advisor-related or investment-related business to operate?
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(4) disciplined the individual by expelling or suspending him or her from membership, barring or suspending the individual's association with its members, or restricting the individual's activities?
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(5) found the individual to have willfully violated any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB, or found the individual to have been unable to comply with any provision of such Acts, rules or regulations?
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(6) found the individual to have willfully aided, abetted, counseled, commanded, induced, or procured the violation by any person of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB?
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(7) found the individual to have failed reasonably to supervise another person subject to your supervision, with a view to preventing the violation of any provision of the Securities Act of 1933, the Securities Exchange Act of 1934, the Investment Advisers Act of 1940, the Investment Company Act of 1940, the Commodity Exchange Act, or any rule or regulation under any of such Acts, or any of the rules of the MSRB?
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Item 6F.
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Item 6G.
Has the individual been notified, in writing, that he or she is currently the subject of any:
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INVESTIGATION DISCLOSURE
If the answer is "Yes" to Item 6G(2) below, complete an Investigation DRP.
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CIVIL JUDICIAL ACTION DISCLOSURE
If the answer is "Yes" to any question below in Item 6H, complete a Civil Judicial Action DRP.
Item 6H.
(1) Has any domestic or foreign court ever:
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CUSTOMER COMPLAINT/ARBITRATION/CIVIL LITIGATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6I, complete a Customer Complaint/Arbitration/Civil Litigation DRP.
Item 6I.
(1) Has the individual ever been the subject of a municipal advisor-related or investment-related, customer-initiated (written or oral) complaint that alleged that he or she was involved in fraud, false statements, omissions, theft, embezzlement, wrongful taking of property, bribery, forgery, counterfeiting, extortion, or dishonest, unfair or unethical practices, which:![radio button unchecked](/img/sec/radio-unchecked.jpg)
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TERMINATION DISCLOSURE
If the answer is "Yes" to any question below in Item 6J, complete a Termination DRP.
Item 6J.
Has the individual ever voluntarily resigned, been discharged or permitted to resign after allegations were made that accused him or her of:
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FINANCIAL DISCLOSURE
Item 6K.
Within the past 10 years:
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Item 6L.
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JUDGMENT/LIEN DISCLOSURE
If the answer is "Yes" to any question below in Item 6M, complete a Judgment/Lien DRP.
Item 6M.
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Item 7 Signature and Self-Certification
NOTE: In addition to completing Item 7, to the extent that the individual is a non-resident, a Form MA-NR completed and signed by the individual must be attached as an exhibit to this Form MA-I.
Complete Either Subpart A or Subpart B:
By typing a name in the signature field, the signatory acknowledges and represents that the entry constitutes in every way, use, or aspect, his or her legally binding signature.
A. For Municipal Advisory Firms filing this form:
The municipal advisory firm has obtained and retained written consent from the individual that service of any civil action brought by, or notice of any proceeding before, the SEC or any self-regulatory organization in connection with the individual's municipal advisory activities may be given by registered or certified mail to the individual's address given in Item 1.
I, the undersigned, sign this Form MA-I on behalf of, and with the authority of, the municipal advisory firm that is filing this form. The municipal advisory firm and I both certify, under penalty of perjury under the laws of the United States of America, that the information and statements made in this Form MA-I, including exhibits and any other information submitted, are true and correct, and that I am signing this Form MA-I as a free and voluntary act.
B. For Natural Person Municipal Advisors (Sole Proprietors) filing this form:
The individual named below consents that service of any civil action brought by, or notice of any proceeding before, the SEC or any self-regulatory organization in connection with the individual's municipal advisory activities may be given by registered or certified mail to the individual's address given in Item 1.
I, the undersigned, certify, under penalty of perjury under the laws of the United States of America, that the information and statements made in this Form MA-I, including exhibits and any other information submitted, are true and correct, and that I am signing this Form MA-I Execution Page as a free and voluntary act.
Full Legal Name of Municipal Advisor:
Enter all the letters of each name and not initials or other abbreviations. If no middle name, enter NMN on that line.
Warning: Intentional misstatements or omissions of fact constitute Federal criminal violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).12.
CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION DISCLOSURE REPORTING PAGE (MA-I)
CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION ACTION DRP – PART 1
This Disclosure Reporting Page (DRP MA-I) is an INITIAL or
AMENDED response to report details for affirmative response(s) to Question(s) 6I on Form MA-I.
Check the question(s) to which this DRP pertains:
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The event or proceeding was resolved in the individual's favor
The DRP was filed in error.
Explain the circumstances:
How to Report a Matter or a Proceeding on this DRP: Use a separate DRP for each matter or proceeding. One matter may result in more than one affirmative answer to the above items. Use a single DRP to report details relating to a particular matter (i.e., a customer complaint, arbitration, CFTC reparation, or civil litigation). If an event gives rise to separate proceedings by more than one regulator or other authority, or other plaintiff, provide details for each proceeding on a separate DRP. Separate cases arising out of the same matter, and unrelated civil judicial actions, must be reported on separate DRPs; if they are later consolidated into a single civil judicial action, the consolidated action can be reported on one DRP.
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Note: The filer may identify a DRP filed by the individual directly, or filed by another SEC-registrant about the individual as an associated person.
If the answer is "Yes," provide the applicable information indicated below that identifies where the DRP may be found.
NOTE: The completion of all or any part of this form does not relieve the individual or any municipal advisor with which the individual is associated of the obligation to update any relevant Form MA or IARD or CRD records.
Disclosure Instructions and the Individual's Status: You must indicate the individual's status in Items II and III below.
CUSTOMER COMPLAINT / ARBITRATION / CIVIL LITIGATION ACTION DRP – PART 2
A. Customer complaints, arbitrations / CFTC reparations and civil litigation in which the individual is not named as a party, as well as,
B. Arbitrations / CFTC reparations and civil litigation in which the individual is named as a party.
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A. If the matter involves a customer complaint, or an arbitration / CFTC reparation or civil litigation in which the individual is not named as a party, complete Items 7-11 as appropriate.
B. If a customer complaint has evolved into an arbitration / CFTC reparation or civil litigation, amend the existing Disclosure Form by completing Items 9 and 10.
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A. Arbitration / CFTC Reparation:
If the matter involves an arbitration / CFTC reparation in which the individual is a named party, check here And complete Items 12-16, as appropriate.
B. Civil Litigation: If the matter involves a civil litigation in which the individual is a named party, check here And complete Items 17-23.
This is an optional space 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).
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Provide the full legal name of the individual's employing firm, if any, when activities occurred which led to the customer complaint, arbitration, CFTC reparation or civil litigation (if there was no such employing firm at that time, enter "None"). Enter the employing firm's MA and CRD registration numbers below, if any.
A. Employing Firm:
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(other than CD)
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Describe the allegation(s) and provide a brief summary of events related to the allegation(s), including dates when activities leading to the allegation(s) occurred:
6. Alleged Compensatory Damage(s)
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Exact
Explanation
If not exact, provide explanation:
If the Individual Is Not a Named Party: If the matter involves a customer complaint, arbitration/CFTC reparation or civil litigation in which the individual is not named as a party, complete items 7-11 as appropriate.
If the Individual Is a Named Party: Report in Items 12-16, or 17-23, as appropriate, only arbitrations/CFTC reparations or civil litigation in which the individual is named as a party.
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B. Is this a written complaint?
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C. Is this an arbitration/CFTC reparation or civil litigation?
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If "Yes," provide:
(1) Arbitration/reparation forum or court name:
(2) Location of the Forum or Court:
Street Address:
City or County:
State / Country:
Postal Code:
(3) Docket/Case Name:
(4) Docket/Case Number:
(5) Filing date of arbitration/CFTC reparation or civil litigation (MM/DD/YYYY):
D. Date received by/served on firm (MM/DD/YYYY):
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If not exact, provide explanation:
Is the complaint, arbitration/CFTC reparation or civil litigation pending?
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If "No," complete item 9.
If the complaint, arbitration/CFTC reparation or civil litigation is not pending, provide status:
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Status:
If the Individual Is Not a Named Party: If the status is arbitration/CFTC reparation in which the individual is not a named party, provide details in Item 7C.
If the Individual Is a Named Party: If the status is arbitration/CFTC reparation in which the individual is a named party, complete Items 12-16. If the status is civil litigation in which the individual is a named party, complete Items 17-23.
10. Status Date (MM/DD/YYYY):
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A. Is there a Settlement/Award/Monetary Judgment?
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If "Yes," provide the details below.
B. Settlement/Award/Monetary Judgment Amount:
C. Was the individual required to pay any portion of the total amount?
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If "Yes," indicate:
(1) The individual's contribution amount:
(2) Was any portion waived?
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If "Yes," how much?
(3) Final Amount:
(4) Was final amount paid in full?
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If "Yes," date paid in full:
If "No," explain the circumstances:
If the matter involves an arbitration or CFTC reparation in which the individual is a named respondent, complete Items 12-16, as appropriate.
B. Location of the Forum
C. Docket/Case Name:
D. Docket/Case Number:
E. Date notice/process was served (MM/DD/YYYY):
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If not exact, provide explanation:
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If "No," complete Items 14 and 15.
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If not exact, provide explanation:
(If you checked "Award to Customer," or "Settlement that includes a monetary payment to customer" in Item 14 or otherwise a payment of money must be made to the customer, provide the following information.)
A. Total Amount:
B. The Individual's Portion: Was the individual required to pay any portion of the total amount?
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C. If you answered "Yes," to Item 16-B, indicate:
(1) The individual's contribution amount:
(2) Was any portion waived?
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If "Yes," how much?
(3) Final Amount:
(4) Was final amount paid in full?
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If "Yes," date paid in full:
If "No," explain the circumstances:
If the matter involves a civil litigation in which the individual is a defendant, complete items 17-23.
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A. Name of the Court:
B. Location of the Court
Street Address:
City or County:
State/Country:
Postal Code:
C. Docket/Case Name:
D. Docket/Case Number :
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If not exact, provide explanation:
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If not exact, provide explanation:
22. Monetary Compensation Details
(If you checked "Monetary Judgment to Customer" or "Settlement that includes a monetary payment to customer" in Item 20, or otherwise a payment of money must be made to the customer, provide the following information.)
A. Total Amount:
B. Was the individual required to pay any portion of the total amount?
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C. If you answered "Yes," to Item 22-B, indicate:
(1) The individual's contribution amount:
(2) Was any portion waived?
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If "Yes," how much?
(3) Final Amount:
(4) Was final amount paid in full?
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If "Yes," date paid in full:
If "No," explain the circumstances:
23. On Appeal - Judicial Review:
If the individual appealed, provide the following information. (If brought in a foreign jurisdiction, provide all the information below in English):
A. Action Appealed to:
(Provide the name of the federal, military, state, foreign, or international court to which the individual appealed):
B. Location of the Court:
Street Address:
City or County:
State/Country:
Postal Code:
C. Docket/Case Name:
D. Docket/Case Number:
E. Date Appeal filed (MM/DD/YYYY)
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If not exact, provide explanation:
F. Appeal Details (including status):
You may use this space to provide a brief summary of the circumstances leading to the customer complaint, arbitration/CFTC reparation and/or civil litigation as well as the current status or final disposition(s). The information must fit within the space provided.