Application For Renewal Of A Broker-Dealer'S Registration printable pdf download

S.A.2

(Rev. 7/99)

COMMONWEALTH OF VIRGINIA

STATE CORPORATION COMMISSION

DIVISION OF SECURITIES AND RETAIL FRANCHISING

APPLICATION FOR RENEWAL OF A BROKER-DEALER'S REGISTRATION

Name of Applicant:_________________________________________________________.

Principal Address of Applicant: ________________________________________________.

Attach the most current audited financial statements of the broker-dealer prepared and

certified by an independent certified public accountant (if they have not been previously

submitted). If the statements are not dated within 120 days of the filing of the application,

financial statements attested to by an officer of the firm or the latest quarterly FOCUS

report must also be submitted. The financial statements or FOCUS report must be dated

within the 120 day period. The financial statements should include all reports, schedules

and statements defined in 21 VAC 5-20-30 B 2.

During the last twelve months, has there been any change in the organization or policy of

the applicant, including form of organization, officers, partners, managers, business

address, changes which would cause affirmative answers to any part of question 10 of form

BD, etc.? ____. If we have not had prior notification of such change(s), attach appropriate

amended page(s) to form BD.

The application must be accompanied by a fee of $200 payable to the Treasurer of Virginia.

If the renewal is not granted, the fee is not refundable.

______________________________________________________

Broker-Dealer

Date

______________________________________________________

(Signature)

Title

COMMONWEALTH OF VIRGINIA

_________________OF__________________, to-wit:

_____________________________________, being first duly sworn, deposes

and says:

I have been authorized by the applicant to execute and file the foregoing application. I have

read the application and exhibits filed with it, and the facts stated in the application and in

the exhibits are true to the best of my knowledge, information and belief.

_________________________________________________________

Affiant

Subscribed and sworn to before me this

_________ day of ___________ _____.

_________________________________________________________

Notary Public

My commission expires: ______________________________ (SEAL)

NOTE:

NON-NASD MEMBER FIRMS SHOULD ALSO ATTACH TO THIS APPLICATION S.D.4.A

AND, IF APPLICABLE, S.D.4.B AND S.D.4.C. A $30 FEE FOR EACH AGENT LISTED ON FORM

S.D.4.A AND A $200 RENEWAL FEE FOR THE FIRM SHOULD BE INCORPORATED INTO ONE

CHECK, PAYABLE TO THE TREASURER OF VIRGINIA.

Application For Renewal Of A Broker-Dealer'S Registration

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