Wisconsin Broker-Dealer Licensing Form And Procedure Page 4
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4§551.31(1)(b) Wis. Stats. and 4.01(2)(a), Wis. Adm. Code
STATE OF WISCONSIN
DEPARTMENT OF FINANCIAL INSTITUTIONS
DIVISION OF SECURITIES
th
345 West Washington Ave., 4
Fl.
You can fill out this form online by clicking on the NO or YES
PO Box 1768
box and filling in the required information by using the TAB key
Madison, WI 53701-1768
to advance to the next item. You must then print out the
(608) 266-3693
completed form for submission to the Division. Use the RESET
TTY: (608) 266-8818
button at the bottom to clear all fields.
Internet:
WISCONSIN BROKER-DEALER ACTIVITY OF APPLICANT
Pursuant to §551.31(1), Wis. Stats., it is unlawful for any person to transact business in Wisconsin as a broker-dealer or agent
unless so licensed under Chapter 551, Wis. Stats., except that a person who effects transactions in this state exclusively for the
account of or exclusively in offers to sell or sales to person specified in §551.23(8)(a) through (f), Wis. Stats., is not required to
be so licensed.
Transacting business includes effecting or attempting to effect transactions in securities and/or soliciting any person in the state
to become a customer of the broker-dealer.
The fact that a person may have transacted business as a broker-dealer in Wisconsin in violation of §551.31(1), Wis. Stats.,
does not mean that a person’s Wisconsin license application will automatically be denied.
As part of the Wisconsin Broker-Dealer License Application, the applicant must respond as to whether or not the applicant has
engaged in broker-dealer business in Wisconsin without being properly licensed. To facilitate your response, please complete
the questionnaire below and return the completed form to this Division.
NO, this applicant is not now transacting and has never transacted broker-dealer business in
Wisconsin.
YES, this applicant has transacted broker-dealer business in Wisconsin prior to this application. The
applicant agrees to stop transacting such business immediately, until properly licensed.
If yes, list all transactions effected in Wisconsin:
Name & Address
Date of
Description of
Date of Client
Name of
Total Commissions
of Customer
Transaction
Transaction
Agreement
Agent
Charged
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
(Attach additional pages if space provided is insufficient.)
Name of Applicant ______________________________________________________________
______________________________________________________________________________
Firm’s Authorized Signatory
______________________________________________________________________________
Typed Name and Title of Signatory
Date _____________________________
This document can be made available in alternate formats upon request to
qualifying individuals with disabilities.
Reset Form
DFI/DOS/BDAA(WI)(R09/00)
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