Form Ny-Iaq - Investment Adviser Qualification - New York State Office Of The Attorney General

Download a blank fillable Form Ny-Iaq - Investment Adviser Qualification - New York State Office Of The Attorney General in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ny-Iaq - Investment Adviser Qualification - New York State Office Of The Attorney General with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Revised 4/2003

NY-IAQ

New York State Office of the Attorney General

Investment Protection Bureau

Investment Adviser Qualification

(A) Name of Individual_________________________________________________________________________

(B) Individual CRD number (or SSN if no CRD number)________________________

(A) Name of Investment Adviser Entity__________________________________________________________

(B) Investment Adviser Firm CRD number____________________________________

__________________________________________________________________

Have you taken and received a passing grade within the past two (2) years on the:

(A) Uniform Investment Adviser Law Examination (Series 65 examination)

G Yes

G No

(B) General Securities Representative Examination (Series 7 examination) and the Uniform Combined State Law

Examination (Series 66 examination)

G Yes

G No

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Request for Waiver of Examination

Are you an investment adviser who is an individual or a business engaged in advising members of the public as

defined in section 11.12(f) and who has been continuously registered in this state for five (5) years?

G Yes

G No

Are you an individual who represents an investment adviser in doing any of the acts which makes that person an

investment adviser as defined in section 11.12(f), or solicits business for an investment adviser, and who has been

continuously registered in any jurisdiction, other than New York, for a period of two (2) years prior to the date of filing

registration information pursuant to section 11.4(c)?

G Yes

G No

Have you had any regulatory actions or arbitrations in the last five (5) years? G Yes

G No

If the answer is yes, attach statement of full particulars.

Do you hold one of the following designations? (Check all that apply and provide documentation)

G Certified Financial Planner(CFP) awarded by the Certified Financial Planner Board of Standards, Inc.

G Chartered Financial Consultant (ChFC) awarded by the American College, Bryn Mawr, Pennsylvania.

G Personal Financial Specialist (PFS) awarded by the American Institute of Certified Public Accountants.

G Chartered Financial Analyst (CFA) awarded by the Association for Investment Management Research.

G Chartered Investment Counselor (CIC) awarded by the Investment Counsel Association of America, Inc.

G Other designation to be considered (attach an explanatory letter and documentation).

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

All statements contained herein are true and correct and undersigned understands that any false statement

shall constitute a violation of Article 23-A of the General Business Law.

Dated:

By: ______________________________

Signature of Individual

Sworn to before me this

day of

200___

______________________________

Notary Public