CHESTER J. CULVER GOVERNOR SUSAN E. VOSS COMMISSIONER OF INSURANCE PATTY JUDGE LT. GOVERNOR IOWA BROKER-DEALER REGISTRATION PACKET July, 2008 TO: COMPLIANCE/REGISTRATION/LICENSING PERSONNEL FROM: JOANN HERRMANN, 515-281-4444; FAX 515-281-3059 : RETURN DOCUMENTS TO JOANN HERRMANN BD/AGENT REGISTRATION SECURITIES & REGULATED INDUSTRIES BUREAU 340 MAPLE STREET DES MOINES, IA 50319-0066 Joann.herrmann@iid.state.ia.us PLEASE PROVIDE FIRM FAX NUMBER(S) AND E-MAIL ADDRESSES TO EACH FILING. BROKER-DEALER REQUIREMENTS: I. BD INITIAL FILING FINRA (formerly NASD) MEMBERSHIP. Unless firm is an FINRA member or has scheduled a pre-membership interview (PMI), do not file a Form BD with CRD, marking Iowa. Contact the Bureau for further instructions. FEES. $200.00 for the broker-dealer. Pay fees directly to CRD. IOWA BROKER-DEALER REGISTRATION AFFIDAVIT . Form Attached. Complete in full applicant and d/b/a name with CRD number. AUDITED FINANCIAL or if an Audit hasn’t been completed, a financial statement, containing net capital computation, certified true and correct by an officer is acceptable. A full audit will be required as soon as available. AGENT/PRINCIPAL. One individual is required to be licensed at all times. Provide Name and CRD number. The U-4 filing requesting Iowa must be done with CRD. See initial agent filing below. II. BD RENEWAL FILING. Renewal fees (same as initial) will be invoiced through the CRD system. PAY CRD. FAILURE TO PAY the fees will result in automatic termination. III. AMENDMENTS to Form BD should be sent directly to the crd. Iowa does not require additional filings with the bureau, except in IV or V. IV. NAME CHANGES involving no change in business structure. Filing done through CRD. V. STRUCTURAL CHANGES. Due to the various alternatives, please contact the Bureau directly for instructions. VI. MASS TRANSFERS. File directly with CRD. Pay Fees directly to CRD. AGENT REQUIREMENTS: I. INITIAL - AGENT FILING FEES. $40.00 for each agent. Pay fees directly to CRD. Effective 7/1/08, fees went to $40.00. U-4 FORM Filed directly with CRD. New Firms should provide name and CRD #. EXAMS. Subject Matter exam and Series 63/66 required. II. RENEWAL AGENT FILING. Renewal fees (same as initial) will be invoiced through the CRD system. PAY CRD. SECURITIES & REGULATED INDUSTRIES BUREAU / 340 MAPLE STREET / DES MOINES, IOWA 50319-0066 / 515-281-4441 / Facsimile 515-281-3059 / http://www.iid.state.ia.us/division/securities; joann.herrmann@iid.state.ia.us American LegalNet, Inc. www.FormsWorkflow.com CHESTER J. CULVER GOVERNOR SUSAN E. VOSS COMMISSIONER OF INSURANCE PATTY JUDGE LT. GOVERNOR IOWA BROKER-DEALER REGISTRATION AFFIDAVIT You must select A or B below. PRIOR SECURITIES ACTIVITIES IN IOWA _____ A) This broker-dealer has effected no securities transactions with persons within the state of Iowa prior to licensing (approval). _____ B) This broker-dealer has effected securities transactions in Iowa prior to licensing (approval). Attached is a listing of the names and addresses of all customers, the dates and amounts of transactions, and the securities sold. I acknowledge that if my response to any of the above is false, the broker-dealer and I are subject to sanction pursuant to the Iowa Uniform Securities Act. _____________________________________________________________________________________ Date Complete in full BD Name BD-CRD Number _____________________________________________________________________________________ Street Address, City, State and Zip Code of Broker-Dealer (print or type) _____________________________________________________________________________________ Signature of Authorized Signatory Name and Title of Officer (print or type) Subscribed and sworn before me this ___________ day of ________________________, ________ by _______________________________. My commission expires ______________________________ County of ___________________________________ State of __________________________________ SECURITIES & REGULATED INDUSTRIES BUREAU / 340 MAPLE STREET / DES MOINES, IOWA 50319-0066 / 515-281-4441 / Facsimile 515-281-3059 / http://www.iid.state.ia.us/division/securities; joann.herrmann@iid.state.ia.us American LegalNet, Inc. www.FormsWorkflow.com