Form 133.4 Texas State Securities Board P.O. Box 13167 Austin, Texas 78711-3167 Request for Consideration of a Registration Application by a Military Applicant (�115.18 or �116.18) 1. 2. Name of Applicant: Application Type (check all that apply): G G 3. 4. 5. Dealer Investment Adviser G G Agent Investment Adviser Representative CRD No. of Applicant (if applicable): SSN of Applicant: Name of Employer: CRD or IARD No. of the Employer, if applicable: 6. Applicant: (check all that apply) F F is a G military service member; G military spouse; G military veteran; as those terms are defined in �115.18(a) or �116.18(a). holds a current registration issued by another state, the District of Columbia, or a territory of the United States. Please list all such jurisdictions where the applicant holds a comparable current registration: F F F was previously registered in Texas within the last five years preceding the date of the application for registration for which expedited review is requested. wishes to resolve any pending and/or deficient items identified in connection with my registration before my registration becomes effective. wishes to become registered at the earliest possible date and acknowledges that any pending and/or deficient items identified in connection with my registration application must be corrected within 12 months after my registration is granted or my registration will be automatically terminated after that 12-month period. 02-24-2016 American LegalNet, Inc. www.FormsWorkFlow.com Form 133.4 F has attached verification of the military service, training, or education that I wish to apply towards the Texas registration requirements, other than the Texas examination requirements contained in �115.3 or �116.3 of the Board rules. The undersigned affirms that to the best of his or her knowledge, information, and belief the statements made on this form are true. Date: (Signature) (Printed name) 02-24-2016 American LegalNet, Inc. www.FormsWorkFlow.com