State of Wisconsin Department of Financial Institutions Jim Doyle, Governor Lorrie Keating Heinemann, Secretary DATE October 12, 2007 TO: All Broker-Dealers with Limited Securities Agents RE: Limited Securities Agent Renewals Attached please find a Wisconsin Broker-dealer Renewal form [BDRL(WI)], which must be completed for all limited securities agents of your firm. The renewal form must be accompanied by a $30 filing fee for each individual listed. The only individuals on the list should be individuals that are currently licensed but do not have their applications processed via the FINRA CRD system, as this is a renewal form only. As all FINRA member broker-dealers licensed in this state and all FINRA securities agents will be renewed through the Central Registration Depository (CRD), it is necessary that this form relating to limited securities agents be filed with this Division each December. If this form is not filed timely with this Division, all limited securities agent licenses will expire on December 31st. The license renewal form must be received in this Division NOT LATER THAN DECEMBER 1ST. If the renewal form is not received by December 1st, a delinquent filing fee of $100 shall be charged pursuant to s. DFI-Sec 7.01(6)(f), Wis. Adm. Code. If you have any questions concerning this matter, please feel free to contact the Licensing & Compliance staff at (608) 266-2139. Division of Securities Mail: PO Box 1768 Madison, WI 53701-1768 Courier: 345 W. Washington Ave. 4th Floor Madison, WI 53703 Voice: (608) 266-1064 Fax: (608) 264-7979 TTY: (608) 266-8818 Internet: www.wdfi.org American LegalNet, Inc. www.FormsWorkflow.com �551.31(2), Wis. Stats. STATE OF WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS DIVISION OF SECURITIES You can fill out this form online by clicking on Line 1, filling in 345 West Washington Ave., 4th Fl. the required information, and using the TAB key to advance to PO Box 1768 the next question. For phone and Social Security numbers, just Madison, WI 53701-1768 enter numbers with no hyphens. You must then print out the (608) 266-2139 completed form for submission to the Division. Use the RESET TTY: (608) 266-8818 Internet: www.wdfi.org button at the bottom to clear all fields. FINRA BROKER-DEALERS LIMITED SECURITIES AGENT RENEWAL 1. Name of Firm: ___________________________________________________________________ 2. Address of Firm:_________________________________________________________________ 3. Name and telephone number of person to contact with questions regarding this form: Name: ____________________________________________________________________________ Phone Number: __________________________________________________ AGENTS TO BE RENEWED First Name Middle Init. Last Name Social Security Number (Attach supplementary sheet if space is insufficient.) RESET FORM This document can be made available in alternate formats upon request to qualifying individuals with disabilities. This form is required under Section 551.32(1) Wis. Stats. Refusal to provide this information may result in the denial of the license renewal. Personally identifiable information on this form may be matched against tax information, outstanding child and family support data and law enforcement agencies. (This space reserved for use of the Division of Securities.) Filing Fees Agent DFI/DOS/BDRL(WI) (R 10/07) Receipt Number ________________ Date Received ____________ American LegalNet, Inc. www.FormsWorkflow.com ___________