Industry and Other Affiliations. Are you, your spouse, or any other immediate family members, including parents, in-laws, siblings or dependents: ⭘ Yes ⭘ No IF CHECKED YES, OBTAIN AND ATTACH THE COMPLIANCE OFFICER’S LETTER OF APPROVAL Employed by or associated with the securities industry (for example, a sole proprietor, partner, officer, director, branch manager, registered representative or other associated person of a broker -dealer firm) or a financial services regulator? If yes, please specify entity below. If this entity requires its approval for you to open this account, please provide a copy of the required authorization letter (with this Application). ⭘ Broker-Dealer or Municipal Securities Dealer ⭘ Investment Adviser ⭘ FINRA or other Self-Regulatory Organization ⭘ State or Federal Securities Regulator Name of Entity(ies): _________________________________________________ ⭘ Yes ⭘ No An officer, director or 10% (or more) shareholder in a publicly-owned company? What is your title? ⭘ 10% shareholder ⭘ CEO ⭘ CFO ⭘ COO ⭘ Other Officer Name of company and symbol: __________________________ ⭘ Yes ⭘ No A senior military, governmental or political official in a non-US country? Name of country: _______________________
Industry and Other Affiliations. Are you, your spouse, or any other immediate family members, including parents, in-laws, siblings, or dependents:
