Form U5 "Uniform Termination Notice for Securities Industry Registration" - Tennessee

What Is Form U5?

This is a legal form that was released by the Tennessee Department of Commerce and Insurance - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2009;
  • The latest edition provided by the Tennessee Department of Commerce and Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form U5 by clicking the link below or browse more documents and templates provided by the Tennessee Department of Commerce and Insurance.

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Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
NOTICE TO THE INDIVIDUAL WHO IS THE SUBJECT OF THIS FILING
Even if you are no longer registered you continue to be subject to the jurisdiction of regulators for at least two years after your
registration is terminated and may have to provide information about your activities while associated with this firm. Therefore, you
must forward any residential address changes for two years following your termination date or last Form U5 amendment to:
CRD Address Changes, P.O. Box 9495, Gaithersburg, MD 20898-9495.
1. GENERAL INFORMATION
FIRST NAME:
MIDDLE NAME:
LAST NAME:
SUFFIX:
FIRM CRD #:
FIRM NAME
FIRM NFA#:
:
INDIVIDUAL CRD #:
INDIVIDUAL SSN
INDIVIDUAL NFA#:
FIRM Billing Code:
:
Office of Employment Address:
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
2. CURRENT RESIDENTIAL ADDRESS
NOTICE TO THE FIRM: This is the last reported residential
FROM (MM/YYYY):
TO (MM/YYYY):
address. If this is not current, please enter the current
residential address.
ADDRESS STREET 1:
CITY:
STATE:
ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
3. FULL TERMINATION
O
O
Is this a FULL TERMINATION?
Yes
No
Note: A "Yes" response will terminate ALL registrations with all SROs and all jurisdictions.
Reason For Termination:
O
O
O
O
O
Discharged
Other
Permitted to Resign
Deceased
Voluntary
Termination Explanation:
If the Reason for Termination entered above is Permitted to Resign, Discharged or Other, provide an explanation below:
If amending the Reason for Termination and/or termination explanation, provide an explanation below:
Page 1 of 24
Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
NOTICE TO THE INDIVIDUAL WHO IS THE SUBJECT OF THIS FILING
Even if you are no longer registered you continue to be subject to the jurisdiction of regulators for at least two years after your
registration is terminated and may have to provide information about your activities while associated with this firm. Therefore, you
must forward any residential address changes for two years following your termination date or last Form U5 amendment to:
CRD Address Changes, P.O. Box 9495, Gaithersburg, MD 20898-9495.
1. GENERAL INFORMATION
FIRST NAME:
MIDDLE NAME:
LAST NAME:
SUFFIX:
FIRM CRD #:
FIRM NAME
FIRM NFA#:
:
INDIVIDUAL CRD #:
INDIVIDUAL SSN
INDIVIDUAL NFA#:
FIRM Billing Code:
:
Office of Employment Address:
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
CRD BRANCH #: NYSE BRANCH CODE#: FIRM BILLING CODE:
START DATE: END DATE:
O
O
Registered
Located At
O
O
Non-Registered
Supervised From
OFFICE OF EMPLOYMENT ADDRESS STREET 1:
CITY:
STATE:
OFFICE OF EMPLOYMENT ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
Private Residence Check Box: If the Office of Employment address is a private residence, check this box.
2. CURRENT RESIDENTIAL ADDRESS
NOTICE TO THE FIRM: This is the last reported residential
FROM (MM/YYYY):
TO (MM/YYYY):
address. If this is not current, please enter the current
residential address.
ADDRESS STREET 1:
CITY:
STATE:
ADDRESS STREET 2:
COUNTRY:
POSTAL CODE:
3. FULL TERMINATION
O
O
Is this a FULL TERMINATION?
Yes
No
Note: A "Yes" response will terminate ALL registrations with all SROs and all jurisdictions.
Reason For Termination:
O
O
O
O
O
Discharged
Other
Permitted to Resign
Deceased
Voluntary
Termination Explanation:
If the Reason for Termination entered above is Permitted to Resign, Discharged or Other, provide an explanation below:
If amending the Reason for Termination and/or termination explanation, provide an explanation below:
Page 1 of 24
Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
4. DATE OF TERMINATION
Date Terminated (MM/DD/YYYY): _______________________________
A complete date of termination is required for full termination. This date represents the date the firm terminated the individual's association
with the firm in a capacity for which registration is required.
For partial termination, the date of termination is only applicable to post-dated termination requests during the renewal period.
Notes: For full termination, this date is used by jurisdictions/SROs to determine whether an individual is required to requalify by examination
or obtain an appropriate waiver upon reassociating with another firm.
The SRO/jurisdiction determines the effective date of termination of registration.
If amending the Date of Termination, provide an explanation below:
Page 2 of 24
Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
5. PARTIAL TERMINATION
For a partial termination, do not complete the Reason for Termination in Section 3 (FULL TERMINATION) or Section 7 (DISCLOSURE
QUESTIONS). The Reason for Termination and Section 7 (DISCLOSURE QUESTIONS) should only be completed on Form U5 for full
termination requests.
5A. SRO PARTIAL TERMINATION
If this is a PARTIAL TERMINATION, mark the appropriate SRO registration categories to be terminated.
REGISTRATION CATEGORY
OP - Registered Options Principal (S4)
IR - Investment Company and Variable Contracts Products Rep. (S6)
GS - Full Registration/General Securities Representative (S7)
TR - Securities Trader (S7)
TS - Trading Supervisor (S7)
SU - General Securities Sales Supervisor (S9 and S10)
BM - Branch Office Manager (S9 and S10)
SM - Securities Manager (S10)
AR - Assistant Representative/Order Processing (S11)
IE - United Kingdom - Limited General Securities Registered
Representative (S17)
DR - Direct Participation Program Representative (S22)
GP - General Securities Principal (S24)
IP - Investment Company and Variable Contracts Products Principal (S26)
FA - Foreign Associate
FN - Financial and Operations Principal (S27)
FI - Introducing Broker-Dealer/Financial and Operations Principal (S28)
RS - Research Analyst (S86, S87)
RP - Research Principal
DP - Direct Participation Program Principal (S39)
OR - Options Representative (S42)
MR - Municipal Securities Representative (S52)
MP - Municipal Securities Principal (S53)
CS - Corporate Securities Representative (S62)
RG - Government Securities Representative (S72)
PG - Government Securities Principal (S73)
SA - Supervisory Analyst (S16)
PR - Limited Representative - Private Securities Offerings (S82)
CD - Canada-Limited General Securities Registered Representative (S37)
CN - Canada-Limited General Securities Registered Representative (S38)
ET - Equity Trader (S55)
AM - Allied Member
AP - Approved Person
LE - Securities Lending Representative
LS - Securities Lending Supervisor
ME - Member Exchange
FE - Floor Employee
OF – Officer
CO - Compliance Official (S14)
CF - Compliance Official Specialist (S14A)
PM - Floor Member Conducting Public Business
PC - Floor Clerk Conducting Public Business
SC - Specialist Clerk (S21)
TA - Trading Assistant (S25)
FP - Municipal Fund (S51)
IF - In-Firm Delivery Proctor
MM - Market Maker Authorized Trader-Options (S56)
FB - Floor Broker (S56)
MB - Market Maker acting as Floor Broker
OT - Authorized Trader (S7)
Page 3 of 24
Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
REGISTRATION CATEGORY
MT - Market Maker Authorized Trader-Equities (S7)
IB - Investment Banking Representative (S79)
OS – Operations Professional (S99)
AF - Floor Broker – Options (S56)
AO - Market Maker – Options (S56)
AC - Floor Clerk-Options
CT - Proprietary Trader Compliance Officer (S14)
PT - Proprietary Trader (S56)
TP - Proprietary Trader Principal (S24)
Other__________________________________ (Paper Form Only)
Page 4 of 24
Rev. Form U5 (05/2009)
UNIFORM TERMINATION NOTICE FOR SECURITIES INDUSTRY REGISTRATION
INDIVIDUAL NAME:
INDIVIDUAL CRD #:
FIRM NAME:
FIRM CRD #:
Page 5 of 24
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