Uniform Application for Municipal Securities Principal or Municipal Securities Representative Associated with a Bank Municipal Securities Dealer

INSTRUCTIONS FOR COMPLETING AND FILING FORM MSD-4
GENERAL INSTRUCTIONS
As used in these instructions and Form MSD-4:
a. The term bank municipal securities dealer
means a municipal securities dealer that is a
bank or a department or division of a bank.
b. The term applicant means a person who is,
or who seeks to be, associated with a bank
municipal securities dealer as a municipal
securities principal or municipal securities
representative.
2. Form MSD-4 is to be used by bank municipal
securities dealers and applicants to comply with
Municipal Securities Rulemaking Board Rule G-7,
"Information Concerning Associated Persons,"
which requires the filing of Form MSD-4.
3. Bank municipal securities dealers are required
to file Form MSD-4 with the appropriate regulatory
agency as set forth below:
a.

A bank municipal securities dealer that is

a
state member bank of the Federal Reserve
System, or a department of any such bank, or
a State branch or agency of a foreign bank, is
required to file with the Board of Governors of
the Federal Reserve System.
b. A bank municipal securities dealer that is a
bank insured by the Federal Deposit Insurance
Corporation (other than a bank which is a
member of the Federal Reserve System) or a
department or division of any such bank, is
required to file with the Federal Deposit Insurance Corporation.
c. A bank municipal securities dealer that is a
national bank or bank operating under the
Code of Law for the District of Columbia, or a
department or division of any such bank, is
required to file with the Comptroller of the Currency.
4. Copies of Form MSD-4 may be obtained from
the appropriate regulatory agency listed in instruction 3.

5. An original and one copy of Form MSD-4 and
any attachments are to be filed with the appropriate
regulatory agency listed in instruction 3 within ten
days of association with the municipal securities
dealer. A bank municipal securities dealer filing
Form MSD-4 shall retain an exact copy in its records for at least three years after the applicant's
employment or other association with such dealer
has terminated.
6. If more space is needed to complete an
answer, an appropriate designation shall be
entered in the answer space provided, and one or
more attachment sheets shall be used to complete
the response. All attachments shall be submitted in
the same format as the items to which response is
made and shall be typed on white 8-1/2 x 11 in.
paper.
7. Form MSD-4 and any attachments may be duplicated by any method which produces legible
copies of type size identical to that of the Form
MSD-4 on white 8-1/2 x 11 in. paper.
8. Form MSD-4 shall be manually signed on page
1 (bottom) by a municipal securities principal of the
employing bank municipal securities dealer and on
page 3 by the applicant.
9. All items on Form MSD-4 must be completed,
except that disclosure of one's social security number is optional. The date on which the Form MSD-4
is received by the appropriate regulatory agency
shall be the date of filing. A Form MSD-4 which is
not prepared and executed in accordance with the
applicable requirements may be returned as unacceptable. Acceptance for filing shall not constitute
any finding that a Form MSD-4 has been completed
in accordance with those requirements or that any
information reported on the form is true, current,
complete, or not misleading.
10. Section 17(c)(1) of the Securities Exchange Act
of 1934 requires every bank municipal securities
dealer that files any application, notice, report, or
document with its appropriate regulatory agency to
file a copy of that application, notice, report, or
document with the Securities and Exchange Commission (SEC). The SEC and the appropriate
regulatory agencies listed in instruction 3 have
developed procedures under which the latter will

send a copy of any application, notice, report, or
document filed with them by a bank municipal
securities dealer to the SEC. Accordingly, when
this form is filed with the appropriate regulatory
agency, it will be deemed to have been filed with
the SEC.

municipal securities representative. NOTE: If this
form is being filed in lieu of Form G-FIN-4, check all
applicable types of qualifications requested in item
6.

INSTRUCTIONS TO SPECIFIC ITEMS ON FORM
MSD-4
11. Items 2 through 8 are to be completed by the
bank municipal securities dealer employing or proposing to employ the applicant named in item 1. All
other items are to be completed by the applicant.

16. Item 25:

15. Item 16: Account for all time periods.

(a) Although this item relates only to
convictions during the past ten years, it should be
noted that section 19 of the Federal Deposit
Insurance Act (12 U.S.C. section 1829) prohibits
any insured bank, except with the written consent
of the Federal Deposit Insurance Corporation, from
employing any person who has ever been
convicted of a criminal offense involving dishonesty
or breach of trust;

12. Item 3: Give the address of the office of the
bank municipal securities dealer in which the applicant is or will be employed.
13. Item 5: Indicate the appropriate regulatory
agency as set forth in General Instruction 3.

(b) Paragraph (iv) of this item relates only to
convictions within the past ten years under sections
152, 1341, 1342, 1343, or Chapters 25 or 47 of
Title 18, United States Code.

14. Item 6: Municipal Securities Rulemaking
Board Rule G-3, "Classification of Principals and
Representatives; Numerical Requirements;
Testing," provides a description of the functions
performed by a municipal securities principal or

2

PRIVACY ACT NOTICE FOR FORM MSD-4
(To Accompany Form MSD-4)

GENERAL
This information, in accordance with the Privacy Act
of 1974, 5 U.S.C. 552a, is provided to those applicants completing Form MSD-4 (Uniform Application
for Municipal Securities Principal or Municipal
Securities Representative Associated with a Bank
Municipal Securities Dealer), which is to be filed
with the appropriate regulatory agency, as defined
in section 3(a)(34) of the Securities Exchange Act
of 1934 [15 U.S.C. 78c(a)(34)].

ity, whether federal, state, local, or foreign, or to the
appropriate self regulatory organization (SRO),
such information as may indicate a violation or
potential violation of law, regulation or rule.
2. To refer to the appropriate court, magistrate or
administrative law judge such information as may
be relevant to proceedings before any such court or
judicial officer.
3. To make use of such information as may aid in
the resolution of any action or proceeding:

AUTHORITY

a. in which the federal securities or banking
laws are at issue;

Sections 15B(c)(5), 17 and 23 of the Securities
Exchange Act of 1934 (15 U.S.C. 78o-4, 78q and
78u).

b. in which the propriety of any disclosure of
information reported on Form MSD-4 is at issue; or

PURPOSE
The appropriate regulatory agency will review the
information reported on Form MSD-4 to determine
the applicant's compliance with the professional
qualifications requirements for municipal securities
principals and municipal securities representatives
set forth in the General Rules of the Municipal Securities Rulemaking Board.
EFFECTS OF NONDISCLOSURE
Applicants who are or seek to be associated with a
bank municipal securities dealer as municipal securities principals or representatives are required to
disclose the information necessary to complete
Form MSD-4, except that disclosure of one's social
security number is optional. Applicants who do not
disclose the necessary information may not be
qualified for purposes of Municipal Securities
Rulemaking Board Rule G-2, "Standards of Professional Qualification."
ROUTINE USES
The information reported in Form MSD-4 may be
routinely used by the appropriate regulatory agency
as follows:
1.

To refer to the appropriate government author-

c. to which the appropriate regulatory agency
or a past or present member of its staff is a
party or otherwise involved in an official capacity.
4. To disclose to a federal, state, local or foreign
government authority or SRO such information as
may be necessary to obtain from such authority or
organization additional information concerning the
applicant's qualifications as a municipal securities
principal or representative who is, or is to be, associated with a bank municipal securities dealer.
5. To disclose such information as may be necessary to respond to a request from a federal, state,
local or foreign government authority or SRO for
information needed in connection with the issuance
of a license, the granting of a benefit, or similar
action affecting the applicant.
6. To disclose such information as may be necessary to respond to any Congressional inquiry made
at the request of the applicant.