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

INSTRUCTIONS FOR PREPARATION OF

The Uniform Application for Municipal
Securities Representative Assoicated
with a Bank Municipal Securities Dealer
Form MSD-4

GENERAL INSTRUCTIONS

Bank municipal securities dealers that file with
the Comptroller of the Currency must submit an
electronic copy of the form and attachments to
the OCC's BankNet website at www.banknet.gov
within ten days of association with the municipal
securities dealer. the Federal Reserve System) or a department or
division of any such bank, is required to file with
the Federal Deposit Insurance Corporation.

1. 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, a
department or division of any such bank, a bank
holding company (including a subsidiary bank of
the bank holding company if the subsidiary is not
otherwise instructed to file this form with the
Federal Deposit Insurance Corporation or the
Comptroller of the Currency in subparagraphs (b)
or ( c) of this paragraph or with the Securities and
Exchange Commission, and a division, department or subsidiary of that subsidiary), a savings
and loan holding company, or a State branch or
agency of a foreign bank is required to file with
the Board of Governors of the Federal Reserve
System.

(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 departmay
ment or division of any such bank, is required to
either file with the Comptroller of the Currency.

mail

4. Copies of Form MSD-4 may be obtained from the
appropriate regulatory agency listed in instruction 3.
5. Bank municipal securities dealers that file with the
Federal Deposit Insurance Corporation or with the
Comptroller of the Currency must submit 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 re- cords for at least three years
after the applicant’s employment or other association with such dealer has terminated.
6. A bank municipal securities dealer required to file
with the Board of Governors of the Federal Reserve
System must submit an electronic copy of the form
and attachments to the secure email address [email protected]. Report the form and
attachments in Portable Document Format (“PDF”).
Form MSD-4 must be submitted 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.

(b) A bank municipal securities dealer that is a bank
7. If more space is needed to complete an answer, an
insured by the Federal Deposit Insurance Corpoappropriate designation shall be entered in the
ration (other than a bank which
is a member ofsubmit an
answer
space provided,
or more attachment
or, alternatively,
electronic
copy ofand
theoneform

xxxx 2017
Form MSD-4
General Instructions April 2016

(available at www.fdic.gov), and attachments, in Portable
Document Format ("PDF") to the secure email address
[email protected] within ten days of
association with the municipal securities dealer.

GEN-1

General Instructions

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.
8. 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.
9. 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.
10. 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.
11. 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.
INSTRUCTIONS TO SPECIFIC ITEMS ON
FORM MSD-4
12. 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.
GEN-2

13. Item 3: Give the address of the office of the bank
municipal securities dealer in which the applicant is
or will be employed.
14. Item 5: Indicate the appropriate regulatory agency as
set forth in General Instruction 3.
15. 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 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.
16. Item 16: Account for all time periods.
17. Item 25:
(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;
(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.

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

xxxx 2017

Form MSD-4
General Instructions April 2013

General Instructions

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 authority,
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

xxxx 2017

Form MSD-4
General Instructions April 2013

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:
(a) in which the federal securities or banking laws
are at issue;
(b) in which the propriety of any disclosure of information reported on Form MSD-4 is at issue; or
(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.

GEN-3