Reporting Form MSD-4

INSTRUCTIONS FOR PREPARATION OF

The Uniform Application for
Municipal Securities Representative
Associated with a Bank Municipal
Securities Dealer
Form MSD-4
General instructions
(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.

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) Bank municipal securities dealers that file with
the Federal Deposit Insurance Corporation may
either mail an original and one copy of Form
MSD-4 and any attachments within ten days of
association with the municipal securities dealer
or, alternatively, submit an electronic copy of the
form (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.
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. 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.
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Form MSD-4

March 2017

Form MSD-4

(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.
(7) 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.
(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.
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.
(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

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March 2017

Form MSD-4

Form MSD-4

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.

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Form MSD-4

March 2019