Form SEC 122 SEC 122 Form BDW

Form BDW

OMB Approval
OMB Number: .....3235-0018
Expires:

December 31, 2023

Estimated average burden
hours per response:

Uniform Request
for
Broker-Dealer Withdrawal

SEC 122 (04-07)

Persons who respond to the collection of information contained
in this form are not required to respond unless the form displays
a currently valid OMB number.

0.25.

FORM BDW INSTRUCTIONS
A.
1.

2.
3.
4.

B.

C.

GENERAL INSTRUCTIONS
Broker-Dealers must file Form BDW to withdraw their registration from the Securities and Exchange Commission (“SEC”),
Self-Regulatory Organizations (“SROs”), and appropriate jurisdictions. These instructions apply to filing Form BDW
electronically with the Central Registration Depository (“CRD”) Some jurisdictions may require a separate paper filing of Form
BDW and/or additional filing requirements. Thus, the applicant should contact the appropriate jurisdiction(s) for specific filing
requirements.
All questions must be answered and all fields requiring a response must be complete before the filing is accepted. If filing
Form BDW on paper, enter “None” or “N/A” where appropriate.
File Form BDW with the CRD, operated by the NASD. Prior to filing Form BDW, amend Form BD to update any incomplete or
inaccurate information.
A paper copy of this Form BDW (or a reproduction of this form printed off the CRD), the original manual signature(s), must be
retained by the broker-dealer filing the Form BDW and be made available for inspection upon a regulatory request. A paper
copy of the initial Form BD filing and amendments to Disclosure Reporting Pages (DRPs BD) also must be retained by the
broker-dealer filing the Form BDW.

FULL WITHDRAWAL (terminates registration with the SEC, all SROs, and all jurisdictions):
1. Complete all items except Item 3.
2. If Item 5 is answered “yes,” file with the CRD a paper copy of FOCUS Report Part II (or Part IIA for non-carrying or nonclearing firms) “Statement of Financial Condition” and “Computation of Net Capital” sections. For firms that do not file FOCUS
Reports, file a statement of financial condition giving the type and amount of the firm’s assets and liabilities and net worth.
This information must reflect the finances of the firm no earlier than 10 days before this Form BDW is filed.
PARTIAL WITHDRAWAL (terminates registration with specific jurisdictions and SROs, but does not terminate registration with
the SEC and at least one SRO and jurisdiction):
1. Complete all items.
2. Check with jurisdiction(s) where registered for additional filing requirements.

The CRD mailing address for questions and correspondence is:
NASAA/NASD CENTRAL REGISTRATION DEPOSITORY
P.O. BOX 9495
GAITHERSBURG, MD 20898-9495

EXPLANATION OF TERMS
(The following terms are italicized throughout this form.)
The term JURISDICTION means a state, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands,
Guam, or any subdivision or regulatory body thereof.
The term INVESTIGATION includes: (a) grand jury investigations, (b) U.S. Securities and Exchange Commission investigations
after the “Wells” notice has been given, (c) NASD Regulation, Inc. investigations after the “Wells” notice has been given or after a
person associated with a member, as defined in the NASD By-Laws, has been advised by the staff that it intends to recommend
formal disciplinary action or, (d) formal investigations by other SROs or, (e) actions or procedures designated as investigations by
jurisdictions. The term investigation does not include subpoenas, preliminary or routine regulatory inquiries or requests for
information, deficiency letters, “blue sheet” requests or other trading questionnaires, or examinations.
The term INVESTMENT-RELATED pertains to securities, commodities, banking, savings association activities, credit union
activities, insurance, or real estate (including, but not limited to, acting as or being associated with a broker-dealer, municipal
securities dealer, government securities broker or dealer, issuer, investment company, investment adviser, futures sponsor, bank,
savings association, credit union, insurance company, or insurance agency). (This definition is used solely for the purpose of Form
BD.)

FEDERAL INFORMATION LAW AND REQUIREMENTS – SEC’s Colllection of Information:
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid control number. Sections 15, 15C, 17(a) and 23(a) of the Exchange Act authorize the SEC to collect the information
on this form from registrants. See 15 U.S.C. §§78o, 78o-4, 78o-5, 78q and 78w. Filing of this Form is mandatory. The principal
purpose of this Form is to permit the Commission to determine whether whether it is in the public interest to permit the brokerdealer to withdraw its registration. The Form also is used by broker-dealers to advise certain self-regulatory organizations and all
of the states that they want to withdraw from registration. The Commission and the National Association of Securities Delaers, Inc.
maintain files of the information on this Form and will make the information publicly available. Any member of the public may direct
to the Commission any comments concerning the accuracy of the burden estimate on application facing page of this Form, and any
suggestions for reducing this burden. This collection of information has been reviewed by the Office of Management and Budget in
accordance with the clearance requirements of 44 U.S.C. §3507. The information contained in this form is part of a system of
records subject to the Privacy Act of 1974, as amended. The Securities and Exchange Commission has published in the Federal
Register the Privacy Act Systems of Records Notice for these records.

Official Use

Uniform Request for Withdrawal from
Broker-Dealer Registration

FORM BDW

WARNING: INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE CRIMINAL VIOLATIONS.
1. A. FULL NAME OF BROKER-DEALER (if sole proprietor, state last, first and middle name):

B. IRS Emp. Ident. No.:

C. NAME UNDER WHICH BUSINESS IS CONDUCTED, IF DIFFERENT:
E. SEC File No.:
G. MAILING ADDRESS, IF DIFFERENT:

SEC

2. Check One:

D. Firm CRD No.:

F. FIRM MAIN ADDRESS: Number and Street
Code
Number and Street
City

[ ] Full Withdrawal (skip Item 3)

City

State/Country

Zip+4/Postal

H. AREA CODE / TELEPHONE NO.:

[ ] Partial Withdrawal (Check box(es) where withdrawing in Item 3.)

SRO

[ ] SECURITIES AND EXCHANGE COMMISSION (check only if intending to conduct an intrastate business)
[ ] FINRA

[ ] NYSE ARCA [ ] NADAQ

[ ] CBOE BYX

[ ] CBOE EDGX [ ] GEMX

[ ] EMERALD

[ ] BOX

[ ] NYSE

[ ] NYSE CHX

[ ] C2

[ ] CBOE BZX

[ ] BX

[ ] MRX

[ ] MIAX

[ ] IEX

[ ] CBOE

[ ] CBOE EDGA [ ] ISE

[ ] PHLX

[ ] PEARL

[ ] LTSE

JURISDICTION

[ ] NYSE AMER [ ] NYSE NAT

[ ] MEMX
[ ] OTHER
___________
specify

[ ] Alabama

[ ] Guam

[ ] Massachusetts

[ ] New York

[ ] Tennessee

[ ] Alaska

[ ] Hawaii

[ ] Michigan

[ ] North Carolina

[ ] Texas

[ ] Arizona

[ ] Idaho

[ ] Minnesota

[ ] North Dakota

[ ] Utah

[ ] Arkansas

[ ] Illinois

[ ] Mississippi

[ ] Ohio

[ ] Vermont

[ ] California

[ ] Indiana

[ ] Missouri

[ ] Oklahoma

[ ] Virgin Islands

[ ] Colorado

[ ] Iowa

[ ] Montana

[ ] Oregon

[ ] Virginia

[ ] Connecticut

[ ] Kansas

[ ] Nebraska

[ ] Pennsylvania

[ ] Washington

[ ] Delaware

[ ] Kentucky

[ ] Nevada

[ ] Puerto Rico

[ ] West Virginia

[ ] District of Columbia

[ ] Louisiana

[ ] New Hampshire

[ ] Rhode Island

[ ] Wisconsin

[ ] Florida

[ ] Maine

[ ] New Jersey

[ ] South Carolina

[ ] Wyoming

[ ] Georgia

[ ] Maryland

[ ] New Mexico

[ ] South Dakota

4. Date firm ceased business or withdrew from registration request (for partial
withdrawals, give the date ceased business in the jurisdictions checked in item 3):

MM

DD
/

YY
/

Yes No
[ ] [ ]
5. Does the broker-dealer owe any money or securities to any customer or broker-dealer
If partial withdrawal, indicate jurisdiction(s) from which you are withdrawing
,
,
Where you owe funds or securities to customers in such jurisdiction(s)
If full withdrawal, complete A-D below
A. Number of customers owed funds or securities
B. Amount of money owed to:
customers
$
broker-dealers
$
C. Market value of securities owed to:
customers
$
broker-dealers
$
D. Describe arrangements made for payment:
__________________________________________________________________________________________________
If this is a full withdrawal and Item 5 is answered “yes,” file with the CRD a FOCUS REPORT Part II (or Part IIA for non-carrying or non-clearing firms) “Statement
of Financial Condition” and “Computation of Net Capital” sections. For firms that do not file FOCUS Reports, file a statement of financial condition giving the type
and amount of the firm’s assets and liabilities and net worth. The FOCUS Report and the statement of financial condition must reflect the finances of the firm no
earlier than 10 days before this Form BDW is filed.

6. Is the broker-dealer now the subject of or named in any investment-related:

NOTE: Update any incomplete or inaccurate information contained in item 11 of Form BD.

7.

- investigation
- consumer-initiated complaint
- private civil litigation

NAME AND ADDRESS OF THE PERSON WHO WILL HAVE CUSTODY OF BOOKS AND RECORDS:
ADDRESS WHERE THE BOOKS AND RECORDS WILL BE LOCATED, IF DIFFERENT:

NUMBER AND STREET

yes
[ ]
[ ]
[ ]

no
[ ]
[ ]
[ ]

AREA CODE / TELEPHONE NO.:
CITY

STATE/COUNTRY

ZIP + 4/POSTAL CODE

EXECUTION: The undersigned certifies that he/she has executed this form on behalf of, and with the authority of, the broker-dealer, and that all information herein, including any attachments hereto, is
accurate, complete, and current. The undersigned and broker-dealer further certify that all the information previously submitted on Form BD is accurate and complete as of this date, and that the broker-dealer’s
books and records will be preserved and available for inspection as required by law.
Date (MM/DD/YYYY)

Name

By:
Signature

Print Name and Title

Subscribed and sworn to me this ___ day of _______, ______ by ___________________________
Year
Notary Public
My Commission expires _______________ County of ______________________ State of ________________