f6200-54i

FDIC OMB No. 3064-0022; Expiration Date: 06/30/2024
FRB OMB No. 7100-0100; Expiration Date: 07/31/2022
OCC OMB No. 1557-0184; Expiration Date: 09/30/2022

Federal Deposit Insurance Corporation

INSTRUCTIONS FOR FORM MSD-4
UNIFORM APPLICATION FOR MUNICIPAL SECURITIES PRINCIPAL OR
MUNICIPAL SECURITIES REPRESENTATIVE ASSOCIATED WITH A BANK
MUNICIPAL SECURITIES DEALER
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 Rule making
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 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.
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.

FDIC 6200/54i (6-21)

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FDIC OMB No. 3064-0022; Expiration Date: 06/30/2024
FRB OMB No. 7100-0100; Expiration Date: 07/31/2022
OCC OMB No. 1557-0184; Expiration Date: 09/30/2022

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 11 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 2c: 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.

FDIC 6200/54i (6-21)

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