Registered Representative Disclosure Documents. All disclosure documents must be on file at the home office before registration begins.

Transcription

1 Registered Representative Disclosure Documents All disclosure documents must be on file at the home office before registration begins. In order to expedite the appointment process with those insurance companies with which you wish to do business, please forward copies of your insurance licenses along with this documentation. Receipt of this document package does not intend to suggest that you are a licensed Registered Representative of Trustmont Financial Group, Inc. You will not be approved as a licensed Registered Representative of Trustmont Financial Group, Inc. until officially notified in writing by the home office. 1

2 PERSONAL DATA SHEET (Please print legibly or use writeable form) Full Name: Business Name: Business Address: Address: Business Phone: Business Fax: Preferred Mailing List Address: Home Business Home Address: Home Phone No.: Social Security No.: of Birth: Place of Birth (City, State, County): 2

3 ADVERTISING ACKNOWLEDGMENT ARTICLE III, SECTION 27, 35 SEC RULE 134, 135a I understand that ALL advertising materials must be submitted for approval to the main office of Trustmont Financial Group in Greensburg, Pennsylvania prior to its publication. I also understand that if the item is questionable, it will be submitted to FINRA s advertising department for approval, and I am aware there are costs associated with submitting advertising material to FINRA. I also understand that if I intend to give a seminar to the general public, I must submit an outline for approval PRIOR to the seminar, and that I must submit a list of attendees of the seminar within a reasonable period of time of the seminar completion. Signature CRD # Witness Signature Print Name Print Witness Name 3

4 DISCLOSURE OF PERSONAL & FAMILY ACCOUNTS ACKNOWLEDGMENT I realize that under SEC and FINRA guidelines, I must disclose any and all of my personal and my immediate family s accounts to my broker/dealer, whether or not these accounts are held at Trustmont Financial Group, Inc. or other brokerage firms. I also understand that I must notify Trustmont Financial Group, Inc. if any such accounts are opened in the future. Please list all accounts currently open: Location of Outside Account Account Name Account No. Registration Signature Witness Signature Print Name CRD # Print Witness Name 4

5 CORRESPONDENCE ACKNOWLEDGMENT Article III, Section 27, 35 I understand that all correspondence to customers or potential customers, whether electronic or hard copy, must have approval prior to dissemination. I acknowledge that all communications to customers must be retained for at least five years after the close of an account. I acknowledge that all securities business-related communications must be directed through my Trustmont-approved account. (A Trustmont-approved account is either an assigned Trustmont Group address or a domain address that is being captured and archived by Trustmont Group.) Should I receive a securities business-related through a personal account, I understand that I must respond to the through my Trustmont-approved address directing all future correspondence be sent to the Trustmont Group-approved address. I acknowledge that the use of Instant Messaging and texting is prohibited by Trustmont Financial Group, Inc. as there is no way of effectively monitoring such activity. Signature Witness Signature Print Name CRD # Print Witness Name 5

6 OUTSIDE ACTIVITIES OF REGISTERED PERSONS OUTSIDE BUSINESS Please submit this form at least 2 weeks prior to the anticipated start of the outside business activity. FINRA Rule 3270 No registered person may be an employee, independent contractor, sole proprietor, officer, director or partner of another person, or be compensated, or have the reasonable expectation of compensation, from any other person as a result of any business activity outside the scope of the relationship with his or her member firm, unless he or she has provided prior written notice to the member, in such form as specified by the member. This document is to be used to report any outside business activity with which you have been engaged prior to December 15, 2010 and subsequent to December 15, 2010, to provide written notice to Trustmont of any proposed outside business activity prior to engaging in that activity. Name: (Each of the following questions requires a detailed answer.) Type of Activity (please list each activity on a separate form). Examples include but are not limited to: Attorney, Insurance/Real Estate Agent, Notary, CPA, Trust/Mortgage-related Services, Consultant, etc. Name of Outside Business (Doing Business As): Where is this activity conducted? What is the start date of your relationship with outside activity: What is your position, title, or relationship with outside activity? Are you compensated for this activity or do you reasonably expect to be compensated for this activity? Briefly describe your duties relating to the outside activity: Could the outside activity be viewed by customers or the public as part of Trustmont Financial/Advisory Group business based upon, among other factors, the nature of the proposed activity and the manner in which it will be offered? Is this outside activity easily or likely to be confused with those activities inside Trustmont Financial/Advisory Group? What steps are you taking to ensure that your customer does not confuse the outside activity with those activities inside Trustmont Financial/Advisory Group? 6

7 Is the product or service introduced to clients during meetings to discuss Trustmont Financial/Advisory Group offerings? Is the product or service ever solicited or discussed on Trustmont Financial/Advisory Group letterhead? What are the potential conflicts of interest between this outside activity and Trustmont Financial/Advisory Group? Does the activity have some of the attributes of securities investments (e.g. notes, private investments, real estate, precious metals, collectibles)? Are Trustmont Financial/Advisory Group products ever liquidated to fund or purchase the outside activity, or for charges for services (e.g. fixed annuities from outside vendors)? Are Trustmont Financial/Advisory Group customers also partners, investors, associates, etc. of the outside business activity? Does the service generate proceeds that are used to purchase Trustmont Financial/Advisory Group products (e.g. mortgage origination, reverse mortgages)? Does the service or activity often result in a recommendation to purchase Trustmont Financial/Advisory Group products or services (e.g. practice of law, financial planning, business valuation services, account practice, Medicaid planning, college funding planning)? What is the approximate number of hours per month you plan to devote to the outside activity? What is the number of hours you plan to devote to the outside activity during securities trading hours: Is a greater percentage of time going to be spent on the outside business activity than with the securities or investment advisory business with Trustmont Financial/Advisory Group? Does the outside activity interfere with or compromise the registered person s responsibilities to Trustmont Financial/Advisory Group and/or customers? Name: 7

8 Please mark product types you engage in: Accident & Health Disability Life Insurance Viatical Settlements Life Settlements Fixed Annuity Hedge Funds Fixed Indexed Annuity Offshore Products Other: Please provide contact information for the Master General Agent/Field Marketing Organization you use for your insurance product(s): Name of MGA/FMO: Contact name and number: I understand the Trustmont E&O policy does not cover any OBA and my contract with Trustmont provides for indemnification of any and all costs incurred by Trustmont arising from any OBA. YES NO By submitting this form, I certify that all answers to the questionnaire are true and correct to the best of my knowledge and the answers provided accurately represent all my activities. I also understand that if there is a change to my business activities, I am required to notify Trustmont by immediately updating this or any subsequent form. _ Signature _ Print Name Witness Signature Print Witness Name Trustmont Use Only: The outside activity involves securities transactions and, therefore, subject to compliance and recordkeeping procedures required by NASD Rule 3040, Private Securities Transactions. Outside business activity approved without Trustmont Financial/Advisory Group oversight. Outside business activity approved with Trustmont Financial/Advisory Group oversight. Outside business activity approved with the following conditions or limitations: What are the regulatory risks associated with this Outside Business Activity? Outside activity disapproved. Additional compliance notes and questions should be attached or printed on the backside of this page. Principal Signature: : 8

9 REGISTERED REPRESENTATIVE REGULATORY GUIDELINES I am aware that Trustmont Financial Group, Inc. and Trustmont Advisory Group, Inc. and their agents and advisors are not permitted under regulatory rules to take possession of clients security certificates or funds. Customer checks should be forwarded immediately along with applications to the insurance company, mutual fund company, or correspondent of record. CUSTOMER SECURITY CERTIFICATES MUST BE MAILED BY THE CUSTOMER TO THE APPROPRIATE CORRESPONDENT. FINRA RULES DO NOT ALLOW FOR ANY REPRESENTATIVE TO TAKE POSSESSION AT ANY TIME OF ANY CERTIFICATES. Signature Witness Signature Print Name CRD # Print Witness Name 9

10 COMPLIANCE MANUAL ACKNOWLEDGMENT I acknowledge the following: I have read and understand the contents of the Trustmont Financial Group Inc. Compliance Manual and agree to be bound by the policies and procedures therein. I will provide new employees, including trainees, with access to the Compliance Manual and will ensure that all persons whom I supervise know and understand the contents of the Compliance Manual, and use it in day-to-day activities. I will ensure that any supplements or revisions to the Compliance Manual are distributed to persons under my supervision with proper instruction for their use of the Compliance Manual. Signature Witness Signature Print Name CRD # Print Witness Name 10

11 Errors and Omission Retroactive Coverage I acknowledge that I have been offered Retroactive Coverage for my Errors and Omission policy with Trustmont Group. If I choose to purchase this coverage, I will contact Trustmont Group within 30 days of my hire date to obtain a quote and I will pay in full for the coverage within 60 days of my hire date. The Trustmont Group Errors and Omission policy does not cover any outside business activities and does have some limitation on products. Signature Witness Signature Print Name CRD # Print Witness Name 11

12 Please use this area for notes or questions. 12

13 Direct Deposit Authorization Agreement Type (please choose one) New Agreement Change Account Registered Representative Name Account Information: I authorize Trustmont Financial Group, Inc./Trustmont Advisory Group, Inc. to deposit net commission/fee into my (please choose one): CHECKING account SAVINGS account Signature Routing/Transit Number: Account Number: Fax form to: Mail to: Trustmont Group Attn: Alicia Walker 200 Brush Run Road, Suite A Greensburg, PA ** Attach a voided check** We cannot process without a voided check NO Starter Checks FINRA rule states a Broker/Dealer can only pay a licensed person--you must be an owner or joint owner listed on the above account. NO CORPORATE ACCOUNTS can be accepted (ex. LLC, S Corp, C Corp, DBA etc.) For Admin. Use Only Set Up (Name) 13