Capital Market Operators Data Update Form

Registration Number:*

Company/Firm Name:*

Date of First Registration:*

RC/BN Number:*

Trade Group/Association 1:*

Trade Group/Association 2:

Trade Group/Association 3:

Trade Group/Association 4:

Registered Function 1:*

Please select your appropriate functions from the provided list.

Registered Function 2:

Please select your appropriate functions from the provided list.

Registered Function 3:

Please select your appropriate functions from the provided list.

Registered Function 4:

Please select your appropriate functions from the provided list.

Registered Function 5:

Please select your appropriate functions from the provided list.

2016 Fidelity Bond Submitted?*

Yes

No

Insurance Company:*

Amount Covered:*

Period Covered:*

Enter a beginning and ending period separated by a dash (e.g. 01/JAN/16 - 31/DEC/16)

Policy Number:*

Head Office Address:*

Head Office State:*

Website Address:*

Enter the company/firm website address in the format (http://webaddress.com)

Contact Number(s):*

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Branch Office 1:

Branch Office 1 State:

Branch Office 1 Email Address:

Branch Office 1 Phone Number(s):

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Branch Office 1 Registered Sponsored Individual?

Confirm if this Branch Head is a registered sponsored individual with SEC

Yes

No

Branch Office 2:

Branch Office 2 State:

Branch Office 2 Email Address:

Branch Office 2 Phone Number(s):

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Branch Office 2 Registered Sponsored Individual?

Confirm if this Branch Head is a registered sponsored individual with SEC

Yes

No

Branch Office 3:*

Branch Office 3 State:

Branch Office 3 Email Address:

Branch Office 3 Phone Number(s):

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Branch Office 3Registered Sponsored Individual?

Confirm if this Branch Head is a registered sponsored individual with SEC

Yes

No

Managing Director's Name*

Surname First

Managing Director's Email Address:*

Managing Director's Phone Number(s):*

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Is the MD a Registered Sponsored Individual?*

Confirm if the MD is a registered sponsored individual with SEC

Yes

No

Director 1's Name:*

Surname First

Director 1's Permanent Home Address:*

Director 1's Phone Number(s):*

Enter multiple numbers in the format (xxxx xxx xxxx) or (xx xxx xxxx) separated by a comma.

Director Type*