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MFD Application for Registration of Mutal Fund Distributor

SEC registration form for mutal fund distributor

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: SECURITIESAND EXCHANGE COMMISSION
APPLICATION FOR REGISTRATION
AS MUTUAL FUND DISTRIBUTOR
For the year

__

(To be accomplished in 4 copies with cover sheet;
3 copies for SEC, I copy for applicant's file)

NOTE: TO BE USED BY APPLICANTS WHO ARE CURRENT HOLDERS OF SECONDARY

Please check applicable

L1CENSE/S ISSUED BY SEC

box

0 RENEWAL REGISTRATION

0 NEW REGISTRATION

Certificate

Name of Applicant:

of Registration No.

Name of Certified Investment Solicitor/s:

TIN#
Tel. No.
Fax No.
E-mail Address:
Certificate of Registration # of CIS:

Contact

Designation:

Applicant's

Main Address:

Person:

Name of Investment

Company

Address:

Adviser:

Name of Fund(s) Managed/Distributed:

"

Branch
# of Branch Office/s offering services as
Location
of
mutual fund distributor:
Please check applicable box/es:
Other services offered by the applicant.
0 Others (please specify):
0 Broker-Dealer in Securities
0 Broker-Dealer in Proprietary Shares

Office/s:

The above-named
applicant hereby makes its application for registration and hereby certifies
that the information contained is true, correct. current, accurate and complete. Applicants
are required to update all information in SEC Form MFD by submitting amendments whenever
the information on file becomes inaccurate for any reason within seven (7) days of any change
to the information previously filed.

Reviewed by:

Printed Name/Signature

Printed Name and Signature of
Associated Person/Compliance Officer

of Company

President

Date

--_

::

_

~

_

Subscribed and sworn to before ine this __
valid identity card

.

_:

day of
issued at

201_, exhibited to me his/her
on
_

Notary Public
Doc No.
f

Page No.
Book No-.
Series
1.

-=-======~
~

Covering letter duly signed by the company's President identifying the names, the respective Certificate of
Registration numbers and TINs of the applicant's CIS;
2.
Copy of the Mutual Fund Distributor's previous license;
3.
Tennination Notice (SEC Fonn ICA T) or a copy thereof duly stamped received by the SEC (if already filed) for CIS
who were issued licenses but are no longer connected with the company or whose licenses will not be renewed for
the next licensing year;
4.
Photocopy of the current distribution agreement between the ICNMFD and the finn duly certified by the Associated
Person/Compliance Officer (valid for the whole licensing year) OR board resolution from both the MFD and
ICAlMFD confinning the existence and validity of their distribution agreement, for renewal purposes;
5.
Written undertaking containing the conditions set by the SEC made under oath and signed by an authorized officer
of the applicant (new applicants only);
6. . Amended Written Supervisory ProCedures to include procedures. under the distribution agreement (new applicants
only) ; and
7.
Payment of fee - PhP3.030.00
 
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