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Division of Securities & Retail Franchising


Securities & Retail Franchising Forms


Form Name Form Description
  Broker-Dealer Forms
BD External Link logo Uniform Application for Broker-Dealer Registration
S.A. 11 Broker-Dealer’s Surety Bond
S.A. 2 Application for Renewal of a Broker-Dealer’s Registration
BDW External Link logo Uniform Notice of Termination or Withdrawal of Registration as a Broker-Dealer
  Agent Forms
S.D. 4 Application for Renewal of Registration as an Agent of an Issuer
S.D.4 A Non-FINRA Broker-Dealer or Issuer Agents to be Renewed Exhibit
S.D.4 B Non-FINRA Broker-Dealer or Issuer Agents to be Canceled with no disciplinary history
S.D.4 C Non-FINRA Broker-Dealer or Issuer Agents to be Canceled with disciplinary history
U-4 External Link logo Uniform Application for Securities Industry Registration or Transfer
U-5 External Link logo Uniform Termination Notice for Securities Industry Registration
Aff Affidavit Regarding SCOR Offering
S.A. 16 Agent Multiple Employment Agreement
  Investment Advisor Forms
ADV External Link logo Uniform Application for Registration of Investment Advisors
IA Surety IA Surety Bond Form
ADV-W External Link logo Notice of Withdrawal From Registration As Investment Advisor
  Investment Advisor Representative Forms
U-4 External Link logo Uniform Application for Securities Industry Registration or Transfer
U-5 External Link logo Uniform Termination Notice for Securities Industry Registration
S.A. 3 Affidavit for Waiver of Examination
S.A. 15 Investment Advisor Representative Multiple Employment Agreement
  Securities Registration Forms
U-1 Uniform Application to Register Securities
U-2 Uniform Consent to Service of Process
U-2a Uniform Form of Corporate Resolution
U-7 External Link logo Small Company Offering Registration - SCOR
S.A. 4 Registration by Notification – Original Issue
S.A.5 Registration by Notification – Non-Issuer Distribution
S.A.6 Registration by Notification – Pursuant to 21 VAC 5-30-50 Non-Issuer Distribution "Secondary Trading"
S.A. 8 Registration by Qualification
S.A. 12 Escrow Agreement
S.A. 13 Impounding Agreement
VA-1 Notice of Limited Offering of Securities
NF Uniform Investment Company Notice Filing
SEC Form DExternal Link logo Notice of Exempt Offering of Securities
Model Form Model Accredited Investor Exemption Uniform Notice of Transaction Form
CR-Equity-1 Application for Coordinated State Review - CR
CR-SCOR
Mid-Atlantic
Small Business Securities Offering Application for Mid-Atlantic Regional Review Form
  Franchise Forms
A Uniform Franchise Registration Application
B Franchisor's Costs and Sources of Funds
C Uniform Franchise Consent to Service of Process
E Affidavit of Compliance – Franchise Amendment/Renewal
F Guarantee of Performance
G Franchise Surety Bond
H Notice of Claim Exemption
K Escrow Agreement
CR-FRAN Application for Coordinated Review of Franchise Registration
  Trademarks/ Service Marks
TM1 Application for Registration of a Trademark or Service Mark
TM2 Application for Renewal of Registration of a Trademark or Service Mark
TM3 Certificate of Name Change of an Applicant or Registrant
TM4 Assignment of Trademark of Service Mark Registration – this is a sample, not really an official form