Registered Fiduciary



Firm Application –Part A

Abbreviated Name:       Date:      

Principal’s Name:      

Firm Name:      

Division:      

Firm Type: RIA

Street Address:      

     

City:       State:    Zip:       -     

Phone:       Fax:      

E-mail:      

Web site:      

Number of advisers in firm (Attach Part B for each adviser):      

|If this firm is owned or controlled by another firm or individual, please explain: |

|      |

|What is the principal business of the firm or individual referenced above: |

|      |

Broker/Dealer (if applicable):      

Firm Certifications

|Please list any certifications or other credentials that your firm holds, including the year it was first issued and the year of its expiration. An |

|example might be GIPS certification. |

|      |

Payment Preference

Credit card (Enter credit card info below) Invoice (Enter billing info below) Check sent

Name on Card:       Name:      

MC VISA AMEX Other:       Department:      

Number:       Address:      

Expiration:       City/State/Zip:      

Verification Code:       Phone:      

Complete Part B for each adviser before submitting this application

By following the link below:

Application Part B

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Due diligence process requires that applicant:

✓ Is an RIA/IAR registered with SEC and with ADV meeting requirements for member’s practice ar慥൳牐癯摩獥攠楶敤据⁥景欠潮汷摥敧漠⁦楦畤楣牡⁹牰捡楴散⁳倍潲畤散⁳慳灭敬⁳景挠楬湥⁴条敲浥湥獴‬畤⁥楤楬敧据⁥湡⁤数晲牯慭据⁥敲潰瑲⁳畣牲湥汴⁹湩甠敳‬牰癩捡⁹潰楬祣‬散瑲晩捩瑡⁥景椠獮牵湡散愠摮挠浯汰瑥⁥楬瑳漠⁦汣敩瑮⹳䠍獡愠椠獮eas

Provides evidence of knowledge of fiduciary practices

✓ Produces samples of client agreements, due diligence and performance reports currently in use, privacy policy, certificate of insurance and complete list of clients.

✓ Has a insurance coverage that is currently in force

✓ Undergo Dalbar verification

Due diligence cost: Send completed application Part A & B to:

Firm Cost DALBAR, Inc. Manager338@

First time $3,250 600 Atlantic Ave Fax: 617-624-7200

Subsequent years $2,500 Boston MA 02110 Phone: 617-723-6400

Annual Cost per Adviser

First IAR No Charge

Each additional IAR $250

(3 digits on back for MC and VISA

4 digits on front for AMEX)

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