FINANCIAL ADVISOR REGISTRATION FORM

Transcription

1 FINANCIAL ADVISOR REGISTRATION FORM COMPLETION OF THIS FORM IS REQUIRED FOR REGISTRATION IN THE UNIVERSITY OF ALABAMA PLAYER-FINANCIAL ADVISOR PROGRAM. NOTE: This form must be completed in its entirety. 1. GENERAL (Please type, if applicable) Date of Birth: SS#: Have you ever been know by any other name or surname? Yes No If yes, state all name used and when used: Firm Name & Address City State ZipCode Address Business Phone: ( ) Employer ID#: Website: Home Address City State ZipCode Home Phone Number 2. EDUCATION Business or Other Graduate School Attended: Colleges or Universities Attended:

2 University Of Alabama Player-Financial Advisor Annual Registration Form Page 2 Colleges or Universities Attended [con t]: High School Attended: School City & State Dates Attended Degree 3. EXPERIENCE Number of years experience as a financial advisor: Sports in which you currently represent athletes: Other sports in which you have represented athletes: 4. OTHER QUALIFICATIONS Are you a member of any professional organizations which directly relate to your occupation or profession: Yes No (Name of organization) (Name of organization) (Name of organization) List any Occupational or professional licenses (i.e., Certified Public Accountant, Chartered Life Underwriter, etc.), CFP Certified Financial Planner CFA Chartered Financial Analyst ChFC Chartered Financial Consultant Other:

3 University Of Alabama Player-Financial Advisor Annual Registration Form Page 3 Other: Other: Are you currently registered by the State of Alabama as a player agent? Yes No Are you currently certified by the NFLPA? Yes No Permanent or Provisional (circle one) Are you currently certified by the NBPA? Yes No Permanent or Provisional (circle one) 5. PROFESSIONAL SERVICES General services performed for client athletes (check those that apply and indicate fee charged): Investment Advice: Yes No Insurance Planning: Yes No Retirement Planning: Yes No Tax Planning: Yes No Financial Planning: Yes No Budgeting: Yes No Purchase or Sale of Securities: Yes No Other: Yes No Provide details of your experience, use additional sheets if necessary: For the services you perform for client athletes, list the names and addresses of individuals, firms or agencies that assist in providing these services. Use additional sheets as necessary. Firm/Agency: Firm/Agency:

4 University Of Alabama Player-Financial Advisor Annual Registration Form Page 4 Firm/Agency: Do you earn income from work performed in some capacity other than as a financial advisor? Yes No If yes, describe other occupation(s) or service(s) for which you are paid? What approximate percentage of your total work time is consumed as a financial advisor? Does anyone else work for you (i.e., middlemen, runners, etc.)? If yes, please list: Yes No * FAILURE TO INDICATE RUNNERS OR MIDDLEMAN COULD RESULT IN NONAPPROVAL OR DISSOCIATION. 6. CLIENT PROFILE List the number of clients you presently represent who are current professional athletes. How many are NFL players?, NBA?, MLB? List the number of individual clients you currently represent who have assets under your primary management or subject principally to your investment advice of over: 1. $1 million per individual client: 2. $5 million per individual client: 3. $10 million per individual client: List the number of individual clients you currently represent who have had assets under your primary management or subject principally to your investment advice of over $1 million per individual client continuously for the immediate past five (5) years:

5 University Of Alabama Player-Financial Annual Registration Form Page 5 Are any of the clients you have listed above willing to serve as references for you? If so, please list such individual clients, including their address and phone number: Client Name Team Address Phone Number PREVIOUS EMPLOYMENT (Please list last three positions and dates of employment): Firm: Position/Dates: Firm: Position/Dates: Firm: Position/Dates: 8. REFERENCES

6 University Of Alabama Player-Financial Annual Registration Form Page 6 9. VERIFICATION STATEMENT I certify that the above information is true, correct and complete to the best of my knowledge. Further, I certify that I will notify the director of athletics (or the designated representative/athletics compliance office) at the UNIVERSITY OF ALABAMA prior to the first contact with a student-athlete who has eligibility remaining in any sport and enrolled at the UNIVERSITY OF ALABAMA or before the first contact with the student-athletes coach. Before signing the registration form, I have read the UNIVERSITY OF ALABAMA Agent-Financial Advisor Policy concerning student-athletes and agree to be bound by and confirm to this policy. I also understand that failure to comply with the terms of this certification and the applicable NCAA legislation may result in the initiation of legal proceedings by the UNIVERSITY OF ALABAMA and the assessment of civil and/or criminal penalties. Signature: Date: PLEASE RETURN COMPLETED FORM TO: Athletics Compliance Office University of Alabama P.O. Box Tuscaloosa, Alabama Or Fax to