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<br />Broker/Dealer Questionnaire and Certification <br /> <br />1. <br />2. <br /> <br />Name of Firm <br />Address <br /> <br />(Local) <br /> <br />(Nationalofficea) <br /> <br />3. <br />4. <br /> <br />9. <br /> <br />Telephone----(----> <br />Primary Representatives/Manager/Partner-in-Charle <br />Name Name <br />Title Title <br />ralephone No. Telephone No. <br />Are you primary dealer in US. Government Securities? n Yes n No <br />If so, for how long has your firm been a primary dealer? years <br />What vas your firm'. total volume in u.S. Government securities trading <br />last year? <br />7irmw1de $ Number of transactions <br />Your local office $ Number of transactions <br />Which instruments are offered regularly by your local desk? <br />[ ] T- bills [] Alencie. (.pecify) [] Instrumentalitie. (] Bank CDs <br />[ ] Treasury notes/bonds <br />[ ] BAs (domestic) <br />( ] BAs (foreign) --rl Commercial paper~ Other (specify) <br />Identify all personnel who viII be tradina with or quotina .ecurities to <br />our governments'. employee.. <br /> <br />5. <br />6. <br />7. <br /> <br />8. <br /> <br />Name <br /> <br />Telephone No. <br /> <br />10. <br /> <br />(Attach Resume. Of All The Above Persons) <br />Which of the above personnel have read our lovernment investmeut policies? <br /> <br />11. <br /> <br />Please identify our moat directly comparable public .ector clients in cur <br />geographical area. <br /> <br />Entity <br /> <br />Contact Person <br /> <br />Telephone No. <br /> <br />Client Since <br /> <br />12. <br /> <br />13. <br /> <br />Have any of your clients ever sustained a loss on a securities transaction <br />arising from a misunderstanding or m1srepresentat!on of the risk <br />characteristics of the instrument? If so, explain. <br />Have any of your public sector clients ever reported to ,our firm, its <br />officers or employees, orally or in writinl. that they sustained a loss(in <br />a single year) exceeding 10 percent of original purchase price on any <br />individual security purchased throulh ycur firm? (Explain) <br /> <br />14. <br /> <br />Has ycur firm ever been subject to a regulatory or state/federal agency <br />investigation for alleged improper. fraudulent. disreputable or unfair <br />activities related to the .ale of securities? Have any of your employees <br />ever been 80 investigated? (Explain) <br /> <br />17 <br />