Email Address: | |
2025 Annual Representative Questionnaire |
Last Name | |
First Name | |
What securities licenses do you hold? | |
A word of caution: This document is considered an annual examination which can and will be viewed by the SEC, FINRA, and State regulators. Your answers will have an impact on the findings of any regulatory audit. Failure to complete this document and return by the due date may result in the suspension of your licenses. If you cannot certify the truth and accuracy of any item listed within this questionnaire, you will have the opportunity at the end to provide a detailed explanation. |
1. I understand that any complaint I receive, whether written or verbal, must be reported to Compliance within 48 hours. In the past 12 months, I have reported any and all customer complaints and will continue to report any complaints that I receive. | I certify my understanding and compliance
Decline
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2. In the past 12 months, I have disclosed and will continue to disclose to Trustmont if I have been the subject of a regulatory exam or inquiry. | I certify my understanding and compliance
Decline
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3. In the last 12 months, I have and will continue to report all material compliance matters and/or potential conflicts of interest to Compliance. | I certify my understanding and compliance
Decline
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4. In the past 12 months, I have and will continue to report any unsatisfied judgments or liens filed against me. | I certify my understanding and compliance
Decline
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5. In the past 12 months, I have not engaged in any sales activity in a state in which I am not licensed. I understand that I am solely responsible for ensuring that I am appropriately licensed. | I certify my understanding and compliance
Decline
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6. In the past 12 months, I have not exercised discretion in any non-advisory account without the client's written approval and Trustmont's written consent. I have obtained client permission for every trade unless the client has granted written authorization to exercise discretion and Trustmont has approved such authority. | I certify my understanding and compliance
Decline
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7. I have disclosed to Trustmont if I and/or any members of my family, or any of my clients are on the board of directors or an owner of 5% or more of the stock of any publicly-traded company. | I certify my understanding and compliance
Decline
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8. During the last 12 months, I have not been in receipt of any material nonpublic information regarding any publicly-traded company. I understand that I am not permitted to trade on any nonpublic information. | I certify my understanding and compliance
Decline
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9. I advise customers of the availability of mutual fund breakpoints. | I certify my understanding and compliance
Decline
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10. I do not promise or guarantee performance of any transaction(s). | I certify my understanding and compliance
Decline
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11. In the past three years, I have not accepted cash from a client. I have not accepted a check made payable to me, my DBA or Trustmont. I have also not taken possession of a customer’s security. | I certify my understanding and compliance
Decline
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12. During my registration at Trustmont, I have never loaned money to a customer, borrowed money from a customer, or co-invested with a customer at any time without prior written approval from Trustmont. | I certify my understanding and compliance
Decline
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13. I do not share commissions or fees with any unregistered entity, individual, or client/customer. | I certify my understanding and compliance
Decline
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14. I do not act on trades left on voicemail, email, or messaging apps without verbal confirmation from the client. | I certify my understanding and compliance
Decline
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15. In the past 12 months, I have submitted all required monthly logs. This includes correspondence logs and check register logs via the Trustmont website. | I certify my understanding and compliance
Decline
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16. In the past 12 months, I have not given any customer gifts that exceeded the value of $100, nor have I received a gift from a customer that has a value exceeding $100. | I certify my understanding and compliance
Decline
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17. In the past 12 months I have submitted the required gift logs quarterly via the Trustmont website. | I certify my understanding and compliance
Decline
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18. In the past 12 months, I have reported all political contributions made by me or a member of my household. I understand that I must request prior approval for any political contributions over $250. | I certify my understanding and compliance
Decline
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19. During the last 12 months, I have reviewed all updates to the Trustmont Written Supervisory Procedures (WSPs) as well as Trustmont’s Compliance Manuals located on the Trustmont website. I acknowledge that I understand and intend to comply with all current policies and procedures outlined within. | I certify my understanding and compliance
Decline
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20. In the last 12 months, I have disclosed to Trustmont any changes in office personnel by completing the certification form located on the Trustmont website. | I certify my understanding and compliance
Decline
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21. I understand that once the minor/owner of an UTMA/UGMA account reaches the age of majority, the custodian no longer has authority over the account. | I certify my understanding and compliance
Decline
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22. In the past 12 months, I have provided the Privacy Disclosure Statement, CIP Notice, SIPC information, and Business Continuity Plan to each new prospective client. As well as the ADV 2A & 2B, if advisory. | I certify my understanding and compliance
Decline
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23. I understand that I am required to provide Form CRS to customers/potential customers when a recommendation is made of particular securities, investments, and/or investment strategies. | I certify my understanding and compliance
Decline
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24. I understand that I am required to complete the Required Disclosures Delivery Confirmation Coversheet for everyone to whom I have provided Form CRS. For those recommendations that do not result in additional paperwork being submitted to the home office, I understand that I am required to maintain the Coversheet in a separate file and make it available to Compliance upon request. | I certify my understanding and compliance
Decline
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25. In the past 12 months, I have provided clients with a copy of the principally-signed Client Profile Form (CPF) when completing new business, material changes or 36-month updates. | I certify my understanding and compliance
Decline
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26. I have and will continue to obtain prior written approval for all securities business-related advertising and retail correspondence. | I certify my understanding and compliance
Decline
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27. I only use my Trustmont approved email address for all securities-related communications, and I understand that I may not use or publish an unapproved email address on business correspondence or provide to clients. | I certify my understanding and compliance
Decline
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28. I understand that when transmitting personal and private information via email it is my responsibility to safeguard the information by utilizing the SECURE email system. | I certify my understanding and compliance
Decline
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29. I am familiar with Trustmont procedures on protection of digital customer information and comply with its requirements in the event that I download, create, and/or maintain customer non-public personal information, such as social security numbers, account numbers, bank routing numbers, etc., on a desktop computer or portable device. | I certify my understanding and compliance
Decline
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30. In the past 12 months, I have reviewed, complied with, and intend on continuing to comply with all current policies and procedures regarding Cyber Security and the protection of digital customer information. If changes to my cyber security occur, I agree to complete and return the certification form located on the Trustmont website. | I certify my understanding and compliance
Decline
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31. I have notified Trustmont of any changes, additions, or discontinuations to my electronic devices by completing the certification form on the Trustmont website. | I certify my understanding and compliance
Decline
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32. I understand that I may not text clients/customers unless I have received approval from Compliance and have properly installed the approved texting application to facilitate archiving and compliance review of text messages. | I certify my understanding and compliance
Decline
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33. I have the proper Trustmont voicemail disclosure message on the phone number(s) used in my securities business, including the use of a cell phone, if applicable. | I certify my understanding and compliance
Decline
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34. I have disclosed and received written approval for all outside business activities/private securities transactions. I retain a copy of the approval in my files. I am responsible for submitting to Compliance any new ventures or changes for approval and to be updated on my U4. | I certify my understanding and compliance
Decline
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35. I certify that I have reviewed my U4 and all information contained therein is complete and correct. I understand that I am solely responsible for verifying the accuracy and content of this information. I also understand that I have an ongoing responsibility to have my U4 amended when any of the information changes by reporting such changes to Compliance. | I certify my understanding and compliance
Decline
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36. I have notified Trustmont of all securities accounts (this includes cryptocurrency) held by me personally or a member of my household. | I certify my understanding and compliance
Decline
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37. I am aware that I must obtain approval prior to opening any new outside brokerage accounts. I acknowledge that for all brokerage accounts held outside of Trustmont, I will be charged $100 annual fee per account. | I certify my understanding and compliance
Decline
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38. I understand that I must receive pre-clearance for all covered security transactions that I make in my personal account or the account of any member of my household. | I certify my understanding and compliance
Decline
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39. List the items of stationery used for your securities business. | Letterhead
Business Card
Fax Coversheet
Printed Envelope
Printed Note Card/Book
None Used
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40. Do you share an address, building location or office space with any individual or entity not registered with Trustmont but who is registered with another broker-dealer, RIA, or investment-related business? | Yes
No
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41. Do you have any financial or business relationships outside of your activities associated with Trustmont? If a Trustmont client is involved, please provide name(s) below. | Yes
No
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Provide name(s) here. | |
42. Do you hold power of attorney for any client, including clients that are also family members? If so, provide name(s) below. | Yes
No
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Provide name(s) here. | |
43. Do you serve as trustee for any client account including family members? If so, provide name(s) below. | Yes
No
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Provide name(s) here. | |
44. Do you serve as executor for any client? If so, provide name(s) below. | Yes
No
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Provide name(s) here. | |
45. Are you listed as a beneficiary on any client account whether held at Trustmont or away? If so, provide name(s) below. | Yes
No
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Provide name(s) here. | |
47. Indicate the social media platforms you use for solely personal use: | Facebook
LinkedIn
X (Twitter)
Instagram
Snapchat
TikTok
Other
None
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48. Indicate the media platforms you use for your securities business: | Website
Facebook
LinkedIn
X (Twitter)
YouTube
Other
None
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49. Which Client Record Management System do you use for your securities business? If you do not use a CRM, place the word "none" on the line. | |
50. Provide the name of the Financial Planning Software used in your business. If you do not use financial planning software, place the word "none" on the line. | |
51. Do you understand that all manually-created consolidated reports must be approved prior to being given to your client(s)? | Yes
No
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52. Do you use any type of vault sharing to send or receive documents? If so, provide the name of program used below. | Yes
No
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Provide name of program here. | |
53. Do you conduct online meetings with your clients? If yes, provide below the name of the program. | Yes
No
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Provide name of program here. | |
54. Do you use third-party remote access software? If yes, provide the name of the program below. | Yes
No
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Provide name of program here. | |
55. Do you use cloud-storage? If yes, provide the name of the system below. | Yes
No
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Provide name of program here. | |
56. Do you use an online fax service for your business? | Yes
No
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57. Do you use a shredding service to dispose of clients’ personal and private information? | Yes
No
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58. I understand that prior to using a cell phone in my securities business, I must disclose its use to Compliance. | Yes
No
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59. Provide the cell phone number used for your securities business. If you do not use a cell phone, place the word "none" on the line. | |
60. Is anyone in your household an employee, associate or independent contractor of a broker/dealer, RIA or any other investment-related business? | Yes
No
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This concludes the 2025 Annual Representative Certification |
If you cannot certify the truth and accuracy of any item listed above, please use this space to give a detailed explanation referencing the specific question number. | |
Attach your signed and dated Code of Ethics here. | |
By entering my name in the space below, I certify that the statements made in this certification are true and complete to the best of my knowledge. |
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Date | |
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