Referral Disclosure

I understand that the purpose of this referral notice is to keep me advised of the nature of this Referral Arrangement, and to comply with applicable regulatory requirements that require certain information regarding the Referral Arrangement be provided to me, specifically:

1.  Name of each party to the Referral Arrangement;
2. The purpose and terms of the Referral Arrangement, including the nature of the services provided by each party;
3. Any potential conflicts of interest arising from the relationship between the parties to the Referral Arrangement;
4. The registration status of each registrant that is a party to the Referral Arrangement, and the nature of the activities that each registrant is authorized to engage in, or, as applicable, prohibited from engaging in;
5. Confirmation that all activity requiring registration resulting from the Referral Arrangement will be provided by the registrant receiving the referral; and
6. Any other information that would reasonably be considered important in evaluating the Referral Arrangement.