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1-AMD AFFILIATED TRANSACTIONS MONITORING SHEET GENERAL INSTRUCTIONS INTRODUCTION Section 30.1 of the Securities Regulation Code provides that “No broker or dealer shall deal in or otherwise buy or sell, for its own account or for the account of its customers, securities listed on an Exchange issued by any corporation where any stockholder, director, associated person or salesman, or authorized clerk of said broker or dealer and all the relatives of the foregoing within the fourth civil degree of consanguinity or affinity, is at the time holding office in said issuer corporation as a director, president, vicepresident, manager, treasurer, comptroller, secretary or any office of trust and responsibility, or is a controlling person of the issuer.” Rule 30.1 requires every Broker Dealer to request its stockholders, directors, associated persons, salesmen and authorized clerks to complete and submit to it an executed copy of SEC Form 30.1 under oath to ensure compliance with section 30.1 of the Code, cited above. An answer of “yes” to any of the questions in items 4 through 9 shall give rise to the obligation to answer item 10, and to include the security in SEC Report 30.1 (Report by Broker Dealer on Restricted Transactions) as among those the Broker Dealer is prohibited from dealing in, purchasing or selling, in accordance with Rule 30.1 The information contained in this Form shall be kept current, thus requiring an individual to make an amended submission to the Broker Dealer on Form 30-1-AMD whenever there is any change. However, the amended form need be completed only with respect to those items affected by the changes. Amended submission should likewise be made to correct deficiencies in a previous filing and to update and keep current the information required by the form. Persons required to submit this form are required under Rule 30.1 of the Implementing Rules and Regulations of the Code, to ensure that this Form is accurate and complete at all times and shall update and submit to the Broker Dealer any amendments hereto within twenty-four (24) hours to reflect any change. The failure to comply with this rule shall be deemed a violation of the said Code. General Instructions 1. 2. All information shall be typed or neatly printed in black ink. All information required shall be submitted on the officially prescribed SEC Form 30.1, or mechanical reproduction thereof. All pages containing this information may be mechanically reproduced by any method producing clear, legible copies of identical type size. A) B) C) 4. 5. If the Broker Dealer accomplishing SRC Report 30.1 is a corporation, then this Form shall be accomplished by the Broker Dealer’s stockholders, directors, associated persons, registered salesmen, and authorized clerks. If the Broker Dealer accomplishing SRC Report 30.1 is a partnership, then this Form shall be accomplished by the Broker Dealer’s partners, associated persons, registered salesmen, and authorized clerks. If the Broker Dealer accomplishing SRC Report 30.1 is a sole proprietorship, then this Form shall be accomplished by the Broker Dealer’s owner, associated persons, registered salesmen, and authorized clerk.


All questions must be answered. Enter “none” or “N/A” (not applicable) where this is the appropriate response. Failure to complete all required items may cause the form to be returned unprocessed or considered deficient. Item 2 shall be completed by including all names by which you are known or have been known other than your current legal name. This includes nicknames, maiden names, or married names by which you are now or have been known since adulthood. Items 4 through 9 shall be accomplished by checking the appropriate box. The term “office of trust and responsibility” referred to in item 9 shall refer to those offices whose holders, as part of their responsibilities, have access to material nonpublic information about the company, such as but not limited to, in house counsel and accountants. An answer of “yes” to any of these items shall obligate the person reporting to answer item 10. Please note that under the New Civil Code, the following are the fourth degree relatives of the person reporting: parents, grandparents, great grandparents, granduncles/grandaunts, siblings, uncles/aunts, first cousins, children, grandchildren, great grandchildren, nephews/nieces, grandnephews/grandnieces. All required signatures must be original. Mechanical reproductions of signatures will not be accepted. Registered Broker Dealers are under a continuing obligation to update the information contained in this Form by filing SEC Form 30.1-AMD no later than twenty four (24) hours of such changes. To amend information, indicate in the appropriate space of the Form that it is an amended filing, and make changes to the Form where appropriate, accompanied by the Execution Page.


7. 8.

SEC Form 30.1 January 2001