Please Complete The Compliance Questionnaire: Compliance Questionnaire Name* First Last Email* Outside Business ActivitiesI understand that I am required to disclose ALL business activities --INCLUDING INSURANCE AND SELF EMPLOYMENT--to The Leaders Group Compliance Department, even if they are not investment related. This applies regardless of whether I have direct contact with customers.*YesNoI further understand that I must disclose any companies or entities that I own, operate, manage, or am employed by to the Compliance Department – even if not investment related (NOTE: passive investments or charitable activities do not need to be reported).*YesNoI will request prior written approval from Compliance for all new outside business activities. Additionally, if my role in a previously-disclosed business activity changes or ceases, I will inform the Compliance Department promptly.*YesNoAre you a director of or do you own 5% or more of ANY companies, private or public (LLCs, corporations, partnerships, sole proprietorships, et al)?*YesNoProvide details:Do you receive any compensation from a general agency as either a direct employee or general/independent contractor?*YesNoDo you hold a leadership position for a non-profit charity?*YesNoList the name of the charity and position held below:Regulatory RequirementsMy conduct, while registered with The Leaders Group, Inc., will conform to all securities regulations, with specific emphasis on the FINRA Conduct Rules, (available at www.finra.org) and applicable state laws, including my resident state.*TrueFalseI understand the following: all investment applications (including index annuities) must be promptly sent to The Leaders Group home office (except for subsequent investments, which may be sent directly to the product sponsor); applications must be accompanied by a completed New Account Form and all applicable Leaders Group forms; variable life applications may be sent directly to the insurance companies with a copy of the entire application and a New Account Form forwarded to The Leaders Group. I will comply with these requirements as long as I am registered with The Leaders Group.*TrueFalseIn the past 12 months, I have raised capital for a business, entity, individual, or participated in an offering of general partnership interests, commercial paper, promissory notes, or joint ventures.*TrueFalseProvide details:I will keep a chronological record (blotter) of every transaction (INCLUDING TRANSFERS) for a client, including a copy of the New Account Form, all other Leaders Group forms and the check (if any). My blotter will include: date received, customer registration, product name, amount invested, check number (if any) and the date the paperwork was sent to The Leaders Group (Daily Transaction Record available at www.leadersgroup.net).*YesNoI understand I must keep copies of confirmations & quarterly statements on file until year-end statements are received, and annual customer statements will be kept on file indefinitely.I understand I must keep copies of confirmations & quarterly statements on file until year-end statements are received, and annual customer statements will be kept on file indefinitely.*YesNoAs detailed in the Registered Representative agreement, I will report any change in my contact information to The Leaders Group Registration Department.*YesNoI will keep copies of my Form U4, RR agreement and fingerprints on file, as required by FINRA. I will also maintain files for advertising, correspondence and customer complaints, EVEN IF EMPTY.*TrueFalseI will keep all files or documents with customer information in a secure area where they cannot be accessed by unauthorized personnel. No non-public customer information will be left in an open trash container. All unnecessary documents with such information will be shredded.*TrueFalseI will not ask my customers to sign blank forms. All documents requiring a customer’s signature or initials will be thoroughly reviewed prior to his/her signing such documents.*TrueFalseI will keep myself informed and maintain records of all relevant circumstances relating to the financial interests and situations of my clients. As such, I will submit updated account information to The Leaders Group at least every three years.*TrueFalseAll recommendations to my clients will be suitable and in the best interest of the client in light of their current financial circumstances, objectives and risk tolerance.*TrueFalseIf I make a specific hold recommendation to a client, I will appropriately document such and keep it in the client’s file.*TrueFalseI will maintain an active email address which archives all investment-related emails via Global Relay and review it at least weekly for notices from The Leaders Group, Inc. I understand any email address not being archived through Global Relay is prohibited from being used to discuss or conduct any investment-related business and failure to follow this may result in termination of my registration.*TrueFalseAll e-mails containing non-public personal information (account numbers, social security numbers, logins/passwords, etc.) will be encrypted or password-protected for privacy and security purposes.*TrueFalseAll electronic devices (computers, laptops, smartphones, tablets, iPads, etc.) I use in the course of my business require passwords to log in, have up-to-date virus protection and data security measures.*YesNoI understand I must complete all Compliance continuing education requirements (regulatory CE, annual firm element, compliance meeting) within the prescribed time periods or my registration will be terminated.*YesNoI will review the firm’s Compliance Manual, as well as all Compliance Bulletins and other notices from the firm, and will continue to do so.*YesNoI understand I may not solicit any security sale prior to the time I am registered in client’s resident state, and that The Leaders Group, Inc. must review and authorize in advance any such security for sale.*YesNoI understand Representatives may not solicit variable or index insurance product sales until they have the necessary insurance license AND have been appointed with the sponsoring insurance company in accordance with the appropriate state regulations.*YesNoI confirm that I will not, in any capacity, act independently as an agent of a client, or for any individual or company in the field of securities, other than The Leaders Group, Inc.*TrueFalseI acknowledge that any promotion, venture or activity involving public funds may involve a “security” and could be prohibited.*TrueFalseAny communications sent to 25 or more customers in a 30-day period will be sent to and approved by Compliance BEFORE USE, and I will keep evidence of such approval.*TrueFalseI will maintain a file of all communications (including stationery and business cards) I use, with evidence of written approval by Compliance prior to first use.*TrueFalseI understand all correspondence, retail communication and institutional communication, must be maintained for a minimum of 3 years?*TrueFalseI hold customer seminars.*YesNoProvide details:I understand that any customer complaints, written or verbal, relating to investments or insurance must immediately be forwarded to The Leaders Group Compliance Department and I must maintain copies at my office location.*YesNoI understand that I should NEVER attempt to resolve a complaint directly with a customer, regardless of the circumstances.*YesNoI understand I cannot warrant or guarantee the present or future value or performance of any security.*TrueFalseI will not agree to repurchase a security from a client for his/her own or any other account.*TrueFalseI will not receive or act as personal custodian of securities, stock, stock powers, money, or other property belonging to a securities client.*TrueFalseI understand I may not take discretion with any customer account.*YesNoI will not borrow money or securities from any client (unless that client is a bank), nor will I commingle customer funds with my personal or business funds.*TrueFalseI will not arrange for the extension of credit to or for any client in connection with any securities transaction unless opened as a margin account.*TrueFalseI am not a trustee, custodian, personal representative, or executor for any customer, unless related by blood or marriage.*TrueFalseI understand I cannot maintain a joint account in securities with any client or share in any benefit with a client resulting from a securities transaction except immediate family.*TrueFalseAny funds that I receive in relation to my retail production with The Leaders Group will be directed into a bank account that is associated with my social security number.*TrueFalseI personally invest in cryptocurrencies.*TrueFalseI will not recommend cryptocurrencies to my clients.*TrueFalseI will disclose all brokerage accounts held by me or by immediate family members. Further, I will notify those firms that I am a Registered Representative of The Leaders Group, Inc, a FINRA member, and request that duplicate statements be sent to The Leaders Group Compliance Department.*TrueFalseI agree that I will transfer my current self-directed trading accounts to TD Ameritrade and that any and all future accounts may be required to be opened under TD Ameritrade.*YesNoPlease explain:I do not use my personal Facebook profile (or any other social networking site) for business purposes and it does not include any links to investment-related websites.*TrueFalseI understand that soliciting or recommending specific investment products is not allowed on ANY social networking site.*TrueFalseThe marketing organization I use for fixed insurance/annuity business is:*I will not generate consolidated statements from any technology product/vendor.*TrueFalsePlease explain:I understand I must have broker-dealer approval to attend any product-sponsored educational events valued over $100:*YesNoI understand all NEW personal production indexed annuities must be submitted to The Leaders Group for supervision.*YesNoI understand that any record kept exclusively in an electronic format must be in an approved software system with a third party, or emailed to or through my archived email address.*TrueFalseEmergency ContactEmergency Contact Name* First Last Emergency Contact Email Emergency Contact Phone*CertificationI hereby verify that the answers provided on this form are true and complete. I understand that submitting false, incomplete or misleading information is a violation of The Leaders Group, Inc. policies and guidelines contained herein and may constitute grounds for immediate termination.*YesNoEnter your full name which will be accepted as a legally binding signature.*Today's Date* Date Format: MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.