Series 50: Form A-12

Form A-12

When completing Form A-12, the broker, dealer, municipal securities dealer, or municipal advisor must designate the following:

• • Primary Regulatory Contact
• • Master Account Administrator
• • Billing Contact
• • Compliance Contact
• • Primary Data Quality Contact

And may designate one of the following for any communication between the firm and the MSRB:

• • Optional Regulatory Contact
• • Optional Technical Contact
• • Optional Quality Contact

The Primary Regulatory Contact and the Optional Regulatory Contact must be registered municipal securities principals of the broker, dealer, or municipal securities dealer. These contacts will receive any official communications from the MSRB. In the case of municipal advisors, each Primary and Optional Regulatory Contact shall be authorized to receive official communications from the Board.

The Billing Contact will receive all MSRB invoices and will answer any of the MSRB’s questions about fees.

Exchange Act Section 15B