LFF & LFAS Disclosure Documents & Form CRS

Disclosure Document Delivery/Form CRS

Purpose: Best Interest Checklist and Disclosure Document Delivery – Determine if delivery of Form CRS is required, document delivery of Form CRS in addition to enhanced due diligence requirements. Additional document delivery of Form ADV Part 2B (supplement), Form ADV Part 2A OR appropriate Wrap Brochure.
Branch ID*
What kind of account is being opened?*

Level Four Financial, LLC - BrokerageLevel Four Advisory Services, LLC - Advisory
Advisor/Rep Name*
REP GONE Advisor/Rep Name
Rep Name*

First NameLast Name
Advisor/Rep Email*
example@example.com
Assistant Email
example@example.com
Are there additional Advisor/Reps?*

YesNo
Are there additional Reps?

YesNo
2nd Advisor Name*
2nd Rep Name

First NameLast Name
2nd Advisor/Rep Email*
example@example.com
Are there additional Advisors?*

YesNo
Are there additional Reps?

YesNo
3rd Advisor Name*
3rd Rep Name

First NameLast Name
3rd Advisor/Rep Email*
example@example.com
Are there additional Advisors?*

YesNo
Are there additional Reps?

YesNo
4th Advisor Name*
Rep Name

First NameLast Name
4th Rep Name

First NameLast Name
4th Advisor/Rep Email*
example@example.com
Investor Name(s)*
Regulation Best Interest defines a "retail investor" as "a natural person or legal represenative of such natural person, who seeks to receive or receives services primarily for personal, family, or household purposes."
- All natural persons, regardless of network or sophistication, are included in the definition of "retail investor."
- Includes "existing" retail clients and "prospective" retail clients.
- Exludes institutional investors.
Is this a Retail Investor (per Reg BI)?*

YesNo
Identify if the Investor is a Prospect, New Client or a Existing Client.*

ProspectNew ClientExisting Client (Client opening a new account that is different than their existing account, receiving a new advisory service or is a new recommendation being made regarding a retirement rollover)
If Existing Client, list account #(s)*
Is this an IRA Transfer or Rollover?*

YesNo
Under RegBI, where applicable, I confirm I have verbally disclosed any personal conflicts with my client.*

Yes
I understand when considering a recommendation, I will be required to:

a. Discuss the account type(s) that I offer and address any investor questions regarding the differences.
b. Discuss any limitations I have in offering account/product types available thru LFF and/or LFAS.
c. Only recommend those account types that are in the investor's best interest.
d. Acknowledge to the investor when certain account types are not in their best interest.
e. Identify and disclose perceived conflicts of interest to the investor.
f. Identify and disclose all investment costs and ensure they are reasonable
g. Disclose any personal conflicts of interest relating to any recommendations made
Acknowledge the above:*

Yes, I understandNo, I do not understand
If no, please provide details.
I understand for complex Account/Product/Rollover recommendations- additional documentation is required, for example:
a. 1106C Margin COB Application
b. 1112CF Option Agreement
c. LFF189 Transfer/Rollover Due Diligence
d. LFF188 Annuity Purchase Disclosure
e. LFF166 MF Share Class-Breakpoint Disclosure
f. 1529 529 Disclosuree
g. LFF Exchange Traded Products Risk Disclosuree
Acknowledge the above:*

Yes, I understandNo, I do not understand
If no, please provide details.
Will the client participate in a LFAS wrap program?*

ICA Platform (Independent Clearing Account – custody at Raymond James)Managed Assets Program (custody at Charles Schwab or Fidelity)Participant Asset Management Program (employer-sponsored and small business retirement plans – custody at Fidelity or TIAA-CREF)N/A (no LFAS wrap account – i.e. financial planning/retirement planning; RJ Freedom; RJ Freedom UMA)
Is the client requesting a Securities Backed Line of Credit?*

YesNo
If your client is requesting a SBLOC, you must complete the SBLOC Client Background & Suitability Checklist.
Is the client purchasing a Category 2 (as classified by Raymond James) Exchange Traded Product (“ETP”) ?*

YesNo
Is the client purchasing a Category 2C Exchange Traded Product (Cryptocurrency ETP)?*

YesNo
Will client assets be managed by LFCM?*

YesNo
If LFCM managed, will client be investing in the Crypto Completion Portfolio?*

YesNo
Will the client be participating in a subadvised Fixed Income portfolio?*

YesNo
If yes, which subadvisor?*

Parametric/Eaton VanceFirst Trust
Document delivery method*

Please email the Form CRS and Disclosure Documents to the investorI have mailed or I will mail the Form CRS and Disclosure Documents to the investorI will hand deliver the Form CRS and Disclosure Documents to the investor
Identify the Date you delivered the Form CRS and Disclosure Documents to the investor*

MonthDayYear
Date
If you are choosing to mail or hand deliver the Document Disclosures, the required documents will be emailed to you.
Investor Email*
example@example.com
Investor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
With my submission of this document to Level Four, I certify that my responses to the questions are complete and accurate to the best of my knowledge. By typing my name and the date below, I attest that I have read and personally answered each of the questions.
Advisor Name*

First NameLast Name
Date Completed*

MonthDayYear
Date
Disclosure Delivery Obligations
LFAS, LFF, LFCM Form CRS
LFF Form CRS Supplemental & Investor Information
LFAS Form ADV Part 2A
LFCM Form ADV Part 2A
LFCM 172C Crypto Portfolio Addendum
Managed Assets Program
Participant Asset Management Program Brochure
ICA Platform Brochure
Securities Backed Line of Credit
Exchange Traded Products Risk Disclosure
Eaton Vance/Parametric Part 2A ADV
First Trust Part 2A ADV
Form ADV Part 2B supplement
Adkins, Kevin
Allman, Ken
Anderson, Robert
Ash, Ryan
Asif, Shabana
Benko, Dawn
Barclay, Marshall
Bidwell, Frances
Bisceglia, Jeremy
Blake, Craig
Blalock, Julie
Blankmeyer, Erik
Brace, Ryan
Brantley, William
Brasse, Jeffrey
Britt, Luke
Bruno, Jack
Bruno, Louis
Bryan, John
Bulot, Todd
Byrnes, David
Choate, Chad
Clarke, Jeremiah
Clauer, Brian
Cochran, Frank
Cohen, Michael
Counts, Kevin
Cowen, Thomas
Craig, Matt
Crews, Marcus
Day, John
Mitchum, Amanda
Devlin, Steven
Doise, Jason
Doll, Michael
Dressler, Richard
Durbin, Suzanne
Edwards, Kerry
Early, Brian
Echterhoff, Lal
Entirety Wealth Solutions
Evans, Robert
Facka, Christopher
Frank, Andrew
Fletcher, Jason
Fraim, Robert
Franques, Russell
Garrett, Leslie
Garza, Marcel
Geaneas, Kerry
Genord, Donald
Glover, Jimmy
Gore, Peter*
Granville-McIntyre, Noelle*
Grigsby, Raymond
Hamiter, John
Hampton, Josh
Harris, Jeff
Harrington, Rich
Hemby, Billy
Herring, Kendrick
Hunter, Charles
Kerfeld, Bennett
Kalaman, Robert
Kumm, William
Inman, Jason
Johnson, John
Keiber, Scott
Kirkley, Kari
Kurihara, Brian
Lavallee, Stefan
Lee, James
Leffingwell, Alan
Linder, Carl
Linton, Ron
Magnuson, Christopher
Magnuson, Peter
Maldonado, Frank
Maloy, Alexis
Manning, Cynthia
Martin, Frank
Mazzeo, Giuseppe (Pepe)
McCloud, William
McCoy, Richard
McDaniels, Doug
McKersie, Michael
McNeely, Darren
Miller, John (Jack)
Moorehead, Randy
Morgia, Deneen
Morris, Paul
Morton, G. Brent
Neubrander, David
Neuner, Tom
Neumann, Cameron
O'Quinn, Bonnie
Orgera, Louis
Overton, Rosilyn
Panquerne, Ray
Parker, Todd
Perry, Chad
Proctor, Scott
Rey, Charles
Raphael, Ryan
Rodriguez, Daniel
Rogers, Matthew
Roberson, Stewart
Sadtler, Benjamin
Saenz, Damian
Sanford, Rick
Sargent, Mary
Scherer, Matt
Schlicht, Jeff
Schmidt, Gary
Shimer, Ray
Smith, Arthur (Lee)
Smithers, Crystal
Steib, Mary Louise
Stiff, Amanda
Sturgess, Connor
Tacco, Angela
Thomas, Brian
Thompkins, Terry
Tipton, Alan
Tomes, Jake
Van Buskirk, Eric
Verity, Glenn
Waldenmaier, Stuart
Walters, Thomas
Wheeler, Brad
Whitehead, Marc
Wilburn, Trey
Wilcox, Richard
Williams, Gregory
Williams, Samuel
Woodall, Marvin "Bo"
Woodard, Blake
Woronoff, Robert
Worthy, Brian
Yother, Paul
Zaleski, John (Jack)
Name

First NameLast Name
Should be Empty:

Disclosure Document Delivery/Form CRS

Disclosure Delivery Obligations

Form ADV Part 2B supplement