Electronic Device Disclosure
Associated persons are required to disclose the use and/or the termination of use of any electronic device used entirely or in part for business purposes by completing the table below.
Associated Persons Name
*
First Name
Last Name
Select the status of the electronic device
*
This is an initial report of electronic device(s)
I have a new device to report
I have a retired device to report
I have a change in usage of a previously reported device to report
Device Details
*
Rows
Device Description (example: “primary office computer”). Include smartphones, tablets and other devices
Device Type (example: iMac, or Dell PC desktop)
Device Name
% Business Use
% Personal Use
Serial Number of device
1
2
3
4
5
6
7
8
Submit
Should be Empty: