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Were You Referred By a Current NEB Member? |
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Please check ALL active professional licenses. |
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Life Insurance License (resident and non-resident) |
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Health Insurance License |
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Property & Casualty or Fire Insurance License |
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Series 6 License (Investment Company or Variable Contracts) |
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Series 7 License (General Securities Registered Representative) |
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Series 65 License (Uniform Registered Investment Advisor) |
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Series 66 License (Uniform Investment Advisor – Combined State Law) |
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Real Estate Agent License |
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Real Estate Broker License |
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Mortgage Broker License |
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Accounting License |
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Do you currently have or have you ever had any other state or federally regulated license(s) besides the ones checked above? If yes, please list license type, state of issue, and approximate year of expiration:
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No
Yes |
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Please read carefully. You must truthfully answer "NO" to qualify for membership. |
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Within the last seven (7) years, have you had a state or federally regulated license revoked, restricted, or terminated for cause? |
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No
Yes |
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| 2) |
Within the last seven (7) years, have you been a defendant or respondent to any consumer complaint or allegation that resulted in any type of settlement, adverse decision, enforcement action, adverse order, disciplinary sanction, or censure against you by any state or federal regulatory agency? |
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No
Yes |
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| 3) |
Within the last seven (7) years, have you been the subject of any investigation, inquiry, or complaint by any state or federal regulatory agency, or any other agency, alleging any violations of ethical conduct, prohibited sales practice, or breach of professional standards that resulted in any type of settlement, adverse decision, enforcement action, disciplinary sanction, or adverse order, such as a consent order, final order, or cease and desist-type order? |
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No
Yes |
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Do you have any regulatory or consumer-related complaints that are pending or unsettled, or are you awaiting any arbitration or civil proceedings? |
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No
Yes |
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Within the last seven (7) years, have you been convicted of any felony or business-related misdemeanor, or are you currently named as a defendant, respondent, or party to any such criminal or civil action? |
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No
Yes |
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Are you currently the subject of any investigation, inquiry, or complaint by any state or federal regulatory agency? |
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No
Yes |
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| 7) |
Within the last seven (7) years, have you been censured, fined, reprimanded, or otherwise disciplined by a grantor of an accredited designation? |
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No
Yes |
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| 8) |
For new members: Within the last seven (7) years, have you filed for or declared bankruptcy?
For renewing members: Have you filed for bankruptcy or have you been declared bankrupt since your last renewal date? |
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No
Yes |
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| 9) |
Are you currently aware of, or involved in any fee dispute with any of your clients? |
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No
Yes |
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Please read carefully. You must truthfully answer "YES" to qualify for membership. |
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Have you read the NEB Member Agreement and do you agree to abide by its Terms and Conditions in every respect? |
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No
Yes |
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| 2) |
Have you read the NEB Ethics Pledge and do you agree to abide by its principles and standards of conduct in every respect? |
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No
Yes |
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Do you understand and acknowledge that membership qualifications are subject to change, and that you must re-qualify annually based on the NEB’s most current qualifications? |
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No
Yes |
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Do you understand and acknowledge that the NEB reserves the right to deny, suspend, or revoke membership to anyone for any reason, and that certain marks prior to our seven (7) year background checks may still disqualify you from membership? |
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No
Yes |
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Do you understand that your membership may be denied or revoked for certain marks on your record that may not be conclusive evidence of guilt or wrongdoing, but may still be considered by the NEB as a reason for disqualification? |
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No
Yes |
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I affirm that all questions answered on this application are true and correct to the best of my knowledge, information and belief. |
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Submit Application |
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