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Run: Code of Ethics and Personal Trading Pre-Clearance Log

Log personal securities trade requests, approvals, exceptions, and post-trade confirmations for access persons in one Code of Ethics pre-clearance form.

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Submission Notice

Submission Type (required)

Acknowledgment of Code of Ethics and PII Disclosure (required)

I understand this form is used for compliance review, that my submission may be retained in an audit trail, and that I should provide only the minimum necessary information. I confirm I have read and will comply with the firm's code of ethics and personal trading policy.

Yes No N/A

Submit anonymously for general policy feedback only

Use anonymous submission only for non-case-specific policy feedback. Personal trading requests and approvals cannot be processed anonymously.

Yes No N/A

Employee and Account Information

Employee Name (required)

Employee ID (required)

Department

Account Type (required)

Account Ownership / Relationship (required)

Brokerage Firm Name

Proposed Trade Details

Security Name (required)

Security Type (required)

Ticker Symbol

Required for publicly traded securities when available.

Transaction Type (required)

Proposed Trade Date (required)

Quantity (required)

Estimated Trade Value (required)

Enter the estimated dollar value of the transaction.

Brokerage Account Ending

Use masked format only, such as account ending in 1234.

Pre-Clearance Review Factors

Do you currently have access to material non-public information (MNPI) related to this issuer or security? (required)

Restricted List Check Required

Compliance will perform the restricted list check as part of the audit trail.

Yes No N/A

Is the security subject to a blackout period or trading restriction? (required)

Related Company, Client, or Counterparty

Only complete if relevant to the compliance review.

Reason for Trade

Briefly describe the purpose of the trade. Do not include unnecessary personal or sensitive information.

Approval, Exceptions, and Audit Trail

Compliance Decision

Decision Date

Approver Name

Approval Conditions

Record any conditions such as holding periods, size limits, or additional reporting requirements.

Post-Trade Confirmation Required

Yes No N/A

Audit Trail Notes

Document any exceptions, escalations, or follow-up actions for the compliance record.

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