Securities Law Compliance Pre-Clearance Request

Securities Law Compliance Pre-Clearance Request — Form Fields

This legal template includes 10 fields. Request pre-clearance before trading company securities to ensure compliance with insider trading policies. Free to customize and use on ZenBuild.

• Requestor Full Name (text, required)
• Requestor Email (email, required)
• Job Title (text, required)
• Date of Intended Trade (text, required)
• Security Type (dropdown selection, required) — options: Common stock, Preferred stock, Options, Restricted stock units, Convertible notes, Other
• Transaction Type (dropdown selection, required) — options: Purchase, Sale, Exercise of options, Gift, Pledge
• Number of Shares or Units (number, required)
• Are you aware of any material non-public information (MNPI)? (multiple choice, required) — options: No – I am not aware of any MNPI, Yes – I may have MNPI (do not proceed)
• Are you within a blackout period? (multiple choice, required) — options: No, Yes – do not proceed
• Additional Context (long text, optional)