Looking for a Sec Form 10-1 Templates? Download it for free!

Sec Form 10-1 - Notice Of Exempt Transaction Under 10.1(K)/ Application For Confirmation Under Section 10.1 Of The Securities Regulation Code Page 3

Exhibits When Notice Being Provided

In addition to the above information, the applicant hereby submits with this Notice the following documents:

(a)

Written Disclosure to Investors containing the required information under Paragraphs (1) and (4)(d)

of SRC Rule 10-1; and

(b)

Copy of other materials to be used/used in connection with the offering for sale or sale.

Filing Fees in Connection with an Application for Confirmation

This application for confirmation of availability of an exemption under SRC Rule 10.1 of the Code has been submitted

along with the payment of the prescribed fee in the amount of ___________________ under O.R. No.

________________. (Fill this up if applicable only)

Signatures

The undersigned hereby certifies that the exemption applied for hereunder is available and all requirements set forth

in SRC Rule 10-1 have been complied with.

Pursuant to the requirements of the Code and SRC Rule 10-1 thereunder _________________________________

)

(Name of Seller

has caused this certification to be signed on its behalf by a duly authorized person who, in case of a juridical person,

shall be the President thereof.

Date: _____________________________

By: _______________________________

Position

Instruction

The applicant shall file with the Commission five (5) copies of this SEC Form 10-1, one of which shall be manually

signed by a duly authorized person who, in case of a juridical person, shall be the President.

Sec Form 10-1 - Notice Of Exempt Transaction Under 10.1(K)/ Application For Confirmation Under Section 10.1 Of The Securities Regulation Code Page 3