Application For Registration, Renewal Or Amendment To An Application Of Investment Adviser - Commonwealth Of Puerto Rico Page 2

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Form R-3
Rev. 03/13
COMMONWEALTH OF PUERTO RICO
COMMISSIONER OF FINANCIAL INSTITUTIONS
Centro Europa Building, Suite 600
1492 Ponce de León Ave.
San Juan, PR 00907-4127
Tel. (787) 723-8403 Fax (787) 724-2604
APPLICATION FOR REGISTRATION, RENEWAL OR AMENDMENT TO AN
APPLICATION OF INVESTMENT ADVISER
Check the appropriate box:
Application for Initial Registration
Application for Renewal of Registration
Amendment to an Application
1.
Full Name of Applicant___________________________________________________________________
2.
Social Security No. ______________________________________________________________________
3.
Address and telephone number of principal place of business _____________________________________
______________________________________________________________________________________
4.
Address of each branch office in Puerto Rico giving the date each branch office was established and
the name of the person in charge of each branch office
_____________________________________________________________________________________
______________________________________________________________________________________
5.
Organization of Applicant:
(a) Form _____________________________________________________________________________
(b) Date organized or incorporated __________________________________________________________
(c) Under laws of _______________________________________________________________________

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