Application For Registration, Renewal Or Amendment To An Application Of Investment Adviser - Commonwealth Of Puerto Rico Page 9

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Form R-3
Rev. 03/13
CONSENT TO SERVICE OF PROCESS
The Applicant irrevocably appoints the Commissioner of Financial Institutions of Puerto Rico, and his (her) successors in
Office, its attorney upon whom may be served any notice, process or pleading in any non-criminal action or proceeding
against it arising out of or in connection with the purchase or sale of securities, the conduct of the securities business or
the business of an investment adviser, or violation of the Uniform Securities Act of Puerto Rico; and the undersigned does
hereby consent that any such action proceeding against it may be commenced in any court of competent jurisdiction and
proper venue by service of process upon said officer with the same effect as if the undersigned has been personally served
with process in said jurisdiction.
It is requested that a copy of any notice, process or pleading served hereunder be mailed to the address given in Item 3
and 4.
EXECUTION
THE APPLICANT OR REGISTRANT SUBMITTING THIS FORM AND THE PERSON BY WHOM IT IS
EXECUTED HEREBY REPRESENT THAT IT CONTAINS A TRUE, CORRECT, AND COMPLETE STATEMENT
OF ALL INFORMATION REQUIRED TO BE FURNISHED.
_________________________________________
_______________________________________
Date
Name of Applicant
BY: ___________________________________
________________________________________
Signature and Title
Print Name
Affidavit Number:
______________________________________________________________________________
Subscribed and sworn before me by ____________________________________________________________________
this
day of
of
, at
.
(Year)
_______________________________________
Notary Public
A filing fee of $500.00 as required by Section 6.8.1 of the Regulation under the Uniform Securities Act of Puerto Rico
must accompany this application in the form of a check or money order drawn to the “Secretary of the Treasury”.

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