Form S-3 - Registration Statement For Registration Of Securities By Qualification (Page 2 of 4) in pdf

Form S-3 - Registration Statement For Registration Of Securities By Qualification Page 2

Form S-3

11/06

Commonwealth of Puerto Rico

COMMISSIONER OF FINANCIAL INSTITUTIONS

Securities Office

Fernandez Juncos Station

PO Box 11855

San Juan, PR 00910-3855

Tel. (787) 723-3131 Fax (787) 724-2604

REGISTRATION STATEMENT

FOR REGISTRATION OF SECURITIES BY QUALIFICATION

INSTRUCTIONS

This form may be filed by the issuer, any other person on whose behalf the offering is to be made,

or a registered broker-dealer.

(a)

Name and address of applicant ________________________________________

________________________________________________________________________

(b)

Name, address and telephone number of person with whom the Securities Office is

requested to communicate regarding the filing ____________________________

________________________________________________________________________

State whether applicant is the issuer, or a broker-dealer registered in Puerto Rico or other person

on whose behalf the securities will be offered:

________________________________________________________________________

(a)

Name and address of issuer:___________________________________________

________________________________________________________________________

(b)

Name and address of any significant subsidiary:___________________________

________________________________________________________________________

Name and address of any person on whose behalf any part of the offering is to be made in a non-

issuer distribution: _________________________________________________________

________________________________________________________________________

Description of the securities being registered: ________________________________________

________________________________________________________________________

Form S-3 - Registration Statement For Registration Of Securities By Qualification Page 2