Form D-2 - Application For License For Agents Of New Hampshire Corporations, Partnerships, Limited Liability Partnerships, Limited Liability Companies And Other Legal Entities

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Form D-2
Fee______Ck. No.____
Each agent's personal statement must accompany this form.
STATE OF NEW HAMPSHIRE
DEPARTMENT OF STATE
BUREAU OF SECURITIES REGULATION
Application for License for Agents of New Hampshire corporations, partnerships,
limited liability partnerships, limited liability companies and other legal entities
Agents' licenses expire December 31 unless revoked.
Licenses will be sent to the dealer unless otherwise requested.
The fee for each license must accompany this registration.
Makes checks payable to State of New Hampshire.
THIS IS TO CERTIFY, That the persons named below, being suitable, have been
appointed agents or salesperson(s) to sell the securities of
(NAME OF CORPORATION OR OTHER LEGAL ENTITY)
The said Corporation or other legal entity requests the Director to license them as
this state
agents or salesperson(s) in
Dated at
this
day of
,
Signed __________________________________________________________
By
(OFFICIAL TITLE)
_______________________________________________________________________________
Name
Residence
Give first name in full
Give full address
______________________________________________________________________________
Sec. form D-2 v1.1

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