Psc/form Ro - Request For Waiver Of Procedures Page 4
ADVERTISEMENT
1
2
3
4
5(B)
W ere sales comm issions or other remuneration paid directly
YES
NO
or indirectly on the securities transactions? If yes, explain.
[ ]
[ ]
If the response to (B) is yes, complete (C) and (D) as applicable:
(C)
W ere the transactions subject to the rescission offer effected through a Broker-Dealer?
YES
NO
If yes, complete (i) and (ii) below.
[ ]
[ ]
(i)
Is the Broker-Dealer registered in Pennsylvania?
YES
NO
If yes, state name, address and CRD Number.
[ ]
[ ]
(ii)
If the Broker-Dealer is not registered in Pennsylvania, describe how the Broker-Dealer has
complied with Section 301 of the Act.
(D) W ere the securities subject to the rescission offer sold directly by a person registered in
Pennsylvania as an Agent or a Principal of a Broker-Dealer ?
YES
NO
If yes, provide the following inform ation:
[ ]
[ ]
____________________________________________________________________________________
Agent's Name
Agent's CRD Number
Broker-Dealer
___________________________________________________________________________________
Number and Street of Broker-Dealer Office Involved in the Sale
____________________________________________________________________________________
City
State
Zip Code
Telephone No.
8.
Each Offeror executing this W aiver Request hereby represents that:
(A) The Offeror, by his signature below, and, if the Offeror is the Issuer, the general partner, prom oter,
chief executive officer, chief operating officer and chief financial officer of the Issuer, by their
signatures below, is aware of the need to comply with the provisions of the Act in the future,
particularly if such person serves in the same or similar position with another person (not the
Offeror). The signature of a person identified in this paragraph is not required if that person was
not affiliated with the Offeror when the sales of securities which are the subject of this rescission
offer occurred.
SIGNATURE
TYPED NAM E
TITLE
DATE
______________________
__________________________ __________________ ______
______________________
__________________________ __________________ ______
______________________
__________________________ __________________ ______
(B)
The Offeror is familiar with the provisions of section 504 of the Act and regulations adopted
thereunder.
(C)
The statements made herein, including attachm ents hereto, are not incomplete in any material
respect or false or m isleading with respect to a material fact.
(D)
The Offeror will advise Com mission staff of the results of the rescission offer within 15 calendar
days after the expiration of the rescission offer period.
42
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal