Form Njbos-5 - New Jersey Addendum To Registration Statement (Page 4 of 4) in pdf

Form NJBOS-5 7/02

(b) Has such entity or person filed a petition under federal bankruptcy laws or any state insolvency law or had

a receiver, fiscal agent, or similar officer appointed by a court for the business or property of such person,

or any partnership in which such person was a general partner at or within two years before the time of

such filing, or any corporation or business association of which such person was an executive officer at or

within two years before the time of such filing?

Yes ___ No ___

3. If the answer to any of the questions above is “Yes,” the following information is required:

(a) Give the citation for each statute under which the relevant action or proceeding was initiated. Give the full

title of the action or proceeding, the docket number, the relevant court or agency, and the date such action

or proceeding was initiated.

(b) Describe the activities which gave rise to such action or proceeding.

2, for each person who was the subject of such action or proceeding.

(d) Describe the final disposition of such action or proceeding and the present status. (The term final

disposition as used herein refers to any conviction, injunction, order, decree, court decision, petition, plea,

or other final adjudication of the action or proceeding.)

(e) State whether or not the final disposition has been modified, reversed, suspended, vacated, or nullified. If a

description of the action or proceeding and the final disposition is not included in the registration statement,

the reason for the omission should be set forth in detail on a rider to this addendum. Include all mitigating

circumstances.

The undersigned is aware of N.J.S.A. 49:3-54 and understands that this addendum is part of the registration

statement filed with the Bureau of Securities, and acknowledges the responsibility to update and keep current the

information contained herein so long as the application is pending.

The undersigned agrees that, as a condition of registration, the underwriter will allow the bureau chief at the bureau

chief’s discretion (subject in all cases to the constitutional or statutory rights of the underwriter, its agents and

principals if any) to:

(1) make such investigations within or outside this State as the bureau chief deems necessary to determine if the

underwriter, the underwriter’s agents, or the underwriter’s principals have violated, or are about to violate, any

provision of this act or any rule or order thereunder, or to act in the enforcement of this act or in the prescribing

of rules and forms hereunder, or

(2) require or permit the underwriter, the underwriter’s agents, and the underwriter’s principals to file a statement in

writing, under oath or otherwise as the bureau chief determines, as to all the facts and circumstances concerning

the matter to be investigated.

_________________________________

Underwriter

By: ______________________________

(Signature)

_________________________________

(Title)

_________________________________

(Date)

Form Njbos-5 - New Jersey Addendum To Registration Statement Page 4