Unregistered Security Rescission Offer Form


Unregistered Security Recission Offer Form
[Offeror Name]
[Offeror Address]
[Investor Name]
[Investor Address]
Dear [Investor Name]:
On [Date of Transaction] you purchased [Number and Type of Security] in [Issuer/
Investment Name] for a total investment of $ [Total Dollar Amount Invested].
Our offer and sale of this investment to you may have violated some of the provisions of
the Maine Uniform Securities Act (the “Act”). Specifically, section 16301 of the Act
requires that any security offered and sold in Maine must be registered with the Maine
Office of Securities (the “Office”) unless the security is exempt from registration. When
we sold you the [Type of Security], we had not registered it with the Office and [we did
not file a timely exemption notice/it did not qualify for an exemption from registration].
Therefore, Section 16509 of the Act provides that we may be liable to you for the sale of
unregistered securities.
We are offering to repurchase your [Type of Security] from you for cash. If you accept
this offer, we will pay you the amount of your purchase price, $ [Total Dollar Amount
Invested], plus interest at [ * ]% from the date of your purchase, $ [Dollar Amount],
{minus the income you have received, $ [Dollar Amount]}, for a total repurchase price of
$ [Dollar Amount]. We will pay you this amount when we receive the certificates
representing your [Type of Security].
This offer extinguishes any right you may have to bring an action against [Offeror Name]
for these possible violations of the Act, whether or not you accept the offer.


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