Form U-1 Or Ct-3 - Application To Register Securities Page 3
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4(c) Notify the above named state authority within two business days (i) upon the receipt of any stop order,
denial, order to show cause, suspension or revocation order, injunction or restraining order, or similar order
entered or issued by any state or other regulatory authority or by any court, concerning the securities
covered by this application or other securities of the issuer currently being offered to the public; and (ii) upon
the receipt of any notice of effectiveness of said registration by the Securities and Exchange Commission.
(d) Notify the above named state authority at least two business days prior to the effectiveness of said
registration with the Securities and Exchange Commission of (i) any request by the issuer or applicant to any
other state or regulatory authority for permission to withdraw any application to register securities described
herein; and (ii) a list of all states in which applications have been filed where the issuer or applicant has
received notice from the state authority that the application does not comply with state requirements and
cannot or does not intend to comply with such requirements.
(e) Furnish promptly all such additional information and documents in respect to the issuer or the securities
covered by this application as may be requested by the above named state authority prior to registration or
acceptance for filing.
Date: __________________________________
_________________________________________________
Name of Applicant
By ______________________________________________
(Name and Title)
State of__________________________________)
)
)
ss
)
County of ________________________________)
The undersigned, ______________________________________________________________, being first
duly sworn, deposes and says:
That he has executed the foregoing application for and on behalf of the applicant named therein; that he is the
____________________________________ of such applicant and is fully authorized to execute and file such
application; that he is familiar with such application; and that to the best of his knowledge, information and belief
the statements made in such application are true and the documents submitted therewith are true copies of the
originals thereof.
_________________________________________________
Name
Subscribed and sworn to before me this
____________ day of ____________________
, 20___.
________________________________________________
NOTARY PUBLIC
My Commission Expires: ___________________________
(Notarial Seal)
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