Exception From The Definition Of Investment Adviser Representative Affidavit

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AFFIDAVIT
This affidavit is made and filed with the Office of the Secretary of the Commonwealth,
Massachusetts Securities Division for the purpose of excepting from the definition of Investment
Adviser Representative the individual named herein who, otherwise, automatically would be
registered pursuant M.G.L. c.110A 202(a).
_________________________________ hereby swears or affirms:
Name of Affiant
1.
I am ____________________ of ________________________________
Title
Name of Investment Adviser
an investment adviser registered or seeking registration in the Commonwealth of
Massachusetts.
2.
In that capacity, I do not engage in any of the following activities:
a)
making recommendations or otherwise rendering advice regarding
securities;
b)
managing accounts or portfolios of clients;
c)
determining which recommendations or advice regarding securities should
be given;
d)
soliciting, offering or negotiating the sale, or selling investment advisory
services;
e)
supervising employees who perform any of the foregoing functions.
Signed under the penalties of perjury this _____ day of __________________, 20 ____
_____________________________________
Signature of Affiant

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