Looking for a Oklahoma Legal Forms And Templates? Download it for free!

Form Obd-015 - Application For Renewal Of Issuer Agent Registration - Department Of Securities

STATE OF OKLAHOMA

DEPARTMENT OF SECURITIES

Application for Renewal of Issuer Agent Registration

The undersigned, _________________________________________________________ (the "Applicant"),

(name of applicant as it appears on the Form U-4)

in compliance with the regulations adopted pursuant to the Oklahoma Uniform Securities Act of 2004, hereby

makes application for renewal of the Applicant's registration as an issuer agent, and remits the required

renewal fee of $50.00, payable to "Oklahoma Securities Department." In support of such renewal application:

1. Applicant does hereby affirm that any and all information previously filed with the Administrator in

connection with his/her registration remains true and correct.

2. Applicant does hereby undertake and agree to promptly notify the Administrator of any material

change occurring in the Applicant's activities, status or functions.

3. Applicant does hereby undertake and agree to promptly notify the Administrator regarding any suit

filed by any person against the Applicant involving securities or any aspect of the securities business

or any disciplinary action instituted or taken against the Applicant by any other state or federal

regulatory agency.

4. Applicant does hereby undertake and agree to abide by the provisions of the Oklahoma Uniform

Securities Act of 2004 and the regulations adopted pursuant thereto.

WHEREFORE, Applicant prays that it continue to be registered as an issuer agent pursuant to

660:11-5-12(d) of the Rules of the Oklahoma Securities Commission and the Administrator of the

Department of Securities, as amended.

Signature of Applicant

Name of Issuer

Subscribed and sworn to before me this ________ day of ____________________, 20___.

Notary Public

My Commission Expires: ___________________________

OBD-015 Revised 07/26/2004

Form Obd-015 - Application For Renewal Of Issuer Agent Registration - Department Of Securities