Form Cm-2 - Commodity Salesperson Statement
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3NY Form CM-2
** File no. ______
(1/87)
STATE OF NEW YORK, Office of the Attorney General
BUREAU OF INVESTOR PROTECTION AND SECURITIES
COMMODITY SALESPERSON STATEMENT
This form must always be accompanied by the Supplemental Commodity
Broker-Dealer Statement (NY Form CM-3) unless this is an original filing.
1.___________________________________________________________
Attach 2 X 2 photo
Last Name
First Name
Middle Name
taken within the
2. ___________________________________________________________
preceding
Residence
City
State
Zip
six months
3. ________________________________ 4. _____________________
Residence Telephone
Social Security
5. ________________________________ 6. _____________________
Place of Birth
Date of Birth
7. _________
8.__________
9. _______
10. Ft.____In.
Color of Hair
Color of eyes
Weight
Height
11. Insert name and address of current employer (Commodity Broker-Dealer)
Name _____________________________ Address___________________________
12. Have you or any entity in which you were a principal ever:
A. been suspended or expelled from membership in any
securities or commodities exchange, association
of securities or commodities dealers or
investment or commodities trading advisors or
counsel? ......................................................................
Yes [ ] No [ ]
B. had a license or registration as a securities
or commodity dealer, broker, investment
advisor, salesperson, futures commission
merchant, associated person, commodity pool
operator or commodity trading advisor
denied, suspended, revoked, cancelled or
refused? .....................................................................
Yes [ ] No [ ]
C. been enjoined or restrained by any court or
government agency from:
1. the issuance, sale or offer for sale of
securities or commodities? ..............................
Yes [ ] No [ ]
2. rendering securities or commodities
advice or counsel? .............................................
Yes [ ] No [ ]
3. handling or managing trading accounts? .........
Yes [ ] No [ ]
4. continuing any practices in connection
with securities or commodities? .......................
Yes [ ] No [ ]
D. Is any action or proceeding seeking the relief
enumerated in A-C presently pending? ...................
Yes [ ] No [ ]
E. been convicted of any crime? ..............................
Yes [ ] No [ ]
F. used or been known by any other name? ..............
Yes [ ] No [ ]
G. been the subject of any professional
disciplinary proceeding? ...........................................
Yes [ ] No [ ]
H. been adjudged a bankrupt or made a general
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