Form Cm-2 - Commodity Salesperson Statement Page 2

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assignment for benefit of creditors; been
the subject of a receivership or bankruptcy
proceeding; been an officer, director, principal,
partner, manager, supervisor or any 10%
or more equity holder of any entity which was
reorganized in bankruptcy, adjudged a
bankrupt or made a general assignment for
benefit of creditors? ..................................................
Yes [ ] No [ ]
I. had a judgment entered against them or it
which is presently unsatisfied? (Not including
judgments involving domestic relations.) .................
Yes [ ] No [ ]
J. been a party in any litigation or administrative
proceeding in which it is alleged that they or it
committed fraud or otherwise violated any
provision of the Martin Act or any other
securities or commodities laws? ...............................
Yes [ ] No [ ]
K. if any answer to any of the above is "YES",
attach statement of full particulars.
13. Following is my complete employment record for the past five years:
(Indicate periods of self-employment & unemployment).
________________________________________________________________________
From
To
Employer
Position Held
Mo. Yr.
Mo. Yr.
________________________________________________________________________
Name
Address
________________________________________________________________________
Present
________________________________________________________________________
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
14. Following is my complete education history:
______________________________________________________________________
Name of School
From
To
Did you
and location
Graduate
______________________________________________________________________
Elementary School
_____________________________________________________________________
High School
_____________________________________________________________________
College University
_____________________________________________________________________
or Technical School

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