Bureau Of Securities Bond Form
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3Bureau of Securities Bond Form
Nebraska Department of Banking & Finance
1526 K Street, Suite 300
PO Box 95006
Lincoln, NE 68509-5006
402-471-3445
Bond #: ____________
KNOW ALL PERSONS BY THESE PRESENTS:
That ________________________________________________________________________
(Name and address of Broker-Dealer or Investment Adviser)
____________________________________________________________________________
as Principal, having filed with the Nebraska Department of Banking & Finance on or about the
_____ day of ______________ , ________, an application to transact business in the State of
Nebraska as a(n):
_______________________________________________________________________ , and
(Designate whether Principal is Broker-Dealer or Investment Adviser)
____________________________________________________________________________
(Name and address of Surety)
as Surety, a corporation organized under the laws of the State/Commonwealth/Territory of
__________________ and being duly authorized to transact the business of indemnity and
suretyship in the State of Nebraska, do hereby acknowledge our indebtedness to the State of
Nebraska, for the use and benefit of any person(s) having a claim under the conditions of this
obligation, including any person(s) having a cause of action under Section 8-1118, in the sum of
twenty-five thousand dollars ($25,000), as required by Section 8-1103 of the Securities Act of
Nebraska; provided, however, that the aggregate liability hereunder shall not exceed the sum of
twenty-five thousand dollars ($25,000), regardless of the number of claimants, and shall not be
construed as individual liability.
LIABILITY for the payment of this sum, to which we hereby obligate and bind ourselves, our
heirs, executors, administrators, successors and assigns, jointly and severally, becomes
effective upon the following conditions:
1. Registration/Licensing of the Principal to transact business in the State of Nebraska as
a(n):
_________________________________________________________________ , and
(Designate whether Principal is a Broker-Dealer or Investment Adviser)
2. Failure by the Principal to strictly comply with all applicable provisions of, and orders,
rules and regulations issued pursuant to, the applicable securities statutes of the State of
Nebraska.
Page 1 of 3
Rev. 7/2014
Securities Bond Form2010.doc
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