Form 260.100.3 - Barclays Official California Code Of Regulations Form - Department Of Corporations Of State Of California Page 4

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12. Describe any material changes which may have occurred subsequent to the dates of
any financial statements or information submitted. Is the Issuer aware of any
information which would give rise to questions regarding the ratings disclosed under
Item 10c? If so, describe the information.
13. There is no adverse order, judgment or decree entered in connection with Issuer's
debt securities that are exempt pursuant to Section 25100 (l), or similar exemption in
another jurisdiction, or Section 3(a)(3) of the Securities Act of 1933, by any state
regulatory authority, any court, or the Securities and Exchange Commission, except as
follows: (If none, so state)
14. Submit any additional statements or information which will assist the Commissioner
in determining whether qualification of such securities is necessary or appropriate in the
public interest or for the protection of investors.
15. The Issuer agrees, in the event it does not reapply for an exemption under
Subdivision (1) of Section 25100, to furnish the information specified in Item 5 above
for the period during which the exemption herein applied for is in effect, if granted,
within 90 days after the expiration of such exemption.
The Issuer has duly caused this request to be signed on its behalf by the undersigned,
thereunto duly authorized.
________________________________
(Issuer)
By______________________________
(Title)
I certify (or declare) under penalty of perjury under the laws of the State of California that I have
read this request and the exhibits thereto and know the contents thereof, and that the statements
therein are true and correct.
Executed at______________________ on_________________, 20_______
(Place) (Date)
___________________________________
(Signature)

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