Form Ct Boia-1 - Application To Register Business Opportunity Investment With The Connecticut Banking Commissioner

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FORM CT BOIA - 1
APPLICATION TO REGISTER
BUSINESS OPPORTUNITY INVESTMENT
WITH THE CONNECTICUT BANKING COMMISSIONER
PURSUANT TO CHAPTER 672c OF THE CONNECTICUT GENERAL STATUTES (THE "ACT")
Application to be submitted to the Department of Banking, Securities and Business Investments
Division, 260 Constitution Plaza, Hartford, Connecticut 06103-1800.
1.
(a) The official name and address and principal place of business of seller:
(b) Official name and address and principal place of business of the parent firm or holding
company of the seller, if any:
(c) Address of principal office in this state and any other locations in Connecticut:
(d) Name, address and telephone number of correspondent to whom notices and communication
regarding this application may be sent:
If the information requested in items 2, 3 and 4 of this application are contained within the
disclosure document, kindly indicate the page and section in the space provided.
2.
The business experience stated individually of each of the sellers, directors and officers, including
the biographical data concerning these persons (attach schedule):
3.
The business experience of the seller, including the length of time the seller has conducted a
business of the type to be operated by the purchaser-investor, has granted business opportunities
for such business, and has granted business opportunities in other lines of business (attach
schedule):

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