Consent To Service Of Process By Issuer Of Or Dealer In Securities Form - State Of Hawaii

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State of Hawaii
DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS
Business Registration Division
335 Merchant Street, Room 203, Honolulu, Hawaii 96813
(808) 586-2722
CONSENT TO SERVICE OF PROCESS
BY ISSUER OF OR DEALER IN SECURITIES
, an issuer of securities, not domiciled in the State of Hawaii,
, an applicant for registration as a dealer in securities,
does hereby give irrevocable consent that in suits, proceedings and actions growing out of the violation of any provision of the Uniform
Securities Act (Modified) of the State of Hawaii, the service on the Commissioner of Securities of the State of any notice, process, or
pleading therein, authorized by the laws of the State, shall be valid and binding as if due service had been made on the undersigned.
Dated at
this
day of
, 20
By
(CORPORATE SEAL)
Title
By
Title
S-3
(OVER)
Rev. 03/04

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