Form M-3 -Supplemental Broker Dealer Statement - State Of New York Department Of Law - 2014 Page 2
Download a blank fillable Form M-3 -Supplemental Broker Dealer Statement - State Of New York Department Of Law - 2014 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form M-3 -Supplemental Broker Dealer Statement - State Of New York Department Of Law - 2014 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Prior home address for past five years:
_________________________________________________________________________________________
MAKE SURE THE FORM IS COMPLETED AND SIGNED ON REVERSE SIDE.
Has any officer, director, principal, partner or salesperson ever:
5.
A. been suspended or expelled from membership in any securities or commodities
exchange, association of securities or commodities dealers or investment advisors?....
Yes [ ] No [ ]
B. had a license or registration as a dealer, broker, investment advisor or salesperson,
futures commission merchant, associated person, commodity pool operator, or
commodity trading advisor denied, suspended or revoked?.......................................
Yes [ ] No [ ]
C. been enjoined or restrained by any court or agency from:
1. the issuance, sale or offer for sale of securities or commodities?.........................
Yes [ ] No [ ]
2. rendering securities or commodities advice?........................................................
Yes [ ] No [ ]
3. handling or managing trading account?................................................................
Yes [ ] No [ ]
4. continuing any practices in connection with securities or commodities?.............
Yes [ ] No [ ]
D. been convicted of any crime (other than minor traffic violation)?............................
Yes [ ] No [ ]
E. used or been known by any other name?...................................................................
Yes [ ] No [ ]
F. been the subject of any professional disciplinary proceeding?..................................
Yes [ ] No [ ]
G. been adjudged a bankrupt or made a general assignment for benefit of creditors;
or been an officer, director or principal of any entity which was reorganized in
bankruptcy, adjudged a bankrupt or made a general assignment for benefit of
creditors?....................................................................................................................
Yes [ ] No [ ]
H. had an offering of securities within the last three years or been an officer, director,
principal or partner of any entity which had an offering of securities within the last
three years?...................................................................................................................
Yes [ ] No [ ]
If the answer to any of the above is “yes,” explain and attach a copy of the judgement, order, etc. if one exists.
6.
Are there any outstanding judgements (not including judgements involving domestic
relations) against the issuer or any officer, director, principal or partner thereof?
If yes, explain...................................................................................................................
Yes [ ] No [ ]
I hereby represent that all statements contained herein are true and that I fully understand that any false statements constitutes a
violation of Article 23-A of the General Business Law.
Dated ____________________________________ Signature _________________________________________________
(Individual proprietor, partner, or principal officer of
corporation, trust or association.)
A fee of $30 must accompany this form. Submit a money order or company, bank or attorney’s check payable to the N.Y.S.
Department of Law. Remit to: N.Y.S. Department of Law, Real Estate Finance Bureau 120 Broadway - 23rd Floor, New
York, N.Y. 10271
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ct-3 - General Business Corporation Franchise Tax Return - New York State Department Of Taxation And Finance - 2012
Financial
Form Au-298 - Application For A Direct Payment Permit - New York Department Of Taxation And Finance
Financial
Form Ct-185 - Cooperative Agricultural Corporation Franchise Tax Return - New York Department Of Taxation And Finance - 1999
Financial
Form Doh-5055 - Health Home Patient Information Sharing Consent - New York Department Of Health
Legal
Related Categories
Parent category: Financial