Form 8q - Registration By Qualification Page 2
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3Official Use ONLY
Control #:_______________
Examiner:_______________
APPLICANT:_______________________________________
E.
General Purpose of Offering
F.
Specific Use of Proceeds
G.
Commissions, Discounts and Expenses of Offering
9.
DIRECTORS, OFFICERS, CONTROL PERSONS, PROMOTERS
A.
Form 8-1 for each director or other persons performing similar
functions
B.
Form 8-1 for each officer
C.
Form 8-1 for each person owning 10% or more of the
outstanding shares of any class of equity security of the issuer
D.
Form 8-1 for each promoter
E.
Compensation to three highest paid officials
F.
Statement concerning all securities transactions with issuer
(including price information)
G.
Material interest in any material transaction, within past three
years, or any proposed transaction
10. ESCROW
A.
Minimum Business Plan
B.
Agreement to Escrow Securities
C.
Agreement to Escrow Proceeds
D.
Petition for Waiver of Escrow
E.
Letter from Escrow Agent regarding Release of Funds
Notification
11. FEES
A.
Initial Registration – 1/20 of 1% of Aggregate Offering
B.
Renewal - $100
C.
Additional Assessments
D.
Reports - $10
12. FINANCIAL STATEMENTS
A.
Balance Sheet Certified by Independent Public Accountant
B.
90 Day Unaudited Balance Sheet
C.
Profit and Loss Statement
D.
Analysis of Surplus
E.
Statement of Financial Condition
F.
Acquired Business Financials
G.
Projections and Forecasts
13. LEGAL AND PROFESSIONAL OPINIONS AND STATEMENTS
A.
Legal opinion that securities to be sold will be fully paid and
nonassessable and, if debt security, a binding obligation of the
issuer
B.
Written consent by anyone whose opinion or statement will be
used in connection with the offering
14. LEGENDS
A.
Rescission
B.
Disclaimer
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