Ny Form Cadv - Commodity Investment Advisor Statement (Page 3 of 5) in pdf

Ny Form Cadv - Commodity Investment Advisor Statement Page 3

person, commodity pool operator or commodity trading advisor denied,

suspended, revoked, cancelled or refused? ..........................................

Yes [ ]

No [ ]

C. been enjoined or restrained by any court or government agency from:

1. the issuance, sale or offer for sale of securities or

commodities? ...................................................................Yes [ ] No [ ]

2. rendering securities or commodities advice or counsel? .Yes [ ] No [

]

3. handling or managing trading accounts? .....................Yes [ ] No [ ]

4. continuing any practices in connection with securities

commodities ...................................................................... Yes [ ] No [ ]

D. Is any action or proceeding seeking the relief enumerated in A - C

presently

pending? ..................................................................................... Yes [ ] No [ ]

E. been convicted of any crime? ..................................................Yes [ ] No [ ]

F. used or been known by any other name? ............................... Yes [ ] No [ ]

G. been the subject of any professional disciplinary

proceeding?.................................................................................. Yes [ ] No [ ]

H. been adjudged a bankrupt or made a general assignment for

benefit of creditors; been the subject of a receivership or

bankruptcy proceeding; been an officer, director, principal, partner,

manager, supervisor or any 10% or more equity holder of any entity

which was reorganized in bankruptcy, adjudged a bankrupt or made

a general assignment for benefit of creditors? ..........................Yes [ ] No [ ]

I. has a judgment entered against them or it which is presently

unsatisfied? (Not including judgments involving domestic

relations.) ................................................................................... Yes [ ] No [ ]

J. been a party in any litigation or administrative proceeding in

which it is alleged that they or it committed fraud or otherwise

violated any provision of the Martin Act or any other securities

laws ? ........................................................................................ Yes [ ] No [ ]

K if any answer to any of the above is "YES", attach statement of

full particulars.

13. As of the date of this statement, the advisor has approximately ____________

clients located in New York State.

Ny Form Cadv - Commodity Investment Advisor Statement Page 3