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

Ny Form Cadv - Commodity Investment Advisor Statement Page 5

b. As a broker (agent) for any person other than the client, sell commodities

to or buy commodities from any client to whom it has recommended such

purchase or sale? [ ] yes; [ ] no.

c. Recommend the purchase or sale of any commodities sold by any company

wherein the advisor or any person named herein has an ownership position

in the company greater than 1% [ ] yes; [ ] no.

d. Or any person named herein receive direct or indirect compensation or

other benefits contingent upon the recommendation of a particular

commodity? [ ] yes; [ ] no.

19. Does advisor have agreements or understandings either written or oral, with

broker-dealer, which would require a client to transfer their account(s) to said

broker-dealer? [ ] yes; [ ] no. If yes, name broker and set forth the agreements.

PART IV: OTHER INFORMATION

20. The person to contact with respect to legal matters relating to this application is

______________________________ ____________________________.

Telephone:

(

)______________________________________.

21. All other matters relating to this application should be referred to

___________________________________________ Telephone ( )

_________________.

22. The advisor's fiscal year ends

________________________________________________________________________

___.

Dated: ___________________________ Signature

______________________________

STATE OF NEW YORK

)

: SS.:

COUNTY OF NEW YORK

)

______________________________________________, being duly sworn,

deposes and says that I am the ______________________________ (Title) of

Registrant and I signed the above form. I have read the questions and

answers and information supplied, and they are true, accurate and complete.

__________________________________________

(Signature of Affiant/Chief

Executive Officer of Registrant)

Sworn to before me this

day of

, 19

(Notary signature and legible official stamp)

Ny Form Cadv - Commodity Investment Advisor Statement Page 5