Form Ri-1 - Registrant Information - Department Of Law
Download a blank fillable Form Ri-1 - Registrant Information - Department Of Law 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 Ri-1 - Registrant Information - Department Of Law 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
2NEW YORK STATE
DEPARTMENT OF LAW
NY FORM RI-1
INVESTOR PROTECTION BUREAU
120 Broadway, 23rd Floor
New York, NY 10271-0332
1-800-771-7755 TDD (for hearing impaired) 1-800-788-9898
REGISTRANT INFORMATION FORM
1. _____________________________________________________________________________________________________________
Last Name
First Name
Middle Name
2. _____________________________________________________________________________________________________________
Business Address
Street
City
State
Zip Code
3. ________________________________
4(a). ___________________________ 4(b). ___________________________________
Place of Birth
Date of Birth
Business Phone
5. Name of Issuer: ________________________________________________________________________________________________
6. Have you ever used or been known by any other name?
Yes [ ]
No [ ]
If “Yes”, please specify______________________________________________________________
7. Have you or has any business entity under your control or in which you were a principal shareholder
(10% or more) or in which you held a substantial equity or controlling interest (10% or more) or of
which you were an officer, director, general partner, trustee or principal:
(a) ever been convicted of any crime (other than minor traffic violations) or is any such
charge presently pending:
Yes [ ]
No [ ]
(b) ever been the subject of any injunction, cease and desist order, assurance of
discontinuance, suspension or restraining order, revocation of a license to practice
a trade, occupation or profession, denial of an application to obtain or renew same,
any stipulation or consent to desist from any act or practice, any disciplinary action
by any court or administrative agency, or is any action or proceeding seeking such
relief presently pending?
Yes [ ]
No [ ]
(c) ever made an assignment for the benefit of creditors, been the subject of a receivership
or bankruptcy proceeding, reorganized in bankruptcy, or been adjudged a bankrupt?
Yes [
]
No [ ]
(d) ever had a judgment entered against you or have a judgement which is presently unsatisfied?
Yes [
]
No [ ]
8. Are you or is any business entity under your control or in which you were a principal shareholder
(10% or more) or in which you held a substantial equity or controlling interest (10% or more) or
of which you were an officer, director, general partner, trustee or principal, a party in any litigation
or administrative proceeding in which it is alleged that you or it committed fraud or otherwise
violated any provision of the Martin Act or any other securities law?
Yes [ ]
No [ ]
9. If the answer to 7(a) through (d), or 8 is "Yes" state full particulars, including dates, nature of
proceeding, title and location of public authority, circumstances and final disposition. If there
is insufficient space below, complete response in an attached, sworn statement.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
10. List all professional, business or occupational licenses or registrations which you now hold, have held, or have applied for:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
IPS RI-1 (11/06) Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 389 - Change Of Registration Information - Department Of Taxation And Finance - New York State
Financial
Procedural Handbook - Leasing And Permitting Chapter 1 - General Information - Department Of The Interior Bureau Of Indian Affairs - 2006
Legal
Related Categories
Parent category: Legal