Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 21

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FORM ADV
Your
Name: _________________________________
SEC File No.: ______________________
Schedule D
Date: _______________________________________
CRD No.: __________________________
Page 2 of 5
Use this Schedule D Page 2 to report details for items listed below. Report only new information or changes/updates to previously submitted
information. Do not repeat previously submitted information.
This is an
INITIAL or
AMENDED Schedule D Page 2.
SECTION 1.L.
Registration with Foreign Financial Regulatory Authorities
List the name, in English, of each foreign financial regulatory authority and country with which you are registered. You must complete a separate
Schedule D Page 2 for each foreign financial regulatory authority with whom you are registered.
Check only one box:
Add
Delete
English Name of Foreign Financial Regulatory Authority ________________________________________________________________________
Name of Country ________________________________________________________________________________________________________
SECTION 2.A(7) Affiliated Adviser
If you are relying on the exemption in rule 203A-2(c) from the prohibition on registration because you control, are controlled by, or are under
common control with an investment adviser that is registered with the SEC and your principal office and place of business is the same as that of the
registered adviser, provide the following information:
Name of Registered Investment Adviser _____________________________________________________________________________
CRD Number of Registered Investment Adviser (if any) _____________________________
SEC Number of Registered Investment Adviser 801-___________________________
SECTION 2.A(8) Newly Formed Adviser
If you are relying on rule 203A-2(d), the newly formed adviser exemption from the prohibition on registration, you are required to make certain
representations about your eligibility for SEC registration. By checking the appropriate boxes, you will be deemed to have made the required
representations. You must make both of these representations:
I am not registered or required to be registered with the SEC or a state securities authority and I have a reasonable expectation that I
will be eligible to register with the SEC within 120 days after the date my registration with the SEC becomes effective.
I undertake to withdraw from SEC registration if, on the 120th day after my registration with the SEC becomes effective, I would be
prohibited by Section 203A(a) of the Advisers Act from registering with the SEC.
SECTION 2.A(9) Multi-State Adviser
If you are relying on rule 203A-2(e), the multi-state adviser exemption from the prohibition on registration, you are required to make certain
representations about your eligibility for SEC registration. By checking the appropriate boxes, you will be deemed to have made the required
representations.
If you are applying for registration as an investment adviser with the SEC, you must make both of these representations:
I have reviewed the applicable state and federal laws and have concluded that I am required by the laws of 30 or more states to
register as an investment adviser with the securities authorities in those states.
I undertake to withdraw from SEC registration if I file an amendment to this registration indicating that I would be required by the
laws of fewer than 25 states to register as an investment adviser with the securities authorities of those states.
If you are submitting your annual updating amendment, you must make this representation:
Within 90 days prior to the date of filing this amendment, I have reviewed the applicable state and federal laws and have concluded
that I am required by the laws of at least 25 states to register as an investment adviser with the securities authorities in those states.

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