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Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 3

Your Name _______________________________ CRD Number _______________

FORM ADV

Part 1A

Date _____________________________________ SEC 801-Number ____________

Page 3 of 16

⁪

Do you have World Wide Web site addresses?

Yes

If ”yes,” list these addresses on Section 1.I. of Schedule D. If a web address serves as a portal through

which to access other information you have published on the World Wide Web, you may list the portal

without listing addresses for all of the other information. Some advisers may need to list more than one

portal address. Do not provide individual electronic mail addresses in response to this Item.

Contact Employee:

___________________________________________________________________________

(name)

____________________________________________________________________________

(title)

________________________________ ____

____________________________________

(area code) (telephone number)

(area code) (facsimile number)

____________________________________________________________________

(number and street)

____________________________________________________________________

(city)

(state/country)

(zip+4/postal code)

_________________________________________________

(electronic mail (e-mail) address, if contact employee has one)

The contact employee should be an employee whom you have authorized to receive information and

respond to questions about this Form ADV.

K. Do you maintain some or all of the books and records you are required to keep under Section 204 of the

Advisers Act, or similar state law, somewhere other than your principal office and place of business?

⁪

Yes

If "yes,” complete Section 1.K. of Schedule D.

⁪

L. Are you registered with a foreign financial regulatory authority?

Yes

Answer “no” if you are not registered with a foreign financial regulatory authority, even if you have an

affiliate that is registered with a foreign financial regulatory authority. If "yes," complete Section 1.L. of

Schedule D.

Form Sec 1707 - Uniform Application For Investment Adviser Registration - Securities And Exchange Commission Page 3