Application For Qualification By Coordination - Department Of Corporations printable pdf download

DEPARTMENT OF CORPORATIONS

STATE OF CALIFORNIA

APPLICATION FOR QUALIFICATION BY COORDINATION

An applicant must comply with the requirements of subdivisions (a) and (b) of Section 25111 of

the Code when filing an application for qualification by coordination. See also, Section 260.111.1

of these rules.

(a) In lieu of the form set forth in subsection (b), the Uniform Application to Register Securities

(Form U-1) recommended by the Subcommittee on Uniform Forms of the Committee on State

Regulation of Securities of the American Bar Association's Section of Corporation, Banking and

Business Law will be accepted for an application for qualification by coordination. If Form U-1 is

utilized, it must be signed and verified as provided in the form set forth in subsection (b) and it

must contain the information required by the form set forth in subsection (b).

(b) An application for qualification of the offer and sale of securities by coordination shall, in

addition to the facing page required by Section 260.110 of these rules, continue in the following

form:

8. Applicant hereby undertakes to forward to the Commissioner of Corporations all future

amendments to the Registration Statement under the Securities Act of 1933 attached hereto as

Exhibit A, other than an amendment which merely delays the effective date of the Registration

Statement, promptly and in any event not later than the first business day after the day they are

forwarded to or filed with the Securities and Exchange Commission, whichever first occurs.

9. A copy of the Registration Statement under the Securities Act of 1933, either two copies of

the prospectus or two additional copies of the Registration Statement, a copy of the Underwriting

Agreement, copies of any pension, retirement or other deferred compensation plan, contract or

arrangement when securities to be issued pursuant to such plan, contract or arrangement are the

subject of the application, is attached hereto as Exhibit A and incorporated herein by reference.

Any of the exhibits (other than exhibits incorporated by reference) to the Registration Statement

that are deemed necessary to evidence compliance with any of the Rules of the Commissioner

contained in Title 10 of the California Code of Regulations may be required to be submitted.

10. The Consent to Service of Process if required by Section 25165 of the California

Corporations Code is attached hereto as Exhibit B. A Customer Authorization of Disclosure of

Financial Records Form (Form No. QR 500.259) is attached hereto as Exhibit C.

11. If the applicant will employ agents (other than licensed broker-dealers) in connection with the

sale of securities in California, the applicant must comply with Sections 260.141.30 and

260.141.31, Title 10, California Code of Regulations, and furnish the following information.

a. The name and business address of each person who will represent the applicant as an agent

in this state.

b. The name and business address of the officer or other official who will supervise such agents

on behalf of the applicant.

c. A statement that all such agents employed in this state are employees of the applicant.

d. A statement of the compensation to be paid to such agents. A statement of the compensation

to be paid to such supervisory personnel, other than their regular salaries if they are regular

employees of the applicant.

e. Describe any order, judgment or decree of any governmental agency or administrator, or of

any court of competent jurisdiction revoking or suspending for cause any license, permit or other

authority of such agent or supervisory person or of any corporation of which he is an officer or

director, to engage in the securities business or in the sale of a particular security or temporarily

or permanently restraining or enjoining any such person or any corporation of which he is an

officer or director from engaging in or continuing any conduct, practice, or employment in

connection with the purchase or sale of securities, or convicting such person of any felony or

misdemeanor involving a security or any aspect of the securities business, or of theft or of any

felony.

f. A surety bond complying with Section 260.216.15, Title 10, California Code of Regulations.

260.111 (rev 9/02)

Application For Qualification By Coordination - Department Of Corporations

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