Application For Qualification By Coordination - Department Of Corporations (Page 2 of 2) in pdf

Application For Qualification By Coordination - Department Of Corporations Page 2

12. Pursuant to Section 25146 of the California Corporations Code and Section 260.146 of Title

10 of the California Code of Regulations, applicant hereby undertakes, as long as required under

the foregoing sections and subject to the exception therein contained, to file with the

Commissioner: (a) within 120 days after the end of each fiscal year a report of financial condition

and a related statement of income and expenses covering such fiscal year; and (b) within 90

days after the first six months of each fiscal year, a like report and statement covering such six

months period.

(NOTE: The application must be signed and verified in the following manner.)

The applicant has duly caused this application to be signed on its behalf by the undersigned,

thereunto duly authorized.

_________________________________

(Applicant)

By _______________________________

(Title)

I certify (or declare) under penalty of perjury under the laws of the State of California that I have

read this application and the exhibits thereto and know the contents thereof, and that the

statements therein are true and correct.

Executed at _____________________________________, on _________________, 20 ____.

(Place)

(Date)

________________________________

(Signature)

260.111 (rev 9/02)

Application For Qualification By Coordination - Department Of Corporations Page 2