For Non-Nasd Members Only Affidavit printable pdf download

For Non-Nasd Members Only Affidavit

FOR NON-NASD MEMBERS ONLY

AFFIDAVIT

State of _______________________

County of ______________________

I, ____________________________________________________, being duly sworn, upon oath depose and say:

reside

_____________________________________________________________________________

________________________________________________________.

telephone

number

_____________________.

I am an applicant for registration with the Arizona Corporation Commission as a securities salesman. I

will

employed

_____________________________________________________________________________________.

In connection with the aforementioned application I state that I have never been arrested, charged,

indicted, or convicted of any crime other than a minor traffic offense, except as set forth below: (If none, so state.)

_________________________________________________________________________________________________

___

_________________________________________________________________________________________________

___

_________________________________________________________________________________________________

___

I have never been charged by the SEC, State Securities Commission, the NASD or any other regulatory

body with violation of their Securities Act or Rules and Regulations. (List any applicable incident on separate sheet and

attach hereto.)

Applicant realizes that this affidavit is an official filing and making any false statement is a felony.

FURTHER, AFFIANT SAYETH NOT.

___________________________________

______________________________________

(Name of Firm)

(Signature of Applicant)

Attest: ____________________________________

(Signature of Officer & Title)

SUBSCRIBED AND SWORN TO before me this _________ day of _____________________, ______.

____________________________________________

(Notary Public)

My Commission Expires ________________________

n:/adminsup/forms/affnnasd

Rev. 10/97

For Non-Nasd Members Only Affidavit