Form R-2 - Application For Registration, Renewal Or Amendment To An Application Of An Agent Page 2

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R-2
Page 2
9.
Has Applicant engaged in the securities business on a full time basis for the 5 years immediately preceding
the date of filing of this application?
______________________________________________________________________________________
Describe Applicant’s proposed method of doing business, including (1) whether Applicant will specialize
10.
in any type of business or securities, (2) whether Applicant will devote his full time to the securities
business, and if not, the approximate percentage of Applicant’s time which will be devoted to the securities
business, (3) whether Applicant will solicit employment as an issuer’s agent from issuers of securities.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
11.
State whether Applicant:
Yes
No
(a) Has ever been convicted of any misdemeanor involving a security or
any aspect of the securities business?
(b) Has ever been convicted of any felony?
(c) Has ever been permanently or temporarily enjoined from engaging
in, or continuing any conduct practice involving any aspect of the
securities business?
d) Has ever been the subject of an order of the Administrator denying,
suspending or revoking registration as a broker-dealer, agent or
investment adviser?
(e) Has ever been the subject of an order entered by the Securities
Administrator of any other state or by the Securities and Exchange
Commission denying or revoking registration as a broker-dealer,
agent or investment adviser?
(f)
Has ever been the subject of an order of the Securities and
Exchange Commission suspending or expelling him from a
national securities exchange or national securities association
registered under the Securities Exchange Act of 1934?
(g) Has ever been adjudicated as bankrupt or insolvent?
(h) Has ever been censured or fined, suspended or expelled by the
National Association of Securities Dealers, Inc. or by any stock exchange?
(I)
Has ever been the subject of a United States Post Office Fraud
Order?
(j)
Has ever been sued civilly for fraud, deceit or misrepresentation?
If the answer to any of the foregoing questions is in the affirmative furnish the complete details including the date and
a statement concerning the current status of the case.
If during the period of your registration an event occurs which cause a current affirmative answer to any part of item 11,
the Assistant Commissioner of the Securities Regulation Division shall be notified in writing as to the facts relative to such
event.

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