Bureau of Securities Bond Form Nebraska Department of Banking & Finance http://www.ndbf.nebraska.gov 1526 K Street, Suite 300 PO Box 95006 Lincoln, NE 68509-5006 402-471-3445 Bond #: ____________ KNOW ALL PERSONS BY THESE PRESENTS: That ________________________________________________________________________ (Name and address of Broker-Dealer or Investment Adviser) ____________________________________________________________________________ as Principal, having filed with the Nebraska Department of Banking & Finance on or about the _____ day of ______________ , ________, an application to transact business in the State of Nebraska as a(n): _______________________________________________________________________ , and (Designate whether Principal is Broker-Dealer or Investment Adviser) ____________________________________________________________________________ (Name and address of Surety) as Surety, a corporation organized under the laws of the State/Commonwealth/Territory of __________________ and being duly authorized to transact the business of indemnity and suretyship in the State of Nebraska, do hereby acknowledge our indebtedness to the State of Nebraska, for the use and benefit of any person(s) having a claim under the conditions of this obligation, including any person(s) having a cause of action under Section 8-1118, in the sum of twenty-five thousand dollars ($25,000), as required by Section 8-1103 of the Securities Act of Nebraska; provided, however, that the aggregate liability hereunder shall not exceed the sum of twenty-five thousand dollars ($25,000), regardless of the number of claimants, and shall not be construed as individual liability. LIABILITY for the payment of this sum, to which we hereby obligate and bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, becomes effective upon the following conditions: 1. Registration/Licensing of the Principal to transact business in the State of Nebraska as a(n): _________________________________________________________________ , and (Designate whether Principal is a Broker-Dealer or Investment Adviser) 2. Failure by the Principal to strictly comply with all applicable provisions of, and orders, rules and regulations issued pursuant to, the applicable securities statutes of the State of Nebraska. Page 1 of 3 Rev. 2/2017 Securities Bond Form American LegalNet, Inc. www.FormsWorkFlow.com THIS Bond shall expire at such time as the Principal's registration is withdrawn, terminated through non-renewal or revoked by the Nebraska Department of Banking & Finance except as to liability for acts or omissions which occur prior to the date of cancellation. This Bond may also be cancelled by the Surety upon thirty days written notice by registered mail to the Principal and to the Nebraska Department of Banking & Finance, in which case this Bond shall be considered cancelled upon expiration of said thirty day period except as to liability for acts or omissions which occur prior to the date of cancellation. Notice shall be deemed effective upon receipt by the Nebraska Department of Banking & Finance of said written notice along with sufficient proof of notice to the Principal. NO suit may be maintained to enforce any liability arising under this Bond unless brought within three years after the contract of sale or the rendering of investment advice upon which liability is based. IT is understood and agreed that any person(s) having a claim under the conditions of this obligation may initiate suit in any court of competent jurisdiction against the Principal and/or Surety upon this Bond. WITNESS OUR SIGNATURES, this ______ day of__________________ , ________. ________________________________________ (Principal) By: ______________________________________ (Title) ________________________________________ (Surety) By: ______________________________________ ________________________________________ ________________________________________ (Counter-Signature of Agent of Surety) Page 2 of 3 Rev. 2/2017 Securities Bond Form American LegalNet, Inc. www.FormsWorkFlow.com Individual Acknowledgement State of ___________________ ss. County of __________________ On this _______ day of __________________ , _______, before me personally appeared ____________ ______________________________________ , known by me to be the person described in and who executed the foregoing instrument, as Principal, and acknowledged to me that he/she executed the same as his/her free act and deed. ________________________________________ (Notary Public) (Notarial Seal) Residing at: ___________________________________ My Commission Expires: ________________________ LLC or Partnership Acknowledgement State of ___________________ ss. County of __________________ On this _______ day of __________________ , _______, before me personally appeared ____________ ______________________________________ , known by me to be a member of the firm who executed the foregoing instrument, and acknowledged to me that he/she duly executed the same as and for the act and deed of said firm. ________________________________________ (Notary Public) (Notarial Seal) Residing at: ___________________________________ My Commission Expires: ________________________ Corporate Acknowledgement State of ___________________ ss. County of __________________ On this _______ day of __________________ , _______, before me personally appeared ____________ _________________________ , and says that he/she is the ___________________ of _____________ _________________________ , Principal heretofore named; that he/she executed the foregoing instrument for and in its behalf, by authority of its Board of directors, and affixed its seal thereto. ________________________________________ (Notary Public) (Notarial Seal) Residing at: ___________________________________ My Commission Expires: ________________________ NOTE: A true and correct copy of the applicable "Power of Attorney" must be attached hereto where the Bond is subscribed to by an "Attorney in Fact." Page 3 of 3 Rev. 2/2017 Securities Bond Form American LegalNet, Inc. www.FormsWorkFlow.com