STATE OF ARKANSAS SECURITIES DEPARTMENT HERITAGE WEST BUILDING, SUITE 300 201 EAST MARKHAM STREET LITTLE ROCK, AR 72201 TELEPHONE: 501.324.9260 FAX: 501.324.9268 INTERNET: www.securities.arkansas.gov FMLA Form 002 PARENTS, SUBSIDIARIES AND AFFILIATES NOTE: PLEASE SUBMIT ORIGINAL FORMS ONLY; THE DEPARTMENT WILL NOT ACCEPT FAXED COPIES. PLEASE RETAIN A COPY FOR YOUR RECORDS. INCOMPLETE APPLICATIONS WILL BE RETURNED FOR COMPLETION. Copy this page as necessary and attach. Applicant/Licensee: AR License Number* *Enter “PENDING” if license number has not yet been issued. Type Name/DBA & Principal Place of Business Telephone Number Tax ID Type of Business Conducted Parent Subsidiary Affiliate Other (Explain) Parent Subsidiary Affiliate Other (Explain) Parent Subsidiary Affiliate Other (Explain) Parent Subsidiary Affiliate Other (Explain) FMLA Form 002 Page 1 of 1 Effective Date: January 1, 2004 Amended: January 2007 American LegalNet, Inc. www.FormsWorkflow.com