SECURITIES AND BUSINESS REGULATION 2 Martin Luther King, Jr. Drive, S.E. Ste 802, West Tower Atlanta, Georgia 30334 (404) 656-3920 http://www.sos.state.ga.us/securities/ ROBERT D. TERRY Assistant Commissioner of Securities KAREN HANDEL Commissioner of Securities DEALER'S BOND Georgia Securities Act of 1973, as amended O.C.G.A. 10-5-3(k) Bond No.: KNOW ALL PERSONS BY THESE PRESENTS: That we, (Name of Dealer) of AS PRINCIPAL, and (Name of Surety), of , a corporation organized and existing under the laws of the State of and authorized to do business in the State of Georgia AS SURETY, are hereby held and firmly bound unto the State of Georgia, for the use and benefit of any interested person damaged by any breach of the conditions of this obligation, in the sum of Twenty-Five Thousand ($25,000.00) Dollars lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, by these presents; provided, however, that the aggregate liabilities hereunder shall not exceed the sum of Twenty-Five Thousand ($25,000.00) Dollars, regardless of the number of claimants, and shall not be construed as individual liability. SEALED with our seals and dated this day of , 20 THE CONDITIONS OF THE ABOVE OBLIGATION ARE SUCH THAT: WHEREAS, the above-mentioned principal has applied for and obtained registration as a dealer in securities under the provisions of the Georgia Securities Act of 1973, as amended, from and after the date hereof for the registration period ending December 31, 20 NOW THEREFORE, if said principal shall faithfully comply with any and all provisions of the Georgia Securities Act of 1973, as now or hereafter amended, and any and all rules, regulations and orders issued or hereafter to be issued by the Commissioner of Securities, then this obligation shall be null and void; otherwise to be and remain in full force and effect. Form 10 Rev 1/2007 American LegalNet, Inc. www.FormsWorkflow.com IN WITNESS WHEREOF, said principal, acting by and through its duly authorized officers, has hereunto set its hand and seal, and the said surety has caused these presents to be signed by its duly authorized officers, and its corporate seal to be hereto affixed this day of , 20 (SEAL) (Principal) By: (Name and Official Position) (SEAL) COUNTERSIGNED: (Name of Surety) By: _________________________________ (Name and Official Position) (Resident Agent of Georgia) (Address of Resident Agent) NOTE: This bond expires, unless otherwise indicated, on the termination date of the registration period shown above. A new bond or continuation certificate must be executed if the dealer's registration is renewed for the following calendar year. NOTE: Resolutions authorizing the execution of this bond should be attached. If this bond has been subscribed to by an "Attorney in Fact," there must be attached a "Power of Attorney." Form 10 Rev 1/2007 American LegalNet, Inc. www.FormsWorkflow.com