________________________ SALESPERSON AFFIDAVIT EVIDENCING COMPLIANCE—KENTUCKY On behalf of __________________(the “Salesperson”) in connection with my application pursuant to the Commonwealth of Kentucky Order (“Order”) entered March 14, 2001, pursuant to KRS 292.330, 292.330(14), 292.500(1), and 292.500(3), I hereby certify that all the information set forth below in this Affidavit Evidencing Compliance, and the exhibits hereto, is true to the best of my knowledge: 1. I represent ________________________ (“_______”), a Canadian broker-dealer that is exempted pursuant to the exemption requirements and procedure set forth in the Order. 2. I am registered and in good standing in ___________ Province (or Territory), Canada, (my “Home Jurisdiction”), and I will maintain my required provincial and/or territorial registrations in good standing. 3. I meet all of the pre-existing conditions of the Order and will continue to meet all the conditions of the Order in the future or else will cease utilizing the exemption contained in the Order. 4. I will provide the Commonwealth of Kentucky with notice of any criminal action taken against me or of any finding or sanction imposed on me as a result of any self-regulatory or regulatory action involving fraud, theft, deceit, misrepresentation or similar conduct. 5. The following exhibits are attached hereto: a. A copy of my application on the form (Application) required by ______________, the province (or territory) in which __________________ (my employer) has its head office, or, if applicable, a copy of said document required by my home jurisdiction; b. A consent (Form U-2) to service of process; c. Evidence (Copy of Letter, Affidavit from Applicant, or Other Document) that I am registered in good standing in my Home Jurisdiction. 6. I stand ready, willing, and able to supply any additional information or materials reasonably requested of me by the Commonwealth of Kentucky in connection with the activities I seek to pursue in connection with this application should such requests ever be made. Dated: ________________ _______, 2_____. Name: Title: _____________________________ (Printed Name Here) Salesperson American LegalNet, Inc. www.USCourtForms.com NOTARY SECTION Place the Notary information or other Canadian equivalent here. The following is a Kentucky sample. Use something appropriate for YOUR jurisdiction. This is just a SAMPLE. STATE OF ______________________ COUNTY OF ____________________ On this _______ day of __________________, 2_______, the signer of the foregoing personally appeared, and did duly acknowledge to me that he was the person referenced therein and acknowledged the same to be his free act and deed, before me. The foregoing was also Subscribed, Acknowledged, and Sworn to before me by ______________, known to me to be the person executing this document on this _____ day of _____________, 2______. __________________________________ Notary Public My Commission Expires: _____________ American LegalNet, Inc. www.USCourtForms.com