C&S 8712 (Rev. 4/00) Michigan Department of Consumer & Industry Services OFFICE OF FINANCIAL AND INSURANCE SERVICES DIVISION OF SECURITIES P.O. Box 30701 Lansing, Michigan 48909-8201 (517) 241-6350 INVESTMENT ADVISER / FINDER APPLICATION CHECKLIST AND GENERAL INFORMATION (Issued under P.A. 265 of 1964, as amended) The following items are required for the review of your Investment Adviser / Finder Application. A complete submission reduces the review time considerably. An ORIGINAL signature of the applicant and notary must be on the forms and both dates must be the SAME. Pages 1 and 2 of Part I, Form ADV, must be dated the same date. 1. FORM ADV - Complete entirely. A. Answer question on top of Part I - Page 1 (Form ADV) “Is Applicant now active in business as an Investment Adviser?” B. Part I & II – All applicants for registration as an Investment Adviser must complete all items. We do not accept copies. Form ADV must have an original signature dated the same date as the notary’s signing date. C. If the answer to either items 13 or 14 of Part I Form ADV is “Yes,” then please provide an explanation of such custody. See Section 102(e) of the Michigan Uniform Securities Act, 1964 PA 265, as amended (the “Act”). The section provides in part that it is unlawful for an investment adviser not registered as a broker-dealer to take or have custody of any securities or funds of any client. Also, please see the attached Release No. 93-3-BD concerning custody or access to custody of funds and securities for Michigan clients. D. If the answer to item 16(b) of Part I Form ADV is “yes”, provide a copy of the document the firm intends to provide to Michigan clients. E. If question requests information for last fiscal year, provide actual numbers. If zero, state “zero”. (Example: Items 17, 18, 19 and 20 of Part I Form ADV.) F. Part I &II – All applicants for registration as a Finder must complete all items regarding business activities as a “finder”. Describe in a narrative form how you will seek these persons in order to locate, introduce or refer potential purchasers or sellers when acting as a Finder. 2. SUPPLEMENTAL APPLICATION FORM (C&S 8706) Michigan does NOT register Investment Adviser Representatives. The persons providing investment advice to Michigan clients will be listed in Item 4 of the Supplemental Application Page. Please submit a Schedule D Form or a completed Form U-4 for each person listed in item 4. If anyone associated with the investment adviser is also registered as a securities agent for Michigan with a broker-dealer, they must be listed in Item 5 of the Supplemental Application Form. Item 5 must be answered - Section 102(f) of the Act states that “It is unlawful for an agent registered with a broker-dealer to conduct business as an investment adviser except through the broker-dealer with which the agent is registered and with the written consent of the broker-dealer filed with the administrator, in a form and subject to terms and conditions acceptable to the administrator.” The Consent and Guaranty Form (C&S 8703) is included for compliance with Section 102(f) and must be attached if anyone associated with the applicant is also registered as a Securities Agent in Michigan. Item 6 - Check if you will operate as a Finder only, as defined in Section 401(u) of the Act. For Finder applications answer all items on ADV also. Complete responses for Finder instead of Investment Adviser. American LegalNet, Inc. www.USCourtForms.com 3. APPLICATION FEE The filing fee is $150.00. Make check or money order payable to the State of Michigan. 4. Investment Advisory Contract Provide a copy of the Investment Advisory Contract the firm will use for Michigan clients. Section 102(b) of the Act provides in part that it is unlawful for an investment adviser to enter into, extend, or renew any investment advisory contract unless it provides in writing that: A. Investment adviser shall not be compensated on the basis of a share of capital gains upon or capital appreciation of funds or any portion of the funds of the client. B. No assignment of the contract may be made by the investment adviser without the consent of the other party to the contract. 5. ASSUMED NAME If the applicant is a sole proprietor and will use an assumed name, please submit authority from the county in which you will conduct business. They will provide you with an assumed name certificate. If the applicant is a corporation, partnership, or limited liability company, please obtain and file a copy of the assumed name certificate from state of incorporation. 6. BALANCE SHEET An accrual balance sheet is required. It must not be older than 45 days and signed as to the accuracy by an officer, partner, member or sole proprietor. If applicant is a sole proprietor, please include a personal balance sheet dated the same date as the business balance sheet. Amendments to Form ADV, the Supplemental Application Form (C&S 8706), and Consent and Guaranty Form (C&S 8703) must be filed promptly in compliance with Section 203(c) of the Act. File amendments within fourteen (14) days. An original signed and dated page 1 (Form ADV) must accompany Form ADV Amendment. ALL AMENDMENTS MUST BE CIRCLED OR HIGHLIGHTED. MAIL COMPLETED APPLICATION TO: Michigan Department of Consumer & Industry Services Office of Financial and Insurance Services Division of Securities P.O. Box 30701 For 1st Class Mail Lansing, MI 48909-8201 OR 7150 Harris Drive For Overnight Delivery P.O. Box 30701 Lansing, MI 48909-8201 American LegalNet, Inc. www.USCourtForms.com