STATE OF MISSISSIPPI SECRETARY OF STATE SECURITIES REGULATION POST OFFICE BOX 136 JACKSON, MISSISSIPPI 39205 Surety Bond Number Know all men by these presents, that as principal, and as surety, hereby acknowledge ourselves indebted to the STATE OF MISSISSIPPI, in the sum of THIRTY THOUSAND DOLLARS ($30,000.00) upon the following conditions, however, and no other, viz: That said (NAME OF PRINCIPAL) on or about the day of ,19 , filled in the Office of the SECRETARY OF STATE of the STATE OF MISSISSIPPI, an application for registration as a broker-dealer or investment adviser in the STATE OF MISSISSIPPI upon which the STATE OF MISSISSIPPI requires that the principal herein rile a surety bond in the amount stated above, pursuant to the provisions of the Mississippi Securities Act. Now Therefore, this bond is executed upon condition that the facts set forth in the application of , Principal, for such registration as a broker-dealer or investment adviser, as the case may be, and the proof and statements offered to the SECRETARY OF STATE, upon which said application is based, are true, and that principal herein will comply with the provisions of said Act in the sale of securities and if the said proof and statements be true and said principal shall well and truly comply with the provisions of said Act then this instrument shall be and become null and void; otherwise to remain in full force and virtue. This bond shall remain in full force and effect unless and until the SECRETARY OF STATE has received thirty (30) days prior written notice of cancellation and has by written authorization approved such cancellation. No suit may be maintained to enforce any liability on the bond unless brought within two (2) years after the sale or other act upon which it is based, except that if the person entitled to bring such suit shall die before the expiration of the time limited therefore, such suit may be commenced by the executor or administrator of the deceased person after the expiration of such time but within one (1) year after the death of such person. of Witness, the signature of said principal and surety on this the ,19 . day (PRINCIPAL - print) BY (SURETY - print) Countersigned: BY (RESIDENT MISSISSIPPI AGENT) NOTE - A surety bond of no less than $10,000.00 is required for firms with discretionary authority unless the firm meets the net worth requirements. A surety bond of no less than $30,000.00 is required for firms having (1) custody or (2) custody and discretionary author unless the firm meets the net worth requirements. Refer to Mississippi Securities Act Rule 607. NOTE- Attach certified copy of certificate of attorney-in-fact, or of such other official of the surety authorizing execution. American LegalNet, Inc. www.USCourtForms.com