Form U-SB Uniform Surety Bond Form State/Commonwealth/Territory of ______________________________________________________________________________ ______________________________________________________________________________ Name of Agency ______________________________________________________________________________ Address of Agency Bond No. __________________ KNOW ALL PERSONS BY THESE PRESENTS: That, ______________________________________________________________________________ Name and address of broker-dealer or investment adviser ______________________________________________________________________________ as Principal, having filed with the office of the __________________________________________________ Name of agency requiring bond on or about the __________ day of _______________, 20_____, an application to transact business in this State/Commonwealth/Territory as a ______________________________________________________________________________ and Designate whether principal is B/D or I/A __________________________________________________ as Surety, a corporation organized Name and address of Surety under the laws of the State/Commonwealth/Territory of _______________________and being duly authorized to transact the business of indemnity and suretyship in this State/Commonwealth/Territory, do hereby acknowledge our indebtedness to the State/Commonwealth/ Territory of ____________________ for the use and benefit of any person(s) having a claim under the conditions of this obligation, in the sum of ____________, Dollars ($_____), as required by ____________________________provided, however, that the Statute Requiring Bond aggregate liability hereunder shall not exceed the sum of ______________________ Dollars, American LegalNet, Inc. www.FormsWorkFlow.com ($_______) regardless of the number of claimants, and shall not be construed as individual liability. LIABILITY for the payment of this sum, to which we hereby obligate and bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, becomes effective upon the following conditions: 1. Registration/Licensing of the Principal to transact business in this State/Commonwealth/Territory as a _____________________________________ Designate whether principal is a broker-dealer or investment adviser and 2. Failure by the Principal to strictly comply with all applicable provisions of, and orders, rules and regulations issued pursuant to, the applicable securities statutes of the particular state, commonwealth or territory in which such Principal is registered. THIS Bond shall expire at such time as the Principal's registration is withdrawn, terminates through non-renewal or issue revoked by the ____________________________________________________________ Name of Agency except as to liability for acts or omissions which occur prior to such time. This Bond may also be canceled by the Surety upon _________ days written notice by registered mall to the Principal and to the ________________________________________________________ in which case this Bond shall Name of Agency be considered canceled upon the expiration of ____________ said days period except as to liability for acts or omissions which occur prior to the date of cancellation. Notice shall be deemed effective upon receipt by the applicable state agency of said written notice along with sufficient proof of notice to the Principal. NO suit may be maintained to enforce any liability arising under this Bond unless brought within ________ years after discovery of the act or omission upon which liability is based. IT is understood and agreed that any person(s) having a claim under the conditions of this obligation may initiate suit in any court of competent jurisdiction against the Principal and/or the Surety upon this Bond. WITNESS OUR SIGNATURES, this the _____ day of ___________, 20________. _______________________________________ PRINCIPAL _______________________________________ BY (corporate seal, if applicable) _______________________________________ SURETY _______________________________________ BY _______________________________________ Counter Signature of _______________________________________ Agent of Surety resident ACKNOWLEDGMENT OF INDIVIDUAL American LegalNet, Inc. www.FormsWorkFlow.com STATE OF __________________________________) ss. COUNTY OF _______________________________) On this_______________________________________ 20___, before me personally appeared ___, ____________________________________, to me known to be the person described who executed the foregoing instrument, as Principal, an acknowledged to me that he executed the same as his free act and deed. (NOTARIAL SEAL) _______________________________________ NOTARY PUBLIC, _______________________________________ _______________________________________ _______________________________________ COUNTY, _______________________________________ MY COMMISSION EXPIRES ACKNOWLEDGMENT OF PARTNERSHIP STATE OF __________________________________) ss. COUNTY OF _______________________________) On this _________________________________________, 19___, before me personally appeared _________________________________________, to me known to be a member of the firm who executed the foregoing instrument, and he duly acknowledged to me that he executed the same as and for the act and deed of said firm. (NOTARIAL SEAL) _______________________________________ NOTARY PUBLIC, _______________________________________ _______________________________________ _______________________________________ COUNTY, _______________________________________ MY COMMISSION EXPIRES ACKNOWLEDGMENT OF CORPORATION STATE OF __________________________________) ss. COUNTY OF _______________________________) On this ______________________________________, 20___, before me personally came ___________________________________ and says that he is the_______________ of _________________ Principal heretofore name; that he executed the instrument for and in its behalf, by authority of its Board of Director, and affixed its seal thereto. (NOTARIAL SEAL) _______________________________________ American LegalNet, Inc. www.FormsWorkFlow.com NOTARY PUBLIC, _______________________________________ _______________________________________ _______________________________________ COUNTY, _______________________________________ MY COMMISSION EXPIRES NOTE: A true and correct copy of the applicable "Power of Attorney" must be atta