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Statement Of Eligibility For Registration By Notification Form. This is a New Jersey form and can be use in Blue Sky Secretary Of State.
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Tags: Statement Of Eligibility For Registration By Notification, NJBOS-7, New Jersey Secretary Of State, Blue Sky
NEW JERSEY BUREAU OF SECURITIES
153 Halsey Street, 6th Floor
PO Box 47029
Newark, NJ 07101
(973) 504-3600
STATEMENT OF ELIGIBILITY
FOR REGISTRATION BY NOTIFICATION
(Pursuant to N.J.S.A. 49:3-61.2)
1. Name of Issuer _____________________________________________________________
2. Original date of organization of the issuer ________________________________________
Number of years issuer has been in continuous operation ______________________________
If issuer has been in continuous operation less than 5 years, give names of predecessors & state
length of time each has been in operation: __________________________________________
____________________________________________________________________________
____________________________________________________________________________
3. Has there been any default during the current fiscal year or within the 3 preceding fiscal years
in the payment of principal, interest, or dividends on any security (of the issuer or any predecessor) with a fixed maturity or a fixed interest or dividend provision? ______________________
____________________________________________________________________________
4. State the net earnings of the issuer and any predecessors during the past 3 full fiscal years,
determined in accordance with generally accepted accounting principles, which are applicable to
all securities without a fixed maturity or a fixed interest or dividend provision, which securities
are outstanding at the date the registration statement is filed.
Fiscal year ended
Net earnings
1. ___________________________________
_______________________________
2. ___________________________________
_______________________________
3. ___________________________________
_______________________________
Total _______________________________
Average net earnings (divide total by 3) _______________________________
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5. If the securities of the issuer or any of its predecessors (which do not have a fixed maturity or
a fixed interest or dividend provision) have been outstanding for 3 full fiscal years, complete the
chart below. (Include all securities which will be outstanding if all the securities being offered
or proposed to be offered are issued, whether or not they are proposed to be registered or offered
in New Jersey.)
Description
of
Securities
No. of
units
now
outstanding
Maximum
offering
price
per unit
(1)
Market
price per
unit as
of
________
date (1)
Book
value per
unit as
of
________
date (2)
Total
value
(3)
_____________
_______
$ _______
$ _______
$ _______
$ _______
_____________
_______
$ _______
$ _______
$ _______
$ _______
_____________
_______
$ _______
$ _______
$ _______
$ _______
A. Total Value
$ _____________
B. 5% of total value
$ _____________
C. Average net earnings
(restate from Item 4)
$ _____________
In order to qualify for Registration by Notification, “C” must be greater than or equal to “B”.
(1) The maximum offering price or the market price on a day selected by the applicant, but must
be within 30 days before the date of filing this registration statement.
(2) Book value must be of a day, selected by the applicant, within 90 days of filing this registration statement. Book value may be used only if there is neither a readily determinable market
price nor a cash offering price.
(3) The total value is the product of either (1) the number of units multiplied by the higher of the
maximum offering price or the market price, or (2) the number of units multiplied by the book
value.
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6. If the securities of the issuer or any of its predecessors (which do not have a fixed maturity or
a fixed interest or dividend provision) have not been outstanding for 3 full fiscal years, complete
the chart below. (Include all securities which will be outstanding if all the securities being offered or proposed to be offered are issued, whether or not they are proposed to be registered or
offered in New Jersey.)
Description
of
Securities
No. of
units
now
outstanding
Maximum
offering
price
per unit
(1)
Market
price per
unit as
of
_______
date (1)
Book
value per
unit as
of
_______
date (2)
Total
value
(3)
_____________
_______
$ _______
$ _______
$ _______
$ _______
_____________
_______
$ _______
$ _______
$ _______
$ _______
_____________
_______
$ _______
$ _______
$ _______
$ _______
A. Total Value
$ _____________
B. 5% of total value
$ _____________
C. Average net earnings
(restate from Item 4)
$ _____________
In order to qualify for Registration by Notification, “C” must be greater than or equal to “B”.
Notes (1), (2), and (3) are explained on the previous page.
The registrant certifies that it has reasonable grounds to believe that it meets all of the requirements for filing pursuant to N.J.S.A. 49:3-61.2.
Date: ____________________________
Issuer: ____________________________
By: ______________________________
Title: _____________________________
Form NJBOS-7
9/2003
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