NY Form CM-2 ** File no. (/) STATE OF NEW YORK, Office of the Attorney General INVESTOR PROTECTION COMMODITY SALESPERSON STATEMENT This form must always be accompanied by the Supplemental Commodity Broker-Dealer Statement (NY Form CM-3) unless this is an original filing. 1. Attach 2 X 2 photo Last Name First Name Middle Name taken within the 2. precedingResidenceCity StateZip six months 3. 4. Residence TelephoneSocial Security 5. 6. Place of BirthDate of Birth 7. 8. 9. 10. Ft.In. Color of Hair Color of eyes WeightHeight 11.Insert name and address of current employer (Commodity Broker-Dealer)Name Address 12.Have you or any entity in which you were a principal ever:A. been suspended or expelled from membership in an y securities or commodities exchange, association of securities or commodities dealers or investment or commodities trading advisors or counsel? ...................................................................... Yes [ ] No [ ]B. had a license or re g istration as a securities or commodity dealer, broker, investment advisor, salesperson, futures commission merchant, associated person, commodity pool operator or commodity trading advisor denied, suspended, revoked, cancelled or refused? ..................................................................... Yes [ ] No [ ]C. been en j oined or restrained b y an y court orgovernment agency from: 1.the issuance, sale or offer for sale of securities or commodities? .............................. 2.rendering securities or commodities advice or counsel? ............................................. 3.handling or managing trading accounts? .........4.continuing any practices in connection with securities or commodities? ....................... Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ]D. Is an y action or proceedin g seekin g the reliefenumerated in A-C presently pending? ................... Yes [ ] No [ ]E. been convicted of an y crime? .............................. Yes [ ] No [ ]F. used or been known b y an y other name? .............. Yes [ ] No [ ]G. been the sub j ect of an y professionaldisciplinary proceeding? ........................................... Yes [ ] No [ ]H. been ad j ud g ed a bankrupt or made a g eneral Page 1of 3Investors - Form CM2 American LegalNet, Inc. www.FormsWorkFlow.com 13.Following is my complete employment record for the past five years:(Indicate periods of self-employment & unemployment). From To Employer Position Held Mo. Yr. Mo. Yr. Name Address Present 14.Following is my complete education history: Name of School From ToDid you and locationGraduate Elementary School High School College University or Technical School assi g nment for benefit of creditors; been the subject of a receivership or bankruptcy proceeding; been an officer, director, principal, partner, manager, supervisor or any 10% or more equity holder of any entity which was reorganized in bankruptcy, adjudged a bankrupt or made a general assignment for benefit of creditors? .................................................. Yes [ ] No [ ]I. had a j ud g ment entered a g ainst them or it which is presently unsatisfied? (Not including j ud g ments involvin g domestic relations.) ................. Yes [ ] No [ ]J. been a part y in an y liti g ation or administrativeproceeding in which it is alleged that they or it committed fraud or otherwise violated any provision of the Martin Act or any other securities or commodities laws? ............................... Yes [ ] No [ ]K. if an y answer to an y of the above is "YES",attach statement of full particulars. Page 2of 3Investors - Form CM2 American LegalNet, Inc. www.FormsWorkFlow.com Other Schools or Special Courses A $25 fee must accompany this statement. Personal checks not accepted. Attorney's check, certified check, bank check, money order only, payable to the NYS Office of the Attorney General. Attach additional sheets where space provided is inadequate. You may submit a photocopy of this form. We will return it with your fee receipt for your records. Send remittance to: Investor Protection, 2 Floor, NY Department of Law, , New York, NY 10. DATED: Signature: STATE OF ) : SS.: COUNTY OF ) , bein g dul y sworn, deposes and says that I am the applicant and I signed the above form. I have read the questions and answers and information supplied, and they are true, accurate and complete. (Signature of Affiant/Commodity Salesperson) Sworn to before me this day of , 19 (Notary signature and legible official stamp) (spe) **Found on the fee receipt you received for original filing. Page 3of 3Investors - Form CM2 American LegalNet, Inc. www.FormsWorkFlow.com