AFFIDAVIT OF BROKER/DEALER ACTIVITY NORTH DAKOTA SECURITIES DEPARTMENT SFN 53495 (8-2018) Securities Department 600 E Boulevard Ave Dept 414 Bismarck ND 58505 (701) 328-2910 www.ndsecurities.com Name of Applicant Applicant does hereby certify: 1. That the above-named Applicant has offered for sale or sold securities, solicited clients, transferred clients,or been involved in wrap-fee programs within this state. (Attach a list of names and addresses of North Dakota residents solicited in our state.) 2. That the above-named Applicant has not offered for sale or sold any securities, solicited clients, transferred clients, or been involved in wrap-fee programs within this state. 3. That the above-named Applicant has offered for sale and sold securities, solicited clients, transferred 240clients, or been involved in wrap-fee programs within this state pursuant to an exempt transaction. 240 (Please specify which exemption was relied upon):I, on behalf of the above-named applicant, acknowledge the foregoing to be truthful with full knowledge that misrepresentation of such facts to the Securities Department of the State of North Dakota may result in administrative action by the Department. Signature of Officer, Partner, or Sole Proprietor State of County ofSigned and sworn to (or affirmed) before me this Date Name(s) of Individual(s) Making Statement Signature of Notary Public or Other Authorized Officer Date Affix Notary StampTHE INFORMATION PROVIDED ON THIS AFFIDAVIT WILL BE VERIFIED WITH YOUR CLEARING FIRM PRIOR TO REGISTRATION APPROVAL. PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING YOUR CLEARING FIRM (IF APPLICABLE): Name of Clearing Firm Name of Contract Person with Firm Address City State ZIP Code Email Address of the Firm American LegalNet, Inc. www.FormsWorkFlow.com