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Form U-1 Uniform Application To Register Securities Form. This is a Official Federal Forms form and can be use in NASAA.
Tags: Form U-1 Uniform Application To Register Securities, U-1, Official Federal Forms NASAA,
Uniform Application to Register Securities Form U-1 1. Issuer name and other identifying information Name of Issuer Entity Type: Previous Name None Jurisdiction of Incorporation/Organization: Date of Incorporation/Organization: Date filed with SEC: Indicate provision under which Issuer seeks registration or exemption federally: SEC Filing Number(s) (if any): 2. Issuer principal place of business Street Address Line 1 City Street Address Line 2 State/Province/Country ZIP/Postal Code Phone No. 3. Contact information of correspondent to whom notices and communications may be sent Last Name Street Address Line 1 City Phone Fax First Name Street Address Line 2 State/Province/Country E-mail ZIP/Postal Code Firm Name 4. Total offering amount, commissions, and filing fees Total Offering Description of Securities Offering Price ($) No. of Shares/Units Amount ($) Total: Maximum commission to be charged: Filing/examination fees enclosed? Note: Please include any footnote disclosures in the response form field at the bottom of Item 5. American LegalNet, Inc. www.FormsWorkFlow.com 5. Jurisdictions where offering is proposed and offering size/amount Mark the jurisdictions below where the Issuer seeks to register pursuant to each jurisdiction's applicable laws, and include the number of shares and offering amount for each jurisdiction: Jurisdiction AL AK No. of Shares or Units Amount ($) Jurisdiction MT NE No. of Shares or Units Amount ($) AZ AR CA CO NV NH NJ NM CT DE DC FL NY NC ND OH GA GU HI ID OK OR PA PR IL IN IA KS RI SC SD TN KY LA ME TX UT VI VT MD MA MI MN MS VA WA WV WI MO Footnotes to Items 4 and 5: WY American LegalNet, Inc. www.FormsWorkFlow.com 6. Offering status by jurisdiction List the jurisdictions, if any, in which the securities are eligible for sale to the public: List the jurisdictions, if any, which have refused, by order or otherwise, to authorize sale of the securities to the public, or have revoked or suspended the right to sell the securities or in which an application has been withdrawn: 7. Additional documents Submitted herewith as part of this application are the following documents (documents on file may be incorporated by reference): (a) One copy of the Registration or Offering Statement and Prospectus in the latest form on file under the Securities Act of 1933 Included Included Not Included Not Included (b) Underwriting Agreement, Agreement among Underwriters, and Selected Dealers Agreement (c) Indenture Included Not Included (d) Issuer's charter or articles of incorporation as amended to date Included Included Included Not Included Not Included Not Included Not Included (e) Issuer's by-laws as amended to date (f) Signed copy of opinion of counsel filed with Registration or Offering Statement pursuant to the Securities Act of 1933 (g) Specimen Included (h) If an earning computation or similar requirement is required to be met in any jurisdiction, attach a separate sheet as an exhibit showing compliance Included Included Not Included Not Included (i) One copy of all advertising matter to be used in connection with the offering (j) Others (list each): 8. Acknowledgements, Consent to Service of Process, and Signature The applicant hereby applies for registration or acceptance for filing of the above described securities under the applicable laws of each jurisdiction in which this application is filed and in consideration thereof agrees so long as the registration remains in effect that it will: (a) Advise the authority of each jurisdiction in which this application is filed of any change prior to registration in any of the information contained herein or in any of the documents submitted with or as part of this application. American LegalNet, Inc. www.FormsWorkFlow.com (b) File with the authority of each jurisdiction in which this application is filed within two business days after filing with the Securities and Exchange Commission (i) any amendments other than delaying amendments to the federal registration or offering statement, designating the changed, revised, or added material or information by underlining the same; and (ii) the final prospectus, or any further amendments or supplements thereto. (c) Notify the authority of each jurisdiction in which this application is filed within two business days (i) upon the receipt of any stop order, denial, order to show cause, suspension or revocation order, injunction or restraining order, or similar order entered or issued by any jurisdiction or other regulatory authority or by any court, concerning the securities covered by this application or other securities of the issuer currently being offered to the public; or (ii) upon the receipt of any notice of effectiveness or qualification by the Securities and Exchange Commission. (d) Notify the authority of each jurisdiction in which this application is filed at least two business days prior to effectiveness or qualification by the Securities and Exchange Commission of (i) any request by the issuer or applicant to any other jurisdiction or regulatory authority for permission to withdraw any application to register the securities described herein; and (ii) a list of all jurisdictions in which applications have been filed and from which the issuer or applicant has received notice that the application does not comply with applicable requirements and cannot or does not intend to comply with the requirements of such jurisdiction(s). (e) Furnish promptly all such additional information and documents in respect to the issuer or the securities covered by this application as may be requested by each jurisdiction in which this application is filed prior to registration or acceptance for filing. The issuer hereby irrevocably appoints the Securities Administrator or other legally designated officer of the jurisdiction(s) in which this application is filed, as its agents for service of process upon whom may be served any notice, process or pleading in any action or proceeding against it arising out of, or in connection with, the sale of securities and the undersigned does hereby consent that any such action or proceeding against it may be commenced in any court of competent jurisdiction and proper venue within the jurisdiction in which this application is filed by service of process upon the officers so designated with the same effect as if the undersigned was organized or created under the laws of that jurisdiction and have been served lawfully with process in that jurisdiction