Oregon Department of Consumer & Business Services Division of Finance & Corporate Securities Securities Section 350 Winter St. NE, Room 410, Salem, Oregon 97301-3881 Mailing address: P.O. Box 14480, Salem, OR 97309-0405 (503) 378-4140 Fax: (503) 947-7862 TTY: (503) 378-4100 www.oregondfcs.org In the matter of the licensing of a ) securities salesperson or investment adviser ) UNDERTAKING representative by two or more firms. ) Firm name:________________________________________________________________________ _____________ and: ________________________________________________________________________ ___________________ (Firm name) and: ________________________________________________________________________ ___________________ (Firm name) and: ________________________________________________________________________ ___________________ (Firm name) desire to license:________________________________________________________________________ _________ (Name) - - __________________________________________________________________________________________ (SSN) (CRD number, if any) as a salesperson or investment adviser representative to represent the a forenamed firms in Oregon. In recognition that the director of the Department of Consumer and Busin ess Services requires certain undertakings by the firms, the undersigned firms undertake as follows: 1. Each consents to the licensing of the individual by each of the other un dersigned firms. 2. Each assumes joint and several liability with the other firms for any ac t or omission of the individual in violation of Oregon securities law or of any rule or order promulgated pursuant to Or egon securities law during the period of licensing. 3. Each agrees to license the individual with the Securities Section of the Department of Consumer and Business Services and to pay the licensing fee. 4. Each acknowledges this undertaking as an addendum to all prior undertaki ngs filed with the director of the Department of Consumer and Business Services. The undersigned, under penalty of perjury, declare that each occupies th e official position indicated and is authorized to signthis document on behalf of the firm. Firm name:________________________________________________________________________ ______________ By: ________________________________________________________________________ ____________________ (Typed name and position) Signature:____________________________________________Date: ___________________________________ Address: ________________________________________________________________________ ________________ ________________________________________________________________________ _______________________ DEPARTMENT OF DD CCONSUMER B BUSINESS S SERVICES American LegalNet, Inc.440-2131 (7/03/COM) (See back for additional employers.) www.USCourtForms.com>>>> 2Firm name:________________________________________________________________________ ______________ By: ________________________________________________________________________ ____________________ (Typed name and position) Signature:____________________________________________Date: ___________________________________ Address: ________________________________________________________________________ ________________ ________________________________________________________________________ _______________________ Firm name:________________________________________________________________________ ______________ By: ________________________________________________________________________ ____________________ (Typed name and position) Signature:____________________________________________Date: ___________________________________ Address: ________________________________________________________________________ ________________ ________________________________________________________________________ _______________________ Firm name:________________________________________________________________________ ______________ By: ________________________________________________________________________ ____________________ (Typed name and position) Signature:____________________________________________Date: ___________________________________ Address: ________________________________________________________________________ ________________ ________________________________________________________________________ _______________________ FOR DEPARTMENT USE ONLY Effective date:______________________________________ Examiner:_________________________________________ American LegalNet, Inc. www.USCourtForms.com