FORM R-3 11/06 Commonwealth of Puerto Rico COMMISSIONER OF FINANCIAL INSTITUTIONS Centro Europa Building, Suite 600 1492 Ponce de León Avenue San Juan, PR 00907-4127 Tel. (787) 723-8403 fax (787) 724-2604 APPLICATION FOR REGISTRATION, RENEWAL OR AMENDMENT TO AN APPLICATION OF INVESTMENT ADVISER Check the appropriate box: Application for Initial Registration Application for Renewal of Registration Amendment to an Application 1. Full Name of Applicant____________________________________________________________________ 2. Social Security No. ______________________________________________________________________ 3. Address and telephone number of principal place of business _____________________________________ ______________________________________________________________________________________ 4. Address of each branch office in Puerto Rico giving the date each such branch office was established and the name of the person in charge of each branch office __________________________________________ ______________________________________________________________________________________ 5. Organization of Applicant: (a) Form ______________________________________________________________________________ (b) Date organized or incorporated ___________________________________________________________ (c) Under laws of __________________________________________________________________________ 6. If Applicant is a corporation state the name, CRD No. or S.S. # of each officer, director and persons with similar status or functions._________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 7. If Applicant is a corporation, give the name of each person owning directly or indirectly 10% or more of any class of any equity securities of Applicant. As to each person indicate class of security, the number of shares Form R-3 American LegalNet, Inc. www.FormsWorkflow.com and the percentage ownership of such person in relation to the number of shares outstanding. _____________ ______________________________________________________________________________________ ______________________________________________________________________________________ 8. If Applicant is a partnership, give the name and title of each partner. _____________________________________________________________________________________ ______________________________________________________________________________________ 9. If Applicant is a sole proprietorship, give the name, date and place of birth of the proprietor. ______________________________________________________________________________________ ______________________________________________________________________________________ 10. If Applicant is other than a sole proprietor, partnership or corporation, give full name of each person or trustee who directs, manages or participates in directing or managing its affairs._______________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 11. Name persons not included in items 6 to 10 who control, directly or indirectly, the business of applicant. none, please indicate. If ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 12. Name any employees of applicant who perform investment advisory work. __________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 13. State whether applicant, any predecessor of applicant, any employees, or any person named in items 6 to 12: Yes (a) Has ever been convicted of any misdemeanor involving a security or any aspect of the securities business. (b) Has ever been convicted of any felony. (c) No Has ever been permanently or temporarily enjoined from engaging in, or continuing any conduct or of or practice involving any aspect of, the securities business. American LegalNet, Inc. www.FormsWorkflow.com Form R-3 (d) Has ever been the subject of an order of the Commissioner denying, suspending or revoking registration as a broker-dealer, agent or investment adviser. (e) Has ever been the subject of an order entered by the Securities Administrator of any other state or by the Securities and Exchange Commission denying or revoking registration as a broker-dealer, agent or investment adviser. (f) Has ever been adjudicated as bankrupt or insolvent. (g) Has ever been censured or fined, suspended or expelled by any association of investment advisers. (h) Has ever been the subject of a United States Post Office Fraud Order. (i) Has ever been sued civilly for fraud, deceit or misrepresentation. If the answer to any question is affirmative, furnish the complete details, including the date and the current status of the case, on a separate attached sheet. 14. Is applicant a successor to another organization. If so, furnish the name of such firm, the date in which the applicant succeeded to the business of such firm, the reason for such succession and the method by which effected. __________________________________________________________________________________________ 15. Is applicant registered as a broker- dealer or investment adviser with the Securities and Exchange Commission? If so, when did the application for such registration become effective? __________________________ 16. (a) Does applicant give continuous advice to clients as to the investment of funds on the basis of the individual . If so, state in detail the basis of compensation, how fees will needs of each client? be computed, the period covered by each fee, and when fees are payable.__________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ (b) Does applicant manage securities accounts for clients under circumstances not involving the giving of continuous advice to clients as to the investment of funds on the basis of the individual needs of each client? . If so, describe the nature of this activity and state in detail the basis of compensation, how fees will be computed, the period covered by each fee and when are fees payable. ____________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ (c) Does applicant furnish investments advise through consultations (Not as part of (a) or (b) above)? . If so, state basis of compensation. American LegalNet, Inc. www.FormsWorkflow.com Form R-3 ___________________________________________________________________________________ ____________________________________________________________________________________ (d) Does applicant issue periodic publications relating to securities on a subscription basis? _____________ . If so, furnish the name of the publication, subscription price, and period covered of the subscription. __________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ (e) Does applicant prepare or issue special reports or analyses relating to securities not included in any service described above? ______________________ If so, state price, fee or basic compensation. ___________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ (f) Does applicant prepare or issue, not as part of any service described above, any charts, graphs formulas, or other devices which clients may use to evaluate securities? If so, describe such services in detail and state price, fee, or basis of compensation._______________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ____________________________________________________________________________________ (g) Does applicant furnish investment advice in any manner not described above? If so, describe such services in detail and state basis of compensation. ___________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________ 17. (a) ____________________________________________________________________________________ Is applicant or registrant engaged in any business or profession other than acting as investment adviser with respect to securities?__________________________________________________________________ ___________________________________________________________________________________ _________________________________________________________ If so, describe briefly each such other business or profession other than acting as investment adviser with respect to securities. ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Form R-3 (b) (c) Is the principal business of applicant or registrant that of an investment adviser? ___________________________________________________________________________________ ___________________________________________________________________________________ Does a substantial part of applicants or registrant’s investment advisory business consist of giving continuous advice to clients as to the investment of funds on the basis of the individual needs of such clients ? _____________________________________________________________________________________ ___________________________________________________________________________________ 18. Does applicant or registrant, or any person connected with applicant or registrant, have discretionary authority to make any of the following determinations without the consent of the client before the transaction is effected?: ? (a) (b) Which security is to be bought or sold ? (c) 19. Whether securities are to be bought or sold The total amount of the security to be bought or sold ? Does applicant or any person connected with applicant have custody, possession or authority to obtain custody or possession of: (a) Securities of any investment advisory client? ________________________________________________ ____________________________________________________________________________________ (b) 20. Funds of any investment advisory client? ____________________________________________________ ____________________________________________________________________________________ Does applicant: (a) (b) (c) As principal sell securities to or buy securities from any investment advisory client? _____________________________________________________________________________________ Effect securities transactions as broker or agent for any investment advisory client? ____________________________________________________________________________________ As broker or agent for any person other than investment advisory client, sell securities to or buy securities from such clients? ___________________________________________________________________________________ ___________________________________________________________________________________ (c) Recommend to investment advisory clients or prospective clients, the purchase or sale of securities in which the applicant or registrant, directly or indirectly has a position or interest? _______________________ ______________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com Form R-3 _____________________________________________________________________________________ Item 21 and 22 are applicable to an investment adviser who has the principal place of business in Puerto Rico or when required by the Commissioner. 21. Section 202 (e) of the Puerto Rico Uniform Securities Act establishes the minimum capital requirement: The term minimum capital is defined by Article 18 of the Regulation under the Uniform Securities Act of Puerto Rico. (a) (b) If a partnership, does applicant have a minimum capital of not less than $5,000 plus $2,500 for each Branch Office in Puerto Rico? (c) 22. If a corporation: Does applicant have a minimum capital of not less than $8,000 plus $2,500 for each Branch Office in Puerto Rico? If a sole proprietorship, does applicant have a minimum capital of not less than $2,500 plus $2,500 for each branch office in Puerto Rico? The following exhibits are to be filed herewith: I. If applicant is a corporation, a certified copy of the resolution of the Board of Directors of applicant authorizing the execution and filing thereof. II. A Bond in the amount of $10,000 as required by Section 6.8.5 of the Regulation under the Uniform Securities Act of Puerto Rico. III. Audited Financial Statements including a detailed Balance Sheet a Income Statement and Cash Flows Statement required by Article 15 of the Regulation under the Uniform Securities Act of Puerto Rico. IV. (a) If applicant is a corporation, a copy of the Articles of Incorporation and By-Laws and all amendments thereto. (b) If applicant is a partnership, a copy of the Articles of Partnership, and Partnership Agreement. (c) If applicant is a Limited Liability Company, a copy of the Certificate of Formation and Limited Liability Company Agreement. WARNING: Failure to keep this form current and to file accurate supplementary information on a timely basis, or the failure to keep accurate books and records or otherwise to comply with the provisions of law applying to the conduct of business as an investment adviser would violate the Securities Act. of Puerto Rico and may result in disciplinary, administrative, injunctive or criminal action. INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACTS MAY CONSTITUTE CRIMINAL VIOLATIONS. CONSENT TO SERVICE OF PROCESS The Applicant irrevocably appoints the Commissioner of Financial Institutions of Puerto Rico, and his (her) successors in Office, its attorney upon whom may be served any notice, process or pleading in any non-criminal action or proceeding against it arising out of or in connection with the purchase or sale of securities, the conduct of the securities business or the business of an investment adviser, or violation of the Uniform Securities Act of Puerto Rico; and the undersigned does hereby consent that any such action proceeding against it may be commenced in any court of competent jurisdiction and proper venue by service of American LegalNet, Inc. www.FormsWorkflow.com Form R-3 process upon said officer with the same effect as if the undersigned has been personally served with process in said jurisdiction. It is requested that a copy of any notice, process or pleading served hereunder be mailed to the address given in Item 3 and 4. EXECUTION THE APPLICANT OR REGISTRANT SUBMITTING THIS FORM AND THE PERSON BY WHOM IT IS EXECUTED HEREBY REPRESENT THAT IT CONTAINS A TRUE, CORRECT, AND COMPLETE STATEMENT OF ALL INFORMATION REQUIRED TO BE FURNISHED. _________________________________________ Date _______________________________________ Name of Applicant BY: ___________________________________ Signature and Title ________________________________________ Print Name Affidavit Number: _________________________________________________________________________________ Subscribed and sworn before me by ____________________________ this day of of , at . Year _____________________________________ Notary Public A filing fee of $500.00 as required by Section 6.8.1 of the Regulation under the Uniform Securities Act of Puerto Rico must accompany this application in the form of a check or money order drawn to the “Secretary of the Treasury”. American LegalNet, Inc. www.FormsWorkflow.com