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Escrow Agreement Form. This is a Puerto Rico form and can be use in Blue Sky Commissioner Of Financial Institutions.
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Tags: Escrow Agreement, S5, Puerto Rico Commissioner Of Financial Institutions, Blue Sky
Form S-5
11/06
Commonwealth of Puerto Rico
COMMISSIONER OF FINANCIAL INSTITUTIONS
Securities Office
Fernandez Juncos Station
PO Box 11855
San Juan, PR 00910-3855
Tel. (787) 723-3131 Fax (787) 724-2604
ESCROW AGREEMENT
KNOW ALL MEN BY THESE PRESENTS:
1.
That I, ________________________, of ___________________________Street, in the city of
___________________________________________, State of _____________, being a shareholder of
the____________________________________________________stock
in
___________________________________________, the issuer, a corporation organized under the laws
of the State of __________________________________________, for the purpose of complying with
Article 40 of the Regulation under de Uniforms Securities Act of Puerto Rico in connection with an
application for the registration by qualification or coordination of _____________________ shares of
the____________________________stock of the said issuer which was filed with said Commissioner on
the ______________________day of _____________, 20____, do hereby and herewith deposit with the
_____________________, as escrow agent, in conformity with the requirements of said Article 40
certificate(s)
numbered________________________________________________________________
representing___________________________________________________shares, respectively, of the
________________________________________stock of the said issuer, of which shares I am the sole
owner.
2.
That I hereby agree that the said shares represented by the said certificate(s) shall be held in
escrow by the said escrow agent subject to the following conditions:
(a)
That there shall be no assignment, sale or disposal of any interest in any of the said shares
represented by the said certificate(s) without the written consent of the said Commissioner.
(b)
That the said shares represented by the said certificate(s)shall not be released to me by the said
Commissioner except as provided in Article 40 which rule is hereby made a part hereof in its
entirety.
In
Witness,
Whereof,
I
have
hereunto
set
my
hand
and
seal
this____day
of
______________________________, 20____.
(Signed)____________________
(SEAL)
Witness ____________________
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