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Form For Use In Filling Quarterly Reports Required By Rule S4 For Securities Registered By Notification Or Qualification Form. This is a Puerto Rico form and can be use in Blue Sky Commissioner Of Financial Institutions.
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Tags: Form For Use In Filling Quarterly Reports Required By Rule S4 For Securities Registered By Notification Or Qualification, S4, Puerto Rico Commissioner Of Financial Institutions, Blue Sky
Form S-4
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
FORM FOR USE IN FILLING QUARTERLY REPORTS REQUIRED BY
ARTICLE 38 OF THE REGULATION UNDER DE UNIFORMS SECURITIES ACT OF
PUERTO RICO FOR SECURITIES REGISTERED BY NOTIFICATION OR
QUALIFICATION
1.
Name of Applicant and file number of the registration statement_________________
____________________________________________________________________
2.
Name of Issuer _______________________________________________________
3.
Name of underwriter, if any _____________________________________________
____________________________________________________________________
4.
Date of this report _____________________________________________________
____________________________________________________________________
5.
(a)
Date offering commenced ________________________________________
(b)
Date offering completed, if completed _______________________________
(c)
If offering has not commenced, state reasons briefly_____________________
________________________________________________________________
6.
Total number of shares or other units offered____________________________
(b)
Number of such shares or other units sold from commencement of offering to
date___________________________
(c)
7.
(a)
Number of shares or other units still being offered________________________
(a)
Total number of shares or other units offered in Puerto Rico________________
(b)
Number of such shares or other units sold in Puerto Rico___________________
(c)
Number of shares or other units still being offered in Puerto Rico_____________
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8.
(a)
(b)
(c)
(d)
Total amount received from public since comencement of offering to date $____
Underwriting discount allowed……$________
Expenses paid to or for the account of the underwriters.$__________
Other expenses paid to date by or for the account of the issuer:
(1)
(2)
(3)
(4)
(5)
(e)
(f)
9.
Legal (including organization)…$___________
Accounting……………..$_________________
Engineer’s fees incurred
Prior to offering…………..$____________
Printing and advertising……..$___________
Other……………$_____________
Total costs and expenses (b), (c) and (d)…………$__________
Proceeds to issuer after such deductions (a) minimum (3)…………….$________
Use of net proceeds from commencement of offering to date:
Payment to
Directors and
Affiliates
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Salaries and fees ……………..
Purchase of real estate………..
Purchase and installation of
machinery and equipment………
Construction of plant building
and facilities……………
Development expense (product
development research,
patent costs, etc.)
Purchase of raw materials,
Inventories, supplies, etc………….
Selling, advertising, and other
sales promotion………………..
Payment to
others
$
$
$______
$______
$
$______
$
$______
$
$______
$
$_________
$
$_________
Instruction:
Item 9 of this form need not be completed unless the securities registered
are being offered on behalf of the issuer.
10.
State briefly the nature and extent of each type of the issuer’s principal activities to date
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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11.
State whether the offering has been discontinued, and if so, state the date and describe
briefly the reasons for such discontinuance.
________________________________________________________________________
________________________________________________________________________
12.
List the names and addresses of all brokers and dealers who have, to the knowledge of
the issuer or underwriters, participated in the distribution of the securities offered during
the period covered by this report.
________________________________________________________________________
________________________________________________________________________
Instructions:
In reports made subsequent to the initial report, the information need be given
only with respect to persons not previously reported.
13.
State the number of shares held by each promoter, director, officer or controlling person
of the issuer, if different from the amount stated in the prospectus.
Date ________________________________
Issuer __________________________
By ____________________________
Name and title
_______________________________
Selling security holder
________________________________
Applicant registering securities
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