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Application For Registration Of Securities Form. This is a Texas form and can be use in Blue Sky Secretary Of State.
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Tags: Application For Registration Of Securities, 133.7, Texas Secretary Of State, Blue Sky
Form
133.7
Texas State Securities Board
P.O. Box 13167
Austin, Texas 78711-3167
Application for Registration of Securities,
Section 7, Article 581, Vernon’s Annotated Civil Statutes
The Texas Securities Act
ANSWER ALL QUESTIONS. IF NOT APPLICABLE, SO STATE.
1.
Name of applicant. If the applicant is not the issuer, state the capacity in which the
application is made (e.g., licensed dealer):
2.
Correspondent:
Firm:
Address:
Telephone:
3.
(_______)
Name of Issuer:
(a)
(b)
4.
Address of Issuer’s principal office:
Address of Issuer’s principal office in Texas:
Is the filing under the Texas Securities Act, Section 7.A G, 7.B G, or 7.C G?
NOTE: An applicant filing under the Texas Securities Act, Section 7.A, is cautioned to
observe the audited financial statement requirements of Sections 7.A(1)f and 7.D, unless
the issuer is a “small business issuer” as defined in Rule 113.5. (See Rule 113.5 for
financial statement requirements.)
5.
Date of Issuer’s fiscal year end:
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6.
Describe the securities to be offered in Texas:
Quantity of
Securities
Type of
Securities
Maximum Price
Per Unit
Aggregate Maximum
Offering Price
Describe the securities to be offered in the total offering:
Quantity of
Securities
Type of
Securities
Maximum Price
Per Unit
Aggregate Maximum
Offering Price
7.
Maximum commissions: ______%. Estimate other offering expenses:
8.
Amount of fees submitted with this application: $
NOTE: Fees are 1/10 of 1% of the aggregate amount of securities to be sold to Texas
residents plus the applicable filing fee. Current information on fees is available on the
Agency’s web site (www.ssb.state.tx.us) or by contacting the Texas State Securities Board.
9.
If registration application has been made with the Securities and Exchange Commission,
state the effective date thereof or the expected date of effectiveness:
10.
Submit one copy of each of the following documents and indicate the documents submitted.
Include:
(a)
Securities and Exchange Commission Registration Statement;
(b)
preliminary prospectus and all amendments thereto;
(c)
each of the following, which may be in preliminary form, with a definitive copy
furnished when available:
Issuer’s charter and all amendments;
Issuer’s bylaws and all amendments;
Underwriting agreement;
Agreement among underwriters and dealers;
Opinion of counsel;
Specimen copy of security; and
Firm offering price commitment from managing underwriter;
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133.7
(d)
(e)
if the Issuer is organized under the laws of any other state, territory, or
government, or domiciled in any other state than Texas, a consent to service of
process under proper resolution or authority of the governing body of the Issuer.
(a)
List the states in which it is proposed to offer the securities for sale to the public:
(b)
List the states, if any, in which the securities are eligible for sale to the public:
(c)
11.
all advertising to be used in connection with the offering of the securities in Texas;
and
List the states, if any, which have refused, by order or otherwise, to authorize sales
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:
12.
Describe any stop order, denial, order to show cause, suspension or revocation order,
injunction or restraining order, withdrawal order or permission, or similar order issued to
date by any state regulatory body, or other governmental authority, or by any court,
concerning the securities covered by this application, or other securities of the issuer
currently being offered to the public, and attach copies of any materials pertaining to any
such orders:
13.
The applicant agrees:
(a)
that any changes or amendments in the prospectus or registration statement shall
be furnished with changes, additions, or deletions marked;
(b)
that within two days after the filing under the Securities Act of 1933 of the final
prospectus or of any further amendments or supplements thereto, whether posteffective or otherwise, one copy thereof will be filed with the Texas State Securities
Board;
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(c)
that upon receipt of notice by the issuer or applicant of any orders of the Securities
and Exchange Commission issued under Section 8(b) (Refusal Order Proceeding)
or Section 8(d) (Stop Order Proceeding) of the Securities Act of 1933, in
connection with the registration of the securities thereunder, and of any notice of
effectiveness of said registration, notice thereof will be given to the Texas State
Securities Board by any means of electronic submission, such as graphic scanning,
modem or facsimile, provided, however, that the office of the Texas State
Securities Board has the necessary equipment to accept such a transmission;
(d)
that upon receipt of notice by the issuer or applicant of any stop order, denial,
order to show cause, suspension or revocation order, injunction or restraining
order, withdrawal order or permission, or similar order issued by any state
regulatory body, or other governmental authority, or by any court, concerning the
securities covered by this application, or other securities of the issuer currently
being offered to the public, notice thereof will be given to the Texas State
Securities Board by any means of electronic submission, such as graphic scanning,
modem or facsimile; provided, however, that the office of the Texas State
Securities Board has the necessary equipment to accept such a transmission; and
(e)
that it will promptly furnish all such additional information and documents
regarding the issuer or the securities covered by this application as may be
requested by the Securities Commissioner prior to registration.
Signed and sealed this
day of
, 20
(Name of Applicant)
By:
(Title)
Attest:
(Secretary or Partner)
STATE OF
COUNTY OF
The undersigned, being duly sworn, deposes and says that he or she executed the foregoing
application for and on behalf of the applicant named therein; that he or she is
(title) of such applicant and is fully authorized to execute and file such
application; that he or she is familiar with such application; that to the best of his or her
knowledge, information and belief the statements made in such application are true and the
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133.7
documents submitted therewith are true copies of the original thereof; and that to date, unless the
Texas State Securities Board has been otherwise notified, no stop order, denial, order to show
cause, suspension or revocation order, injunction or restraining order, withdrawal order or
permission, or similar order has been issued by any state regulatory body, or other governmental
authority, or by any court, concerning the securities covered by this application, or other securities
of the issuer currently being offered to the public.
(Signature)
(Capacity)
Subscribed and sworn to before me the
day of
, 20
Notary Public in and for the County of
State of
(NOTARY SEAL)
My commission expires:
The Texas State Securities Board will mail the correspondent a notice of receipt of the application.
Pursuant to the requirements of the Texas Government Code, Chapter 2005, the Rules and
Regulations of the Texas State Securities Board, Chapter 104, set forth time periods for processing
applications and a process for appeal where, without good cause, an application is not processed
within the time periods prescribed.
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