ADDENDUM TO INVESTMENT ADVISER AND FEDERAL COVERED INVESTMENT ADVISER VERMONT BRANCH OFFICE FORM (Form VT-2) This addendum must be completed for each branch office which will be owned, leased or rented by any person other than the firm filing a branch office form; or for any branch office which will conduct business under a name other than that of the firm filing a branch office form. 1. Name of investment adviser or federal covered investment adviser (same as item 1 on Form VT-1): _____________________________________________________________________________________ 2. Will business be conducted at this branch office under any name other than that of the above-named firm? _____ NO _____ YES If “Yes,” provide the name(s) under which business will be conducted at this location: _____________________________________________________________________________________ 3. What types of businesses or services will be offered at this office? Check all that apply. _____ Insurance _____ Investment Advice _____ Law Office _____ Accounting Services _____ Financial Planning _____ Tax Advice _____ Securities _____ Banking (Specify bank): ______________________________ _____ Other - please describe with specificity: _______________________________________________ 4. Is there any agreement or contract between the above-named applicant and any person concerning the operations at this office? _____ NO _____ YES If "YES", attach a copy of the agreement to this form. (not required for renewals) 5. What person(s) are responsible, directly or indirectly, for paying the expenses of this office? Please provide name, CRD number, address, and phone number for each: _____________________________________________________________________________________ _____________________________________________________________________________________ 6. This office will be: _____ owned _____ leased _____ rented for purposes of conducing an investment advisory business. If this property will be owned, leased or rented by someone other than the investment advisor or federal covered investment adviser, attach a list with the name(s), address(es) and phone number(s) of the person(s) owning, leasing or renting such property. If owned, leased or rented by a corporation or partnership, attach the names, titles, addresses, and phone numbers of all officers, directors, and owners of such corporation or partnership. Revised 10/18/06 VT Branch Office Form American LegalNet, Inc. www.FormsWorkflow.com 7. By executing this form, the undersigned, in his or her individual capacity and on behalf of the above-named applicant firm hereby swears and affirms that all information on this form and all materials filed in connection with it are true, correct and complete. The undersigned stipulates, recites, acknowledges and agrees that if the Vermont Securities Division finds that any information contained in this application or in an amendment to this application is false, such finding shall constitute a violation of 9 V.S.A. § 5505. Signed: _________________________________________________ Officer, Partner or Sole Proprietor of Applicant Firm Date: _______________________ _______________________________________________________________________________ Typed Name and Title of Signatory Revised 10/18/06 VT Branch Office Form American LegalNet, Inc. www.FormsWorkflow.com