VERMONT SURETY BOND FORM STATE OF VERMONT Department of Financial Regulation 89 Main Street Montpelier, Vermont 05620-3101 Bond No. ____________________ KNOW ALL PERSONS BY THESE PRESENTS: That, ________________________________________________________________________________as Name and address of Investment Advisor Principal, having filed with the office of the Vermont Department of Financial Regulation on or about the ___________ day of ____________, __________, an application to transact business in Vermont as an investment advisor and ___________________________________________________________________________________ Name and address of surety as Surety, a corporation organized under the laws of the State of ________________ and being duly authorized to transact the business of indemnity and suretyship in Vermont, do hereby acknowledge our indebtedness to the State of Vermont, for the use and benefit of the State of Vermont and any person(s) having a claim under the conditions of this obligation, in the sum of _____________________________________________________________Dollars ($______________), as required by Section 5411 of Title 9, V.S.A, Chapter 150 ("Vermont Securities Act" ), provided, however, that the aggregate liability hereunder shall not exceed the sum of _____________________________________Dollars, ($__________) regardless of the number of claimants, and shall not be construed as individual liability. The effective date of this Bond is ________________________, _____________. LIABILITY for the payment of this sum, to which we hereby obligate and bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, becomes effective upon the following conditions: 1. Registration of the Principal to transact business in Vermont as an investment advisor 2. Failure by the Principal and/or its agents to strictly comply with all applicable provisions of, and orders, rules and regulations issued pursuant to the Vermont Securities Act. 3. The Surety shall notify the Commissioner within five business days of receipt by the Surety of any claim under this bond or upon the making of any payment under this bond. This Bond may be canceled by the Surety upon 30 days written notice by registered mail to the Principal and to the Department of Financial Regulation in which case this Bond shall be considered canceled upon the expiration of said 30 day period except as to liability for acts or omissions which occur prior to the date of cancellation. Notice shall be deemed effective upon receipt by the Department of Financial Regulation of said written notice along with sufficient proof of notice to the Principal. DFR 2/2012 IA American LegalNet, Inc. www.FormsWorkFlow.com It is understood and agreed that any person(s) having a claim under the conditions of this obligation may initiate suit in any Vermont court or any other court of competent jurisdiction against the Principal and/or the Surety upon this Bond. WITNESS OUR SIGNATURES, this _____________day of ____________________, ____________. _________________________________________ PRINCIPAL (CORPORATE SEAL, IF APPLICABLE) _____________________________________________________________ By _____________________________________________________________ SURETY (CORPORATE SEAL, IF APPLICABLE) _____________________________________________________________ By Attorney in Fact ACKNOWLEDGEMENT OF INDIVIDUAL STATE OF ______________________________) ss. COUNTY OF ____________________________) On this __________ day of _______________, 20______, before me personally appeared ______________________________, to me known to be the person described in and who executed the foregoing instrument, as Principal, and acknowledged to me that she/he executed the same as his/her free act and deed. (NOTARIAL SEAL) __________________________________________________ Notary Public __________________________________________________ County, ___________________________________________ My commission expires _____________________________ DFR 2/2012 IA American LegalNet, Inc. www.FormsWorkFlow.com ACKNOWLEDGEMENT OF PARTNERSHIP STATE OF _________________________) COUNTY OF _______________________) On this ____________day of __________________, 20_______, before me personally appeared _______________________________, to me known to be a member of the firm who executed the foregoing instrument, and she/he duly acknowledged to me that she/he executed the same as and for the act and deed of said firm. (NOTARIAL SEAL) __________________________________________________ Notary Public, __________________________________________________ County, ___________________________________________ My commission expires ______________________________ ACKNOWLEDGEMENT OF CORPORATION STATE OF _________________________) COUNTY OF _______________________) On this __________ day of _________________, 20_______, before me personally came ___________________________________________________, and says that she/he is the ______________________________of _______________________________. Principal heretofore names; that she/he executed the instrument for and in its behalf, by authority of its Board of Directors, and affixed its seal thereto. (NOTARIAL SEAL) _______________________________________________________________ Notary Public, __________________________________________________ County, ___________________________________________ My commission expires ______________________________ NOTE: A true and correct copy of the applicable "Power of Attorney" must be attached hereto where the Bond is subscribed to by an "Attorney in Fact". DFR 2/2012 IA American LegalNet, Inc. www.FormsWorkFlow.com