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Application For Registration Of Securities By Notification S1 - Puerto Rico

Application For Registration Of Securities By Notification Form. This is a Puerto Rico form and can be used in Securities Blue Sky Commissioner Of Financial Institutions .
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Form S-1 Rev. 03/13 COMMONWEALTH OF PUERTO RICO COMMISSIONER OF FINANCIAL INSTITUTIONS Securities Regulation Division Centro Europa Building, Suite 600 1492 Ponce de León Avenue San Juan, PR 00907-4127 Tel. (787) 723-3131 Fax (787) 724-2604 APPLICATION FOR REGISTRATION OF SECURITIES BY NOTIFICATION The undersigned applicant hereby applies for registration by notification of the securities described herein under the applicable provisions of the Puerto Rico Uniform Securities Act. 1. Name of applicant ___________________________________________________________ Address of applicant _________________________________________________________ __________________________________________________________________________ 2. Name, address and telephone number of person with whom the Securities Regulation Division is requested to communicate regarding this filing___________________________ _________________________________________________________________________ _________________________________________________________________________ State the name and address of any person on whose behalf any part of the offering is to be made (Issuer, registered broker-dealer or non-issuer).______________________________ _________________________________________________________________________ _________________________________________________________________________ Name of the Issuer __________________________________________________________ Location of issuer's principal business office _____________________________________ __________________________________________________________________________ Principal branch office in Puerto Rico ___________________________________________ __________________________________________________________________________ 3. 4. 5. 6. American LegalNet, Inc. www.FormsWorkFlow.com Form S-1 Page 2 7. State the form and date of organization of the issuer: _______________________________ __________________________________________________________________________ Incorporation under laws of what state? __________________________________________ __________________________________________________________________________ Class and amount of securities to be offered: ______________________________________ __________________________________________________________________________ Maximum offering price per unit and number of securities to be offered in Puerto Rico. __________________________________________________________________________ Maximum aggregate offering price of securities to be offered in Puerto Rico. __________________________________________________________________________ Amount and rate of commission to be paid per unit: ________________________________ __________________________________________________________________________ The issuer has been in continuous operation for ______years. (If business was previously operated, explain below).______________________________________________________ __________________________________________________________________________ 14. Has any adverse order, judgment or decree been entered in connection with the offering by the regulatory authorities in any state or by any court or by the Securities and Exchange Commission? __________________________. If so, give complete details on attached sheet. 8. 9. 10. 11. 12. 13. 15. Filing Fee $______________________1/5 of 1% of the maximum aggregate offering price at which the registered securities are to be offered in Puerto Rico. The minimum filing fee is $350.00 and the maximum is $1,500.00. 16. If the offering is on behalf of the issuer state the use of the proceeds. If any part will be outside Puerto Rico, give details. _______________________________________________ __________________________________________________________________________ __________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form S-1 Page 3 17. If this offering is made by or on behalf of an issuer, state whether the issuer contemplates offering any additional equity securities within the period of this offering or within 13 months from the effective date of the registration statement. _________________________. _____________. If so, give complete details concerning the proposed offering including the number and class of shares and the price per share to be received by the issuer. ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com EXHIBITS The following exhibits, numbered and captioned as indicated, and containing the information required by the appropriate subsections of Section 302 of the Puerto Rico Uniform Securities Act, are filed with this application and made a part hereof: Exhibit 1. A statement of earnings, demonstrating eligibility for registration by notification, as set forth in Section 302 (a). Exhibit 2. Description of the business of the issuer and any significant subsidiary as defined in Article 34 of the Regulation under the Uniform Securities Act of Puerto Rico giving the location of business of any significant subsidiary as well as the address and form, date and state or jurisdiction of organization. Exhibit 3. As to any person on whose behalf any part of the offering is to be made, state his name and address, the amount of securities of issuer held as of the date of filing this application, the number of shares or units offered on his behalf and a statement of his reasons for making the offering. Exhibit 4. Financial statement of issuer and any significant subsidiary as of a date within four (4) months prior to the date of this application. Issuer's (and any significant subsidiary's) balance sheet and income statements for the two (2) fiscal years ended next preceding the date of filing this application, together with an opinion of an independent Certified Public Accountant covering such financial statements. Exhibit 5. Exhibit 6. Furnish a description of the security being registered. American LegalNet, Inc. www.FormsWorkFlow.com Form S-1 Page 4 Exhibit 7. Copy of any prospectus, pamphlet, circular, form letter, advertisement, or other sales literature intended to be used in connection with the proposed offering. If a prospectus is used, it is recommended that it be prepared in accordance with Article 34 of the Regulation under the Uniform Securities Act of Puerto Rico. Exhibit 8. Opinion as to validity and legality of the security. To be furnished by competent
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