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Application To Register Business Opportunity Investment With Connecticut Banking Commissioner CT BOIA-1 - Connecticut
| Application To Register Business Opportunity Investment With Connecticut Banking Commissioner Form. This is a Connecticut form and can be used in Securities Blue Sky Secretary Of State . |
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FORM CT BOIA - 1 APPLICATION TO REGISTER BUSINESS OPPORTUNITY INVESTMENT WITH THE CONNECTICUT BANKING COMMISSIONER PURSUANT TO CHAPTER 672c OF THE CONNECTICUT GENERAL STATUTES (THE "ACT")Application to be submitted to the Department of Banking, Securities and Business InvestmentsDivision, 260 Constitution Plaza, Hartford, Connecticut 06103-1800.1. (a) The official name and address and principal place of business of seller: (b) Official name and address and principal place of business of the parent firm or holding company of the seller, if any: (c) Address of principal office in this state and any other locations in Connecticut: (d) Name, address and telephone number of correspondent to whom notices and communication regarding this application may be sent: If the information requested in items 2, 3 and 4 of this application are contained within the disclosure document, kindly indicate the page and section in the space provided.2. The business experience stated individually of each of the sellers, directors and officers, including the biographical data concerning these persons (attach schedule):3. The business experience of the seller, including the length of time the seller has conducted a business of the type to be operated by the purchaser-investor, has granted business opportunities for such business, and has granted business opportunities in other lines of business (attach schedule): <<<<<<<<<********>>>>>>>>>>>>> 24. Factual description of the business opportunities to be offered and sold, and the services, training and assistance which will be provided by the seller to the purchaser-investor (attach additional sheet if necessary): 5. Describe any services, supplies, products, signs, fixtures or equipment relating to the establishment or the operation of the business opportunity which the purchaser-investor is required to purchase, lease or rent directly or indirectly from the seller (attach additional sheet if necessary):6. (a) List of other states in which business opportunities will be offered for sale to public: (b) List of the states in which business opportunities are eligible for sale to the public: (c) List of states, if any, which have refused, by order or otherwise, to authorize the sale of business opportunities to the public, or have revoked, or suspended the right to sell business opportunities, or in which an application has been withdrawn:7. (a) The seller shall file with the commissioner a financial statement of the seller audited by an independent public accountant or an independent certified public accountant, as of the close of the most recent fiscal year of the seller. (Note: If any material changes in the financial condition of the seller occur after the statement is prepared, the seller must disclose the changes and explain their significance to the operation of a business opportunity.) (b) Fiscal Year Month/Day -2-<<<<<<<<<********>>>>>>>>>>>>> 38. (a) Is the seller required to obtain a surety bond or establish a tru st account pursuant to Section 36b-64 of the Act (answer "yes" or "no")? (b) If question (8)(a) is answered in the affirmative, submit evidence that an appropri ate surety bond has been obtained or that a trust account has been established as required by Section 36b-64 of the Act. 9. (a) Check # and name of maker of the $400 fee submitted with this application as required by Section 36b-62(a)(5) of the Act, or; (b) Check # and name of maker of the $100 renewal fee submitted with this application as required by Section 36b-79(1) of the Act. (c) Check # and name of maker of the $50 post-sale registration fee submitted with this application as required by Section 36b-62(e ) of the Act.10. Submit a copy of any contracts, agreements, brochures or other documents relating to the business opportunity. 11. Submit a copy of the disclosure statement as required by Section 36b-63 of the Act.12. Submit a copy of the Consent to Service of Process as required by Sectio n 36b-62 of the Act.13. The applicant hereby applies for registration or acceptance for filing o f the above-named business opportunities under the Act and in consideration thereof agrees so long as the registration remains in effect that it will: (a) Advise the Commissioner of any change in any of the information containe d herein or in any of the documents submitted with or as a part of the application, and amend the disclosure statement to show such changes. (b) Notify the Commissioner immediately upon the receipt of any stop order, denial, order to show cause, suspension or revocation order, injunction or restraining order, or similar order entered or issued by any state or other regulatory authority or by any court con cerning the business opportunities of the seller currently being offered to the public. (c) Furnish promptly all additional information and documents in respect to the business opportunities covered by the application as may be requested by the Comm issioner or his duly authorized representative. -3-<<<<<<<<<********>>>>>>>>>>>>> 414. Disclose to the State of Connecticut Securities and Business Investments Division whether any sale of business opportunities have been made within or from Connecticut prior to the date of this application. Yes No If sales have been made, provide the names, addresses and telephone numbers of purchaser- investors the dates of purchase, amounts invested and the names of those persons who effected the sales on behalf of the seller. (Attach additional sheet if necessary.) 15. Disclose to this Division whether any offers of this business opportunity have been made within or from Connecticut, or whether any monies have been accepted of if the seller entered into any agreements with any Connecticut purchaser-investors. ________Yes ________No If yes, provide copies of any and all signed agreements as well as the names, addresses and telephone numbers for all Connecticut purchaser-investors offered this business opportunity, and the name of the individual(s) who offered this business opportunity on behalf of the seller.Date: Name of the Applicant By (Name and Title) -4- <<<<<<<<<********>>>>>>>>>>>>> 5State of County of The Undersigned, , being first duly sworn, deposes and says: That he has executed the foregoing application for and on behalf of the applicant named therein; that he is of the applicant and is fully authorized to execute and file this application; that he is familiar with this application; and that to the best of his knowl
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