District Of Columbia > Secretary Of State > Blue Sky > General
Representative(s) Affidavit RA - District Of Columbia
| Representative(s) Affidavit Form. This is a District Of Columbia form and can be used in General Blue Sky Secretary Of State . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Government of the District of Columbia Department of Insurance, Securities and Banking Lawrence H. Mirel Commissioner DISTRICT OF COLUMBIA REPRESENTATIVE(S) AFFIDAVIT Please be advised that I, (Principal/Officers name) of the Investment Adviser (Adviser/Firms name) on behalf of its applicant(s) (Representative (s) name) certify that: The applicant has not transacted any business in the District of Columbia, and will not provide investment advice until registered with the Securities Bureau of the District of Columbia. If the applicant has effected transactions on behalf of District of Columbia residents or within the District of Columbia while not effectively licensed under the Act, please provide the followin g information: (a) name, address and telephone number of each client; (b) date of each agreement with clients involved; (c) a description of services provided to each client along with the total a mount of assets managed or involved and the total amount of all fees received. Signature State of County of Subscribed and sworn before me this day of , 200 . Notary Public My Commission Expires 810 First Street, NE, Suite 622Washington, DC20002Tel: (202) 442-4934Fax: (202) 442-8661 maurice.goff@dc.gov American LegalNet, Inc. www.USCourtForms.com
|
|||||||
