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Designated Dealer Notification DD - Georgia
| Designated Dealer Notification Form. This is a Georgia form and can be used in Securities And Business Regulation Blue Sky Secretary Of State . |
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SECURITIES AND BUSINESS REGULATION 2 Martin Luther King, Jr. Drive, S.E. Ste 802, West Tower Atlanta, Georgia 30334 (404) 656-3920 http://www.sos.state.ga.us/securities/ CATHY COX H. WAYNE HOWELL Secretary of State Director DESIGNATED DEALER NOTIFICATION Georgia Securities Act of 1973, as amended O.C.G.A. 10-5-3(p) and R ule 590-4-2-.16 1. NAME & MAILING ADDRESS OF DEALER 2. DEALERS CRD NUMBER 3. GA DEALER NUMBER 4. NAME OF DEALERS COMPLIANCE OFFICER 5. TELEPHONE NUMBER 6. THE DEALER IS FILING DESIGNATED DEALER STATUS DUE TO (check one) : (a) INCOME LEVEL TEST - O.C.G.A. 10-5-2(a) (9) (A) [ ] (b) MARKET MAKER TEST - O.C.G.A. 10-5-2(a) (9) (B) [ ] 7. DATE FIRM BECAME A DESIGNATED DEALER: 8. DATE FIRM CEASED TO BE A DESIGNATED DEALER: 9. CHECK NUMBER OF $20.00 FILING FEE CHECK #: 10. EXECUTION AND ACKNOWLEDGEMENTS. The undersigned, for the purpose of complying with the Georgia Securities Act of 1973, as amended, certifies that the dealer named herein is in compliance with said Act and has determined tquihatred t it is ore notify the Commissioner of Securities of the State of Georgia, that it has become a designated dealer as that term is defined in O10-.C.G.5-2(a) (9).A. By submitting this notification in the form of a Georgia only amendment to Form BD, the designated dealer and the applicanlet ackdge thnoat itsw salesmen are in compliance with the training requirements of O.C.G.A. 10-5-3(d) and the Rules and Regulations promulgeunder and tated therhat such designated salesmen have received or have begun and will complete, prior to offering and selling designated securainingities reg, trarding the requirements relating to designated dealers, designated salesmen and designated securities including, but not limitedef toinitio, thne ds ofaccredited investor, designated security, blank check offering, designated dealer and established customer [See O.C.G.A. 10-5-2(a)]requi; tred cohe ntents of trade confirmations [See O.C.G.A. 10-5-3(p)]; suitability of customer accounts [See O.C.G.A. 10-5-12(m) (2)]; requiredis rclisok sdure document [See O.C.G.A. 10-5-12(m) (3)]; customer right of rescission [See O.C.G.A. 10-5-12(m) (4)]; requSiree Oed .C.G.A. See O.C.G.A. 10-5-12(o) account statement disclosure [See O.C.G.A. ee O. provisions of O.C.G.A. 10-5-12; the requirement for designated securities to be listed on an approved quotation system [See O. civil liability [See O.C.G.A. 10-5-14(h)]; and the criminal penalties for willful violations of the Act [See O.C.G.A. 10-5-24]. The undersigned represents that the information and statements contained herein are true and co mplete. 11. NAME AND TITLE OF AUTHORIZED OFFICIAL 12. SIGNATURE DATE: FOR OFFICE USE ONLY FILING DATE: CODE: DOCKET #: EXAMINER: FEE: $ COMPLETED: FORM DD Rev. 8/2002
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