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Designated Salesman Training Certification DST - Georgia

Designated Salesman Training Certification Form. This is a Georgia form and can be used in Securities And Business Regulation Blue Sky Secretary Of State .
 Fillable pdf Last Modified 10/11/2007
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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 DESIGNATED SALESMAN TRAINING CERTIFICATION Director Secretary of State Georgia Securities Act of 1973, as amended O.C.G.A. 10-5-3(d) and Rule 590-4-2-.15 1. NAME & MAILING ADDRESS OF THE INDIVIDUAL APPLICANT 2. APPLICANTS CRD NUMBER 3. TELEPHONE NUMBER 4. NAME & MAILING ADDRESS OF THE DESIGNATED DEALER 5. DEALERS CRD NUMBER 6. NAME OF THE DEALERS COMPLIANCE OFFICER 7. TELEPHONE NUMBER 8. CHECK NUMBER OF $20.00 FILING FEE CHECK #: 9. EXECUTION AND ACKNOWLEDGEMENTS. We, the undersigned, for the purpose of complying with the Georgia Securities Act of 1973, as amended, certify that the applicant named herein is in compliance with said Act and has completed or has begand willun complete, prior to offering and selling designated securities within or from Georgia, a four month period of training with the d dealesigner namated ed above. The designated dealer and the applicant acknowledge that such training included, or will include, the definitions of accr inveeditedstor, designated security, blank check offering, designated dealer and established customer [See O.C.G.A. 10-5-2(a)]; the required conttradente cos ofn firmations See O.C.G.A. 10- See O.C.G.A. [See O.C.G.A. 10-5-3(p)]; suitability of customer accounts [See O.C.G.A. 10-5-12(m) (2)]; required risk disclosure document [ compensation limits [See O.C.G.A. 10-5-12(n)]; representations as to market price [See O.C.G.A. 10-5-12(o)]; the anti-fraud rovisipons of ee O.C.G.A. O.C.G.A. 10-5-12; the requirement for designated securities to be listed on an approved quotation system [See O.C.G.A. [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 undersined representgs that the information and statements contained herein are true and complete. 10. NAME AND TITLE OF AUTHORIZED OFFICIAL 11. SIGNATURE DATE: 12. NAME AND TITLE OF APPLICANT 13. SIGNATURE DATE: FOR OFFICE USE ONLY FILING DATE: CODE: DOCKET #: EXAMINER: FEE: $ COMPLETED: FORM DST Rev. 8/2002
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