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Bureau Of Investor Protection And Securities Commodity Broker-Dealer Statement CBD - New York
| Bureau Of Investor Protection And Securities Commodity Broker-Dealer Statement Form. This is a New York form and can be used in Investor Protection And Securities Blue Sky Secretary Of State . |
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NY Form CBD (1/87) ** File No. _________ (for renewals only) STATE OF NEW YORK Office of the Attorney General BUREAU OF INVESTOR PROTECTION AND SECURITIES COMMODITY BROKER-DEALER STATEMENT (Section 359-e(14) Gen. Bus. Law) Firm Principal Name_______________________ Office__________________________________ Telephone No.______________ Street Address City State Zip The registrant [ ] does [ ] does not maintain other offices or facilities. If it does, state where. _________________________________________________ ____________________________________________________________________ 1. Is registrant now licensed, or otherwise qualified to transact securities or commoditie sbusiness in any other state? .............................. Yes [ ] No [ ] If "YES" attach list of states. 2. Has registrant, any officer, director, principal, partner, manager, supervisor, 10% or more equity holder or any entity in which such individual was a principal ever: A. been suspended or expelled from membership in any securities or commodities exchange, association of securities or commodities dealers or investment or commodities trading advisors or counsel? ...................... Yes [ ] No [ ] B. had a license or registration as a securities or commodity dealer, broker, investment advisor, salesperson, futures commission merchant, associated person, commodity pooloperator or commodity trading advisor denied, suspended, revoked, cancelled or refused? .......... Yes [ ] No [ ] C. been enjoined or restrained by any court or government agency from: 1. the issuance, sale or offer for sale of securities or commodities? .....Yes [ ] No [ ] 2. rendering securities or commodities advice or counsel? .. Yes [ ] No [ ] 3. handling or managing trading accounts?.............................Yes [ ] No [ ] 4. continuing any practices in connection with securities or commodities?. Yes [ ] No [ ] ** Found on the fee receipt you received for your original filing. ____________________________________________________________________________ Found Fee Enclosed as Follows: Commodity Broker-Dealer Statement........$100.00 Personal checks not accepted. Attorney's check, bank check, check, money order and only, payable to the N.Y.S Office of the Attorney General. Please indicate to whom you wish the fee receipt sent. ( ) Attorney ( ) Firm Send remittance to: Bureau of Investor Protection Securities, 23rd Floor N.Y.S. Office of the Attorney General 120 Broadway 2002 © American LegalNet, Inc. New York, NY 10271 D. Is any action or proceeding seeking the relief enumerated in A-C presently pending?...... Yes [ ] No [ ] E. been convicted of any crime?................... Yes [ ] No [ ] F. used or been known by any other name?.......... Yes [ ] No [ ] G. been the subject of any professional disciplinary proceeding?....................... Yes [ ] No [ ] H. been adjudged a bankrupt or made a general assignment for benefit or creditors; been the subject of a receivership or bankruptcy proceeding; been an officer, director, principal, partner, manager, supervisor or any 10% or more equity holder of any entity which was reorganized in bankruptcy, adjudged a bankruptcy or made a generalassignment for benefit of creditors?......................... Yes [ ] No [ ] I. had a judgment entered against them or it which is presently unsatisfied? (Not including judgment involving domestic relations.)....... Yes [ ] No [ ] J. been a party in any litigation or administrative proceeding in which it is alleged that they or it committed fraud or otherwise violated any provision of the Martin Act or any other securities or commodities laws?................ Yes [ ] No [ ] K. if any answer to any of the above "YES", attach statement of full particulars. 3. Does registrant furnish investment advice for compensation?................................... Yes [ ] No [ ] 4. Has registrant sold securities or commodities to the public within the last three years?.......... Yes [ ] No [ ] 5. Registrant has been a commodity broker-dealer since _________. 6. If actual control of registrant has changed during past 5 years give in detail the sources of all registrant's capital: Amount Source _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 7. Give the location of each business in which registrant has engaged during the preceding five years. From To Mo./Yr Mo./Yr. Business Location and Nature ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 8. What type of commodities do you sell? (for instance, numismatic coins, precious metals, bullion, precious metals leverage contracts, etc. _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ 2002 © American LegalNet, Inc. 9. List below all managers and supervisors in the employ of registrant. For each person listed attach a copy of Form CI-1. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 10. List below the name and position of each officer, director, principal, partner, or any 10% or more equity holder. For each person listed attach a copy of form CI-1. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 11. List name, residence and nature of employment of all commodity salespersons employed to sell in N.Y. State. These people must file or have on file a N.Y. Form CM-2 (Commodity Salesperson Statement). Name Address Nature of Employment ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _____________________
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