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Commodity Salesperson Statement CM-2 - New York
| Commodity Salesperson 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 CM-2 ** File no. ______ (1/87) STATE OF NEW YORK, Office of the Attorney General BUREAU OF INVESTOR PROTECTION AND SECURITIES COMMODITY SALESPERSON STATEMENT This form must always be accompanied by the Supplemental Commodity Broker-Dealer Statement (NY Form CM-3) unless this is an original filing. 1.___________________________________________________________ Attach 2 X 2 photo Last Name First Name Middle Name taken within the 2. ___________________________________________________________ preceding Residence City State Zip six months 3. ________________________________ 4. _____________________ Residence Telephone Social Security 5. ________________________________ 6. _____________________ Place of Birth Date of Birth 7. _________ 8.__________ 9. _______ 10. Ft.____In. Color of Hair Color of eyes Weight Height 11. Insert name and address of current employer (Commodity Broker-Dealer) Name _____________________________ Address___________________________ 12. Have you or any entity in which you were 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? ...................................................................... B. had a license or registration as a securities or commodity dealer, broker, investment advisor, salesperson, futures commission merchant, associated person, commodity pool operator or commodity trading advisor denied, suspended, revoked, cancelled or refused? ..................................................................... C. been enjoined or restrained by any court or government agency from: 1. the issuance, sale or offer for sale of securities or commodities? .............................. 2. rendering securities or commodities advice or counsel? ............................................. 3. handling or managing trading accounts? ......... 4. continuing any practices in connection with securities or commodities? ....................... D. Is any action or proceeding seeking the relief enumerated in A-C presently pending? ................... E. been convicted of any crime? .............................. F. used or been known by any other name? .............. Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] 2002 © American LegalNet, Inc. G. been the subject of any professional disciplinary proceeding? ........................................... H. been adjudged a bankrupt or made a general assignment for benefit of 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 bankrupt or made a general assignment for benefit of creditors? .................................................. I. had a judgment entered against them or it which is presently unsatisfied? (Not including judgments involving domestic relations.) ................. 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? ............................... K. if any answer to any of the above is "YES", attach statement of full particulars. Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] Yes [ ] No [ ] 13. Following is my complete employment record for the past five years: (Indicate periods of self-employment & unemployment). ________________________________________________________________________ From To Employer Position Held Mo. Yr. Mo. Yr. ________________________________________________________________________ Name Address ________________________________________________________________________ Present ________________________________________________________________________ _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2002 © American LegalNet, Inc. 14. Following is my complete education history: ______________________________________________________________________ Name of School From To Did you and location Graduate ______________________________________________________________________ Elementary School _____________________________________________________________________ High School _____________________________________________________________________ College University _____________________________________________________________________ or Technical School ______________________________________________________________________ Other Schools or ______________________________________________________________________ Special Courses ______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ A $25 fee must accompany this statement. Personal checks not accepted. Attorney's check, certified check, bank check, money order only, payable to the N.Y.S. Office of the Attorney General. Attach additional sheets where space provided is inadequate. You may submit a photocopy of this form. We will return it with your fee receipt for your records. Send remittance to: Bureau of Investor Protection and Securities, 23rd Floor, N.Y. Department of Law, 120 Broadway, New York, NY 10271. DATED: __________ Signature: _________________________________________ STATE OF COUNTY OF ) : SS.: ) ____________________________, being duly sworn, deposes and says that I am the applicant and I signed the above form. I have read the questions and answers and information supplied, and they are true, accurate and complete. ______________________________ (Signature of Affiant/Commodity Salesperson) Sworn to before me this day of , 20 (Notary signature and legible official stamp) (spe) **Found on the fee receipt you received for original filing. 2002 © American LegalNet, Inc.
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