Puerto Rico > Commissioner Of Financial Institutions > Blue Sky > Securities
Registration Statement For Registration Of Security By Qualification S3 - Puerto Rico
| Registration Statement For Registration Of Security By Qualification Form. This is a Puerto Rico form and can be used in Securities Blue Sky Commissioner Of Financial Institutions . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Form S-3 05/10 Commonwealth of Puerto Rico COMMISSIONER OF FINANCIAL INSTITUTIONS Securities Regulation Division Fernandez Juncos Station PO Box 11855 San Juan, PR 00910-3855 Tel. (787) 723-3131 Fax (787) 724-2604 REGISTRATION STATEMENT FOR REGISTRATION OF SECURITIES BY QUALIFICATION INSTRUCTIONS This form may be filed by the issuer, any other person on whose behalf the offering is to be made, or a registered broker-dealer. 1. (a) Name and address of applicant ________________________________________ ________________________________________________________________________ Name, address and telephone number of person with whom the Securities Regulation Division is requested to communicate regarding the filing ____________________ _______________________________________________________________________ 2. State whether applicant is the issuer, or a broker-dealer registered in Puerto Rico or other person on whose behalf the securities will be offered: ________________________________________________________________________ ________________________________________________________________________ 3. (a) Name and address of issuer:___________________________________________ (b) ________________________________________________________________________ (b) Name and address of any significant subsidiary:___________________________ ________________________________________________________________________ 4. Name and address of any person on whose behalf any part of the offering is to be made in a nonissuer distribution: _________________________________________________________ ________________________________________________________________________ 5. Description of the securities being registered: ________________________________________ ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form S-3 Page 2 6. 7. 8. 9. Total amount of securities to be offered: _______________________________________ Maximum offering price per security: _________________________________________ Number of securities to be offered in Puerto Rico: ________________________________ Maximum aggregate offering price of securities to be offered in Puerto Rico: _________________________________________________________________________ 10. Filing fee (1/5 of 1% of maximum aggregate offering price of securities to be offered in Puerto Rico but in any case not less than $1,000.00 or more than $2,500.00): ________________________________________________________________________ Other states in which a registration statement or similar document in connection with this offering has been or is to be filed: ________________________________________________________________________ Has any adverse order, judgement, or decree been entered in connection with this offering by the regulatory authorities in any state, or by any court, or the Securities and Exchange Commission? ______. If so, give complete details.__________________________________________ ________________________________________________________________________ ________________________________________________________________________ 11. 12. 13. If this offering is made by or on behalf of an issuer, state whether the issuer contemplates offering any additional equity securities within the period of this offering or within 13 months from the effective date of the registration statement. _____________________________ If so, give complete details concerning the proposed offering. ________________________________________________________________________ ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form S-3 Page 3 The registrant is to file herewith as a part hereof the following exhibits: (1) Three (3) copies of a prospectus containing the information required by Article 34 of the Regulation under the Uniform Securities Act of Puerto Rico accompanied by a separate cross-reference sheet setting forth the pages of such prospectus upon which the information required by each item of said Article is supplied. (2) A copy of any underwriting or selling group agreement pursuant to which the distribution is to be made, or the proposed form of any such agreement, the term of which have not yet been determined. (3) Copy of every management or other material contact made or to be made otherwise than in the ordinary course of business if it is to be performed in whole or in part at or after the filing of the registration statement, or was made within the past two (2) years. (4) A copy of any prospectus (other than the prospectus furnished pursuant to paragraph (1)), pamphlet, circular, form letter, advertisement or other sales literature intended as of the effective date to be used in connection with the offering. (5) A specimen or copy of the security being registered. (6) A copy of the issuer's articles of incorporation and by-laws, or their substantial equivalents, as currently in effect. (7) A copy of any indenture or other instrument covering the security to be registered. (8) A signed or conformed copy of an opinion of counsel as to the legality of the security being registered, which shall state whether the security when sold will be legally issued, fully paid, and non-assessable, and if a debt security, a binding obligation of the issuer. (9) The written consent of any accountant, engineer, appraiser, or other person whose profession gives authority to a statement made by him, if any such person is named as having prepared or certified a report or valuation (other than a public or official document or statement) which is used in connection with the registration statement. (10) Appointment and Consent to Service of Process as required by Section 414 (g) of the Puerto Rico Uniform Securities Act, on Form R-6. (11) Resolution of issuer's Board of Directors on Form R-5. (12) If the offering is to be made on behalf of the issuer of the securities being registered and the issuer has not been organized and in operation for at least two (2) years prior to the date of filing, the issuer shall file a Form R-4 report completed and signed by each of its promoters, director officers and/or partners. ________________________________ Registrant Attest: ____________________________________ (Name and Title) _______________________________ (Name and Title) American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
