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Broker Dealer Affidavit - New Mexico
| Broker Dealer Affidavit Form. This is a New Mexico form and can be used in Licensing Securities Statewide . |
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(Rev. 11/98) BROKER-DEALER AFFIDAVIT STATE OF NEW MEXICO I, the undersigned, ___________________________________________, being first duly sworn,upon oath state: I am an official of the broker-dealer firm of ______________________________ (hereinafterBroker-dealer) and, as such, authorized to make this affidavit on behalf of Broker-dealer. I am familiar with Section 58-13B-11D of the New Mexico Securities Act of 1986 (the Act), whichprohibits dual licensing of sales representatives, and Rule 12 NMAC 11.1.1.7.1, which defines branchoffices to include any place of business in the State of New Mexico of one or more licensed agents. Broker-dealer will comply with all provisions of the Act and the Rules thereunder, including theprovisions cited in the previous paragraph. I have executed this Affidavit in behalf of Broker-dealer after having read and understanding thecontents hereof. I hereby represent that all information contained herein is true, current and complete, to the bestof my knowledge and belief. Dated this _____ day of ________________________, _________. _____________________________________________ (Print Broker-dealer Name) By: _________________________________________ (Signature of Authorized Official) Title: ________________________________________ ACKNOWLEDGMENT STATE OF ____________________________ ) ) ss. COUNTY OF __________________________ ) On this _____ day of ____________________, _______, before me personally appeared_______________________, to me known to be the person described in and who executed the foregoinginstrument and acknowledged to me that he/she executed the same as his/her free act and deed. ______________________________________ (Notarial seal) Notary PublicMy Commission expires: _________________________
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