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Affidavit Of Broker-Dealer Activity ABDA - North Dakota
| Affidavit Of Broker-Dealer Activity Form. This is a North Dakota form and can be used in Securities Blue Sky Secretary Of State . |
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AFFIDAVIT OF BROKER/DEALER ACTIVITY NORTH DAKOTA SECURITIES DEPARTMENT SFN 53495 (7-2011) Securities Department 600 E Boulevard Ave Dept 414 Bismarck ND 58505 (701) 328-2910 www.ndsecurities.com Name of Applicant: Applicant does hereby certify: 1. That the above-named Applicant has offered for sale or sold securities, solicited clients, transferred clients,or been involved in wrap-fee programs within this state. (Attach a list of names and addresses of North Dakota residents solicited in our state.) 2. That the above-named Applicant has not offered for sale or sold any securities, solicited clients, transferred clients, or been involved in wrap-fee programs within this state. 3. That the above-named Applicant has offered for sale and sold securities, solicited clients, transferred clients, or been involved in wrap-fee programs within this state pursuant to an exempt transaction. (Please specify which exemption was relied upon): I, on behalf of (Name of Applicant), acknowledge the foregoing to be truthful with full knowledge that misrepresentation of such facts to the Securities Department of the State of North Dakota may result in administrative action by the Department. Signature of Officer, Partner or Sole Proprietor: Subscribed and sworn to before me this day of , 20 . Notary Public County of (NOTARIAL SEAL) State of My commission expires on THE INFORMATION PROVIDED ON THIS AFFIDAVIT MAY BE VERIFIED WITH YOUR CLEARING FIRM. PLEASE PROVIDE THE FOLLOWING INFORMATION REGARDING YOUR CLEARING FIRM (IF YOU HAVE A CLEARING FIRM ARRANGEMENT): Name of Clearing Firm: Name of Contact Person with Firm: Address of Firm:
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