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Securities Regulation Checklist - Colorado
| Securities Regulation Checklist Form. This is a Colorado form and can be used in Securities Blue Sky Secretary Of State . |
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SECURITIES REGISTRATION CHECKLIST Name of Offering:________________________________________________________________ Date of Filing _________ _____ 1. Filing fee: Examiner:________________________________________________ Amount $__________ _____ 2. Amount of securities offered:______________________________________________ _____ 3. Any adverse order, judgment or decree (copy thereof): _____ 4. Issuer information: _____ a. name _____ b. address _____ c. form of organization, state and date _____ d. general character and location of business _____ e. description of physical properties and equipment _____ f. statement of general competitive conditions in the business _____ 5. For each director and officer of the issuer: _____ a. name _____ b. address _____ c. principal occupation for the past five years _____ d. amount of securities held by each, of a date within 30 days of the filing _____ e. any material interest in any material transaction with the issuer or any significant subsidiary effected within the past three years or proposed to be effected _____ f. remuneration paid during the past 12 months and estimated to be paid during the next 12 months, directly or indirectly _____ 6. Listing of persons owning of record, or beneficially, if known, 10% or more of outstanding shares of any class of equity security of issuer: _____ a. name _____ b. address _____ c. amount of securities held, from date within 30 days of filing _____ 7. Listing of promoters (if issuer organized within past 3 years): _____ a. name _____ b. address _____ c. principal occupation for the past five years _____ d. amount of securities held by each, of a date within 30 days of the filing _____ e. any material interest in any material transaction with the issuer or any significant subsidiary effected within the past three years or proposed to be effected _____ f. remuneration paid during the past 12 months and estimated to be paid during the next 12 months, directly or indirectly _____ 8. Persons on whose behalf any part of offering is to be made in a non-issuer distribution: _____ a. name _____ b. address _____ c. amount of securities held as of the date of filing _____ d. description of any material interest in any material transaction with issuer or subsidiary effected within the past three years or proposed to be effected. _____ e. statement of reasons for non-issuer offering ____ 9. Capitalization _____ a. current _____ b. pro-forma basis _____ c. description of securities outstanding or issued within past two years _____ d. amount and type of consideration received or that will be received for such issue 10. Description of securities to be offered. 1 American LegalNet, Inc. www.FormsWorkflow.com ____ ____ ____ ____ ____ 11. Offering price or method by which it will be computed. 12. Estimated underwriting and selling discounts or commissions, finders fees: _____ a. if variable, how determined, maximum and minimum amounts 13. Other estimated selling expenses: legal, engineering, accounting, etc. 14. Underwriters (for each): _____ a. name _____ b. address 15. Listing of any other recipient of a finder's fee. 16. Copy of any underwriting or selling group agreement or description of proposed form of agreement. 17. Description of the plan of distribution of securities which are to be offered through someone other than an underwriter. 18. Estimated cash proceeds to be received by issuer from the offering: _____ a. purposes for which the proceeds are to be used _____ b. amount to be used per each purpose _____ c. order of priority in use of proceeds _____ d. amounts of any funds to be raised _____ e. amounts to purchase property, goodwill _____1. name(s) and address(es) of vendors _____2. amount paid or to be paid _____ f. names of persons who have received commissions in connection with the acquisition _____1. amount of commissions _____ g. any other expenses in connection with acquisition 19. Stock options or other options outstanding: _____ a. amount _____ b. name(s) and address(es) of all such persons 20. Management and other material contracts within past two years: _____ a. copy of contracts 21. Description of any pending litigation or proceedings: _____ a. copy of any pending litigation or proceedings 22. Copy of prospectus, pamphlets, form letters, circulars, advertisements or other sales literature. 23. Specimen or copy of the security being registered. 24. Copy of issuer's articles of incorporation and bylaws or equivalent. 25. Copy of an indenture or other instrument covering the security to be registered. 26. Written opinion of counsel as to the legality of the security being registered: _____ a. state whether the security when sold will be legally issued, fully paid and non-assessable _____ b. if a debt security, whether the security is a binding obligation of the issuer 27. Written consent of any accountant, engineer, appraiser or other person whose profession gives authority to a statement made by him (if such person is named as having prepared or certified a report or valuation used in connection with the registration statement). 28. Issuer's balance sheet as of a date within four months prior to filing date. 29. Issuer's profit and loss statement and analysis of surplus for each of the three fiscal years preceding the date of balance sheet. 2 American LegalNet, Inc. www.FormsWorkflow.com ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ 30. Same financial statement as in No. 28 and 29 above of any business, if part of offering proceeds is to be applied to the purchase of such business. 31. Escrow requirement: ________ yes ________ no 32. Copy of escrow agreement, if applicable. 33. Minimum amount prior to release of escrow, if applicable: ___________ Percentage of min. to max. ________% 34. Other requirements: ____________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ __________________________________
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