Indemnity Bond Agent {4-5BA}

Page 1 of 2 (Rev. 2/9/90) STATE OF UTAH DEPARTMENT OF COMMERCE DIVISION OF SECURITIES FORM 4-5BA Indemnity Bond of Agent STATE OF UTAH ) ) ss. COUNTY OF ) KNOW ALL MEN BY THESE PRESENTS, THAT (Agent) of the County of State of as PRINCIPAL and State of ,a surety corporation duly qualified to do business in the State of Utah, as surety, is held and firmly bound unto the State of Utah and/or any person, firm or corporation intereste d, in the sum of TWENTY-FIVE THOUSAND DOLLARS lawful money of the United States of America for the payment whereof well and truly to be made, we do bind ourselves, our and each of our he irs, assigns, executors and administrators, jointly and severally, firmly by these pre sents. The condition of this obligation is such, that whereas, the Utah Division o f Securities of the State of Utah, under the provisions of the Utah Uniform Securities Act, has r egistered the said principal herein named as an AGENT in the State of Utah. NOW, THEREFORE, if the above bounden principal herein named as an AGENT shall well and truly comply with the provisions of the Utah Uniform Securities Act, then thi s obligation to be void, otherwise to remain in full force and effect. PROVIDED, HOWEVER, AND UPON THE FOLLOWING EXPRESS CONDITIONS: PROVIDED, ALWAYS, that nothing herein shall be construed to make the total maximum liability hereunder of the above named principal and/or surety more than TWENTY-FIVE THOUSAND DOLLARS regardless of the number of acts of omission or commission of the above named principal. PROVIDED, FURTHER, that before any person, firm or corporation shall have any right of action, or any right whatsoever, against the principal and/or surety upon this bond, and before any such right of action, or any such right whatsoever shall exist or arise, suc h person, firm or corporation, within the period of two years after the termination of this bond, must have given to the surety and the principal written notice of claim under this bond, and it is he reby stipulated and agreed that the giving of such notice of claim under this bond within said period o f two years shall be a condition precedent to any right of action or right whatsoever against t he principal and/or surety and the failure to give such notice as aforesaid shall render this obligation n ull and void and of no effect as to such person, firm or corporation. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2Page 2 of 2 Form 4-5BA PROVIDED, FURTHER, that the liability of the surety on this bond is limited to actual case s of fraud or dishonesty committed by the principal in an AGENT capacity. PROVIDED, FURTHER, that either the principal or the surety may cancel this bond as an enti rety by giving sixty (60) days written notice to the Utah Division of Securit ies at Salt Lake City, Utah, and if cancelled by the surety, copy of said notice of cancellation shall be sent by registered mail to the principal hereunder. Said notice to the Utah Division of Securities shall also b e sent by registered mail. In case of such cancellation by either the principal or the surety, no further obligation shall be incurred under this bond after the expiration of said sixty days, but the liability of the principal and surety shall apply as above set out as to any acts or omissions which may have occurred prior to the effective date of such cancellation. The period for which this bond shall remain in force and effect, unless previously cancelled as hereabove provided for, shall be for the effective period of the regi stration statement of , at the expiration of which time it shall ipso facto cease and terminate as to all future transactions only. IN WITNESS WHEREOF, the said parties hereunto have set their hands and affixed their respective seals this day of , 19 . (Signature of Principal) By (Title) (Surety) By (Capacity of person signing) (Seal) Attach Statutory Affidavit in this space. American LegalNet, Inc. www.USCourtForms.com