Form 7-M Irrevocable Appointment Of Agent For Service Of Process (Individual) (SEC876) {7-M}

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20459 FORM 7-M OMB APPROVAL Not subject to OMB Clearance (44 U.S.C 3501, et. seq.) IRREVOCABLE APPOINTMENT OF AGENT FOR SERVICE OF PROCESS, PLEADINGS AND OTHER PAPERS BY INDIVIDUAL NON-RESIDENT BROKER OR DEALER THIS FORM SHALL BE FILED IN DUPLICATE ORIGINAL 1. I, ______________________________________________________________________________________________________, (Name) of ____________________________________________________________________________________________________________, (Residence address in full) doing business as _________________________________________________________________________________________________, (Name under which business is conducted) at _____________________________________________________________________________________________________________, (Business address in full) hereby designate and appoint, without power of revocation, the United States Securities and Exchange Commission as my agent upon whom may be served all process, pleadings, and other papers in any civil suit or action brought against me in any appropriate court in any place subject to the jurisdiction of the United States, with respect to any cause of action which (a) accrues during the period beginning when my registration as a broker or dealer becomes effective pursuant to Section 15 of the Securities Exchange Act of 1934 and the rules and regulations thereunder and ending either when registration is cancelled or revoked, or when the Commission receives a notice to withdraw from such registration, whichever is earlier, (b) arises out of any activity, in any place subject to the jurisdiction of the United States, occurring in connection with the conduct of my business as a broker or dealer, and (c) is founded, directly or indirectly, upon provisions of the Securities Act of 1933, the Securities Exchange Act of 1934, the Trust Indenture Act of 1939, the Investment Company Act of 1940, the Investment Advisers Act of 1940, or any rule or regulation under any of said Acts; and 2. I hereby consent, stipulate and agree, without power of revocation, (a) that any such civil suit or action may be commenced against me by the service of process upon the Commission and the forwarding by the Commission of a copy thereof by registered mail to me at the last address of record filed by me with the Commission, (b) that all service of process, pleadings, or other papers upon the Commission and the forwarding by the Commission of a copy thereof by registered mail to me at the last address of record filed by me with the Commission shall be taken and held in all courts to be as valid and binding as if due personal service had been made upon me, and (c) that service upon the Commission may be effected by delivering copies of said process, pleadings or other papers to the Secretary of the Commission or to any other person designated by it for such purpose, and that the certificate of the Secretary of the Commission or of such other person reciting that said process, pleadings or other papers were received by the Commission and that a copy thereof was forwarded to me at the last address of record filed by me with the Commission shall constitute evidence of such service upon me. IN WITNESS WHEREOF, I have executed this irrevocable power of attorney, consent, stipulation and agreement at _________________________________________________________________________________ this_____________ day of ___________________A.D., ______________. (Seal) _____________________________________ SEC 876 (6-12) American LegalNet, Inc. www.FormsWorkFlow.com NOTE: The person executing this irrevocable power of attorney, consent, stipulation and agreement should appear before a person authorized to administer acknowledgments in the jurisdiction in which it is executed and acknowledge that he executed it as his free and voluntary act. The acknowledgment should be in the form prescribed by law of the jurisdiction in which it is executed. The form of acknowledgment suggested below should be used only if it is consistent with the requirements of the law of such jurisdiction. The failure of any acknowledgment to meet applicable requirements shall not affect the validity or effect of the foregoing irrevocable power of attorney, consent, stipulation and agreement. Province (or State) of ___________________________ County of ____________________________________ }ss I, ______________________________________________________________________________________________________, (Name) __________________________________________________________________________________________, in and for (said County in) (Official position of person administering acknowledgement) the Province (or State) aforesaid, do hereby certify that _________________________________________________________________ personally appeared before me this day and signed and sealed the above instrument as his free and voluntary at for the uses and purposes therein set forth. Given under my hand and seal this _______________________ day of ___________________________________A.D., __________. _________________________________________ (Signature of Official) _________________________________________ (Official Position) (Seal) My Commission (or office) expires: ______________________________ (Date) SEC 876 (6-12) American LegalNet, Inc. www.FormsWorkFlow.com