Application For Registration Renewal Or Amendment To An Application Of An Agent {R2}

Rev. 03/13 COMMONWEALTH OF PUERTO RICO COMMISSIONER OF FINANCIAL INSTITUTIONS Centro Europa Building, Suite 600 1492 Ponce de León Ave. San Juan, PR 00907-4127 Tel. (787) 723-8403 Fax (787) 724-2604 AGENTS The requirements for registration as agent are the following: NEW REGISTRATION a) an application for registration on Form U-4 or our Form R-2 b) a bond in the amount of $2,000 on Form R-7 c) the appointment and application for registration as agent on Form R-8 d) notice of engagement or termination of services of an agent on Form R-9 e) an initial fee of $150.00 with check payable to the Secretary of the Treasury, and; f) evidence of FINRA examination (in absence of this evidence it is necessary to comply with the examination requirement of Article 7 of our Regulations). RENEWALS Since registration is effective for a one (1) year period, they must be renewed each year so as to keep them current. A renewal of a registration is accomplished by filing; a) Form U-4 or our Form R-2 at least fifteen (15) days prior to the expiration date of the registration. Only the first four (4) items and the execution need to be filled out. Exhibits and the other information called for by Form R-2 may be incorporated by reference if kept current. The renewal fee of $150.00 with check payable to the Secretary of the Treasury. b) Enclosed are copies of each of the above mentioned forms. The U-4 Form is also acceptable for filing in Puerto Rico. If you have any questions related with the above, please contact Mariel Martínez at (787) 7233131 ext. 2309 or (787) 723-8403. American LegalNet, Inc. www.FormsWorkFlow.com FORM R-2 Rev. 03-13 COMMONWEALTH OF PUERTO RICO COMMISSIONER OF FINANCIAL INSTITUTIONS Centro Europa Building, Suite 600 1492 Ponce de León Ave. San Juan, PR 00907-4127 Tel. (787) 723-8403 Fax (787) 724-2604 APPLICATION FOR REGISTRATION, RENEWAL OR AMENDMENT TO AN APPLICATION OF AN AGENT _____________________________________________________________________________________________ Check the appropriate box: Application for Initial Registration Application for renewal of registration Amendment to an application _____________________________________________________________________________________________ 1. Name of Applicant_______________________________________________________________________ Social Sec. No.________________________________________________________________________ CRD No. _____________________________________________________________________________ 2. Home Address of Applicant _______________________________________________________________ ______________________________________________________________________________________ 3. Name and Address of issuer whom Applicant will represent . ______________________________________________________________________________________ _____________________________________________________________________________________ 4. Address and telephone number of Applicant's regular place of business in Puerto Rico ____________ _____________________________________________________________________________________ ______________________________________________________________________________________ 5. 6. 7. Date and place of birth Citizenship _______________________________ How long has Applicant lived in Puerto Rico__________________________________________________ Summarize Applicant's educational background, including schools attended, dates of attendance and degrees received. _____________________________________________________________________________________ 8. Summarize Applicant's occupation for the last 10 years, including names and addresses of employers, dates of employment and a general description of the duties of each employment. ___________________________________________________________________________________ ___________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com R-2 Page 2 9. Has Applicant engaged in the securities business on a full time basis for the 5 years immediately preceding the date of filing of this application? ______________________________________________________________________________________ 10. Describe Applicant's proposed method of doing business, including (1) whether Applicant will specialize in any type of business or securities, (2) whether Applicant will devote his full time to the securities business, and if not, the approximate percentage of Applicant's time which will be devoted to the securities business, (3) whether Applicant will solicit employment as an issuer's agent from issuers of securities. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 11. State whether Applicant: Yes (a) Has ever been convicted of any misdemeanor involving a security or any aspect of the securities business? (b) Has ever been convicted of any felony? (c) Has ever been permanently or temporarily enjoined from engaging in, or continuing any conduct practice involving any aspect of the securities business? d) Has ever been the subject of an order of the Administrator denying, suspending or revoking registration as a broker-dealer, agent or investment adviser? (e) Has ever been the subject of an order entered by the Securities Administrator of any other state or by the Securities and Exchange Commission denying or revoking registration as a broker-dealer, agent or investment adviser? Has ever been the subject of an order of the Securities and Exchange Commission suspending or expelling him from a national securities exchange or national securities association registered under the Securities Exchange Act of 1934? (g) Has ever been adjudicated as bankrupt or insolvent? (h) (I) (j) Has ever been censured or fined, suspended or expelled by the National Association of Securities Dealers, Inc. or by any stock exchange? Has ever been the subject of a United States Post Office Fraud Order? Has ever been sued civilly for fraud, deceit or misrepresentation? (f) No If the answer to any of the foregoing questions is in the affirmative furnish the complete details including the date and a statement concerning the current status of the case. If during the period of your registration an event occurs which cause a current affirmative answer to any part of item