Application For Registration Renewal Or Amendment To An Application Of Investment Adviser {R3}

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 INVESTMENT ADVISER REGISTRATION REQUIREMENTS 1. 2. Filing of application on Form R-3. Corporate Resolution on Form R-5, if applicable, or Written Consent of members for Limited Liability Companies. Audited Financial Statements, which should include a Balance Sheet, Income Statement and Cash Flow Statement. If said financial statements are not within three (3) months of the date filed, then you must also submit a balance sheet in compliance with said date. Filing of Form R-4 for officers and Form U-4 for Investment Adviser Representatives. Any person within the Investment Adviser firm that is giving investment advice is required to be registered as an investment adviser representative. Examination requirements for Officers and Investment Advisors Representatives a) Series 65 or Series 66 6. The initial and renewal fees a) $500.00 for the Investment Adviser firm registration b) $150.00 for the individual registration 7. Certification of Incorporation, if applicable, or Certificate of Formation for Limited Liability Companies. Certification stating that the applicant has not rendered investment advice to residents of Puerto Rico. If any client has been solicited, please submit a list of the persons contacted and their addresses. A surety Bond in the amount of $10,000.00 must be filed on Form R-7. If the capital or net worth as determined under Article 18 of our Regulation No. 6078 is lesser than $25,000.00, the amount of the surety bond is $25,000.00. 3. 4. 5. 8. 9. For more information you may contact Mariel Martínez at 723-3131 ext. 2309 or (787) 7238403. American LegalNet, Inc. www.FormsWorkFlow.com Form R-3 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 INVESTMENT ADVISER Check the appropriate box: Application for Initial Registration Application for Renewal of Registration Amendment to an Application 1. 2. 3. Full Name of Applicant___________________________________________________________________ Social Security No. ______________________________________________________________________ Address and telephone number of principal place of business _____________________________________ ______________________________________________________________________________________ 4. Address of each branch office in Puerto Rico giving the date each branch office was established and the name of the person in charge of each branch office _____________________________________________________________________________________ ______________________________________________________________________________________ 5. Organization of Applicant: (a) Form _____________________________________________________________________________ (b) Date organized or incorporated __________________________________________________________ (c) Under laws of _______________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form R-3 Rev. 03/13 6. If Applicant is a corporation, state the name, CRD No. or S.S. # of each officer, director and persons with similar status or functions. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 7. If Applicant is a corporation, give the name of each person owning directly or indirectly 10% or more of any class of any equity securities of Applicant. As to each person indicate class of security, the number of shares and the percentage ownership of such person in relation to the number of shares outstanding. ______________________________________________________________________________________ ____________________________________________________________________________________ ______________________________________________________________________________________ 8. If Applicant is a partnership, give the name and title of each partner. ______________________________________________________________________________________ ______________________________________________________________________________________ 9. If Applicant is a sole proprietorship, give the name, date and place of birth of the proprietor. ______________________________________________________________________________________ ______________________________________________________________________________________ 10. If Applicant is other than a sole proprietor, partnership or corporation, give full name of each person or trustee who directs, manages or participates in directing or managing its affairs. ______________________________________________________________________________________ ______________________________________________________________________________________ 11. Name persons not included in items 6 to 10 who control, directly or indirectly, the business of applicant. If none, please indicate. ______________________________________________________________________________________ ______________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Form R-3 Rev. 03/13 12. Name any employees of applicant who perform investment advisory work. __________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 13. State whether applicant, any predecessor of applicant, any employees, or any person named in items 6 to 12: 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. No (c) Has ever been permanently or temporarily enjoined from engaging in, or continuing any conduct or practice involving any aspect of the securities business. Has ever been the subject of an order of the Commissioner denying, suspending or revoking registration as a broker-dealer, agent or investment adviser. Has ever been the subject of an order entered by the Securities Administra