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Form Obd-02 - Registered Securities Principal For A Non-Finra Firm Applicant Certification

REGISTERED SECURITIES PRINCIPAL

for a Non-FINRA firm

APPLICANT CERTIFICATION

I, ______________________________, CRD number _____________, in connection with my application

to register as a principal of

_______________________________________________________________, hereby certify to the

Administrator of the Oklahoma Department of Securities that:

1. I have carefully reviewed the Oklahoma Uniform Securities Act of 2004, 71 O.S., §§ 1-101 through

1-701, as well as the rules and regulations adopted thereto, and I fully understand my

responsibilities there under as a registered principal, including but not limited to, my responsibility

for the supervision of all agents of said broker-dealer who are registered in the State of Oklahoma;

and

2. All information concerning myself as filed on the Form U-4 with the Central Registration Depository

(CRD) or as filed on the Form U-4 directly with the Administrator of the Oklahoma Department of

Securities is true and correct and a correcting amendment shall be promptly filed when such

information becomes inaccurate or incomplete in any material respect.

Dated this _____day of _____________. 20___.

______________________________________________

(Signature)

STATE OF..........................................................)

) SS

COUNTY OF......................................................)

Subscribed and sworn before me this _____ day of ____________, 20 ____.

_______________________________________

My Commission Expires:____________________

Notary Public

MANAGEMENT CERTIFICATION

I, _______________________________________, an officer, director, partner or sole proprietor of

_____________________________________________________________________, hereby certify to

the Administrator of the Oklahoma Department of Securities that the above applicant for registration as a

principal has been provided adequate instruction with respect to his/her responsibilities under the

Oklahoma Uniform Securities Act of 2004, and the rules and regulations.

Dated this _____day of _____________. 20___.

_____________________________________________

(Signature)

_____________________________________________

(Title)

STATE OF..........................................................)

) SS

COUNTY OF......................................................)

Subscribed and sworn before me this _____ day of ____________, 20 ____.

_______________________________________

My Commission Expires:____________________

Notary Public

OBD-02 6/2009

Form Obd-02 - Registered Securities Principal For A Non-Finra Firm Applicant Certification

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