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