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REGISTERED SECURITIES AGENT
APPLICANT CERTIFICATION
I,
_______________________________________, CRD number ____________, hereby certify to the Administrator of the Oklahoma Department of Securities that 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 thereunder,
and I fully understand my responsibilities thereunder as a registered securities agent.
I so certify and make this filing with the Administrator in connection with my
application as a securities agent:
| Dated this _____day of
_____________. 20___. |
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______________________________________________
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(Signature)
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| STATE
OF.......................................................... |
) |
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) SS |
| COUNTY
OF...................................................... |
) |
| Subscribed and sworn before me this _____ day of
____________, 20 ____, |
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_______________________________________
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My Commission Expires:____________________ |
Notary Public
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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
registered securities agent has been provided adequate instruction with respect to
his/her responsibilities under the Oklahoma Uniform Securities Act
of 2004, and the rules and regulations
adopted and promulgated pursuant thereto.
| Dated this _____day of _____________. 20___.
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______________________________________________
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(Signature)
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______________________________________________
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(Title)
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| STATE
OF.......................................................... |
) |
|
) SS |
| COUNTY
OF...................................................... |
) |
| Subscribed and sworn before me this _____ day of
____________, 20 ____, |
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_______________________________________
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My Commission Expires:____________________ |
Notary Public
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