New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 47A - BUREAU OF SECURITIES
Subchapter 10 - REGISTRATION OF SECURITIES
Appendix C
Current through Register Vol. 56, No. 18, September 16, 2024
STATEMENT OF
ELIGIBILITY FOR REGISTRATION
BY NOTIFICATION
(Pursuant to 49:3-61.2)
1. Name of issuer
.....................................................................
2. Original date of organization of the issuer .......... Number of years issuer has been in continuous operation .......... If issuer has been in continuous operation less than 5 years, give names of predecessors & state length of time each has been in operation:
.....................................................................
.....................................................................
.....................................................................
3. Has there been any default during the current fiscal year or within the 3 preceding fiscal years in the payment of principal, interest, or dividends on any security (of the issuer or any predecessor) with a fixed maturity or a fixed interest or dividend provision?
.....................................................................
.....................................................................
4. State the net earnings of the issuer and any predecessors during the past 3 full fiscal years, determined in accordance with generally accepted accounting practices, which are applicable to all securities without a fixed maturity or a fixed interest or dividend provision, which securities are outstanding at the date the registration statement is filed.
| Fiscal year ended | Net earnings |
| 1. ............................. | ............................. |
| 2. ............................. | ............................. |
| 3. ............................. | ............................. |
| Total | |
| ............................. | |
| Average net earnings (divide total | ......................................... |
| by 3) |
5. If the securities of the issuer or any of its predecessors (which do not have a fixed maturity or a fixed interest or dividend provision) have been outstanding for 3 full fiscal years, complete the chart below.
| Market price | Book value | ||||
| No. of | Maximum | per units as | per unit as | Total | |
| Description | units now | offering price | of......... | of........ | value |
| of Securities | outstanding | per unit (1) | date(1) | date (2) | (3) |
| $ | $ | $ | $ | ||
| A. | Total value | $ ....... | |||
| B. | 5% of total value | $ ....... | |||
| C. | Average net | $ ....... | |||
| earnings | |||||
| (restate from | |||||
| Item 4) |
In order to qualify for Registration by Notification, "C" must be greater than or equal to "B".
is neither a readily determinable market price nor a cash offering price.
6. If the securities of the issuer or any of its predecessors (which do not have a fixed maturity or a fixed interest or dividend provision) have not been outstanding for 3 full fiscal years, complete the chart below. (Include all securities which will be outstanding if all the securities being offered or proposed to be offered are issued, whether or not they are proposed to be registered or offered in New Jersey.)
| Maximum | Market price | Book value | |||
| No. of | offering | per units as | per unit as | Total | |
| Description | units to be | price per | of.......... | of........ | value |
| of Securities | outstanding | unit (1) | date (1) | date (2) | (3) |
| $ | $ | $ | $ | ||
| $ | |||||
| A. | Total value | $ ....... | |||
| B. | 5% of total value | $ ..... | |||
| C. | Average net | $ ....... | |||
| earnings | |||||
| (restate from | |||||
| Item 4) |
In order to qualify for Registration by Notification, "C" must be greater than or equal to "B". The registrant certifies that it has reasonable grounds to believe that it meets all of the requirements for filing pursuant to 49:3-61.2.
| Date: ............................... |
| ..................................... |
| Issuer |
| By: ................................. |
| (Title) |
