N.J. Admin. Code § Tit. 13, ch. 47A, subch. 10, app C

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Current through Register Vol. 56, No. 21, November 4, 2024

Appendix C

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".

(1) The maximum offering price or the market price on a day selected by the applicant, but must be within 30 days before the date of filing this registration statement.

(2) Book value must be of a day, selected by the applicant, within 90 days of filing this registration statement. Book value may be used only if there

is neither a readily determinable market price nor a cash offering price.

(3) The total value is the product of either (1) the number of units multiplied by the higher of the maximum offering price or the market price, or (2) the number of units multiplied by the book value.

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)

N.J. Admin. Code Tit. 13, ch. 47A, subch. 10, app C

New Rule, R.1990 d.241, effective 5/21/1990.
See: 21 New Jersey Register 2903(a), 22 New Jersey Register 1617(a).