Schedule Sch 2 - Securities Industry Regulations

SCHEDULE 2

Witnesses' fees and travelling expenses

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Statutory Rules 1981 No. 1271

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Securities Industry Regulations

WHEREAS it is provided by sub-section (5) of section 150 of the Securities Industry Act 1980 that the power of the Governor-General to make regulations under that Act shall be exercised only in accordance with advice that is consistent with resolutions of the Ministerial Council for Companies and Securities established under the Agreement made on 22 December 1978 between the Commonwealth and the States:

AND WHEREAS it is provided by section 16a of the Acts Interpretation Act 1901 that a reference in an Act to the Governor-General is, unless the contrary intention appears, to be deemed to include the person for the time being administering the Government of the Commonwealth of Australia and is, unless the contrary intention appears, to be read as referring to that person acting with the advice of the Federal Executive Council:

AND WHEREAS the making of the following Regulations is in accordance with advice that is consistent with those resolutions:

NOW THEREFORE I, the Administrator of the Government of the Commonwealth of Australia, acting with the advice of the Federal Executive Council and in pursuance of section 4 of the Acts Interpretation Act 1901, hereby make the following Regulations under the Securities Industry Act 1980.

Dated 3 June 1981.

STANLEY BURBURY

Administrator

By His Excellency's Command,

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(Sgd) John Moore

Minister of State for Business and Consumer Affairs

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Citation

These Regulations may be cited as the Securities Industry Regulations.

Interpretation

In these Regulations, unless the contrary intention appears—

"bank" means a bank as defined in section 5 of the Banking Act 1959 of the Commonwealth, the Primary Industry Bank of Australia Limited or a bank constituted under a law of a State or Territory;

"corporation" means any body corporate, whether formed or incorporated within or outside the Territory;

"life office" means a body corporate registered under the Life Insurance Act 1945 of the Commonwealth;

"superannuation scheme" means a fund the income of which is for the time being exempt from income tax by reason of paragraph 23 (jaa) or 23 (ja) of the Income Tax Assessment Act 1936 of the Commonwealth or a fund to which section 23f of that Act applied in relation to its last year of income;

<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:30pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">1. (a) Applicant's surname.................................</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">Other names.................................</td></tr><tr style="height:22.2pt"><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(b) Residential address</td></tr><tr style="height:28.95pt"><td style="width:29.7%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Date of birth............/............/................</td><td style="width:15.58%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">Place of birth</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Number of years applicant has resided in Australia.........</td></tr><tr style="height:21.3pt"><td colspan="5" style="padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(d) Name or names under which business *is to be/*is carried on</td></tr><tr style="height:57.3pt"><td colspan="4" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(e) Full address of the principal place at which the business of the applicant *is to be/*is carried on</td><td style="width:17.08%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Telephone No</td></tr><tr style="height:44.4pt"><td colspan="5" style="border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(f) The full address of all other places whether within the Territory or elsewhere at which the business of the applicant *is to be/*is carried on(Indicate clearly those places established and those to be established.)</td></tr><tr style="height:55.2pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(g) Address of place at which applicant's Register under Part VII of the Securities Industry Act 1980 will be kept</td></tr><tr style="height:30.6pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:middle">2. State the nature of the principal business of the applicant</td></tr><tr style="height:40.8pt"><td colspan="5" style="border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:middle">3. State in detail the nature of the activity for which the applicant requires a licence</td></tr><tr style="height:0pt"><td style="width:145.95pt"></td><td style="width:76.55pt"></td><td style="width:22.55pt"></td><td style="width:162.45pt"></td><td style="width:83.95pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><tbody><tr style="height:21pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:middle">4. In relation to the business carried on or to be carried on by the applicant—</td></tr><tr style="height:64.8pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(a) Set out name and address of each person with whom the applicant carries on or intends carrying on business in partnership—</td></tr><tr style="height:40.95pt"><td colspan="2" style="width:477pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Applicant's interest in partnership (expressed as a percentage of total capitalin the partnership).........................................—–––––%</td></tr><tr style="height:108pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(b) Set out name and address of each person who directly or indirectly exercises or has or will have power to exercise a controlling influence over the management and policies of the business other than persons referred to in paragraph (a) above</td></tr><tr style="height:78.75pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(c) Set out name and address of any person who directly or indirectly has or will have any share in profits of the business other than persons referred to in paragraph (a) above</td></tr><tr style="height:58.2pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">5. Is the applicant a director of any corporation incorporated in the Territory or elsewhere?………………………..(Answer "Yes" or "No")</td></tr><tr style="height:64.35pt"><td colspan="2" style="width:477pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">If "Yes", using an annexure, give details of:(a) names of the corporations;(b) places of incorporation;(c) dates of appointment</td></tr><tr style="height:19.2pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">6. Does the applicant have a relevant interest as determined in accordance with section 5 of the Securities Industry Act 1980 in one or more shares in any corporation incorporated in the Territory or elsewhere, amounting to not less than 10% of the aggregate of the nominal amount of all the issued shares in the corporation?………………………..(Answer "Yes" or "No")</td></tr><tr style="height:24pt"><td colspan="2" style="width:477pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">If "Yes", using an annexure, give details of:(a) names of the corporations;(b) places of incorporation; and(c) the relevant interests</td></tr><tr style="height:40.2pt"><td colspan="2" style="width:477pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">7. (Answer questions "Yes" or "No" in space provided. If "Yes", attach annexures giving all relevant particulars.)Answer</td></tr><tr style="height:59.4pt"><td colspan="2" style="width:477pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Has the applicant within the past 10 years</td></tr><tr style="height:59.4pt"><td style="width:379.65pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(a) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration in relation to dealing in securities as defined in sub-section 4 (1) of the Securities Industry Act 1980 or acting as investment adviser</td><td style="width:86.55pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:bottom">...........</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:99.3%; border-collapse:collapse"><tbody><tr style="height:23.3pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(b) been licensed, registered or otherwise authorized by law to carry on any trade, business or profession in any place?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:32.4pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(c) been refused the right or restricted in his right to carry on any trade, business or profession for which a specific license, registration or other authority is required by law in any place?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:12.7pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(d) been a member or partner in a member firm of a stock exchange?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:26.15pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(e) been suspended from membership of any stock exchange or otherwise disciplined by a stock exchange?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:16.55pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(f) been refused membership of any stock exchange?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:20.9pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(g) carried on business under any name other than the name or names shown in this application?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:24.7pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(h) been known by any name other than the name or names shown in this application?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:33.1pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(i) been convicted of any offence other than a traffic offence in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:42pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(j) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (if "Yes" attach annexure giving full details, including whether judgment is unsatisfied)</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:24.7pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(k) been declared bankrupt or compounded with or made an assignment for the benefit of his creditors in the Territory or elsewhere?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:24.7pt"><td style="width:80.66%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(1) been engaged in the management of any corporations other than those referred to in answer to question 5?</td><td style="width:19.34%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:29.3pt"><td style="width:80.66%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(m) been refused a fidelity or surety bond in the Territory or elsewhere?</td><td style="width:19.34%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:bottom">...........</td></tr><tr style="height:34.2pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">8. In the case of an applicant for a dealers licence who is, or intends to become, a member, or a partner in a member firm of a stock exchange, has the applicant or the member firm been granted any exemption from capital requirements by the Committee of the stock exchange?.................(Answer "Yes" or "No")If "Yes" attach annexure giving full details</td></tr><tr style="height:70.8pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">9. Has the applicant had any experience in performing the functions of a dealer or investment adviser as defined in sub-section 4 (1) of the Securities Industry Act 1980?.................(Answer "Yes" or "No")If "Yes" attach annexure giving all relevant particulars</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:98%; border-collapse:collapse"><tbody><tr style="height:19.2pt"><td colspan="4" style="border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">10. Set out below details of the applicant's employment and business activities during the previous 5 years:</td></tr><tr style="height:29.4pt"><td style="width:28.58%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Name and address of employer</td><td style="width:23.92%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of business of employer</td><td rowspan="2" style="width:23.52%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of employment or activity</td><td rowspan="2" style="width:23.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Period of employment or activity (give exact dates)</td></tr><tr style="height:16.55pt"><td colspan="2" style="border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">(if self-employed so state)</td></tr><tr style="height:108.7pt"><td style="width:28.58%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom"></td><td style="width:23.92%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:23.52%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:23.98%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:36.85pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">1. (a) Name:</td></tr><tr style="height:40.55pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Registered office:</td></tr><tr style="height:44.55pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(c) Place of incorporation:</td></tr><tr style="height:84.75pt"><td style="width:82.7%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(d) Full address of the principal place at which the business of the applicant *is to be/*is carried on</td><td style="width:17.3%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Telephone No.</td></tr><tr style="height:125.95pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(e) The full address of all other places whether within the Territory or elsewhere at which the business of the applicant is to be carried on or is carried on(Indicate clearly those places established and those to be established)</td></tr><tr style="height:85.15pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(f) Address of place at which applicant's register under Part VII of the Securities Industry Act 1980 will be kept</td></tr><tr style="height:39.55pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(g) Set out as an annexure hereto details of each director and secretary showing full name residential address, date of birth, office held and date of appointment</td></tr><tr style="height:38.2pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">2. State the nature of the principal business of the applicant</td></tr><tr style="height:35.95pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">3. State in detail the activity for which the applicant requires a licence</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:54.6pt"><td rowspan="2" style="width:33%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Name of director or secretary</td><td style="width:17.1%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Name and address of employer</td><td style="width:16.5%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of business of employer</td><td rowspan="2" style="width:16.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of employment or activity</td><td rowspan="2" style="width:16.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Period of employment or activity (give exact dates)</td></tr><tr style="height:19.8pt"><td colspan="2" style="border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">(if self-employed so state)</td></tr><tr style="height:140.15pt"><td style="width:33%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:17.1%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:16.5%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:16.7%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top"></td><td style="width:16.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:37.45pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. (a) Applicant's surname</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Other names</td></tr><tr style="height:39.65pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Residential address</td></tr><tr style="height:45.15pt"><td style="width:27.86%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Date of birth........../........../..........</td><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:top">Place of birth</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Number of years applicant has resided in Australia</td></tr><tr style="height:52.95pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(d) Occupation for which representatives licence is sought</td></tr><tr style="height:49pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(e) Full name of principal(s)</td></tr><tr style="height:78pt"><td colspan="4" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(f) The full address of the head office at which the business of each principal *is/*is to be carried on</td><td style="width:22.86%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Telephone No.</td></tr><tr style="height:61.95pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(g) Nature of business of each principal</td></tr><tr style="height:91.9pt"><td colspan="5" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(h) Address of place at which Register under Part VII of the Securities Industry Act 1980 will be kept</td></tr><tr style="height:0pt"><td style="width:136.9pt"></td><td style="width:67.6pt"></td><td style="width:35.5pt"></td><td style="width:139.1pt"></td><td style="width:112.35pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:33.7pt"><td style="width:26.58%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">Name and address of employer</td><td style="width:24.24%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of business of employer</td><td rowspan="2" style="width:22.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Nature of employment or activity</td><td rowspan="2" style="width:26.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">Period of employment or activity (give exact dates)</td></tr><tr style="height:18.65pt"><td colspan="2" style="border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:middle">(if self-employed so state)</td></tr><tr style="height:120pt"><td style="width:26.58%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom"></td><td style="width:24.24%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:22.82%; border:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:26.36%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:34.55pt"><td style="width:43.84%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">1. (a) Applicant's Surname</td><td colspan="3" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Other Names</td></tr><tr style="height:46.3pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Residential Address</td><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Licence No. of Applicant</td></tr><tr style="height:46.3pt"><td colspan="4" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">2. (a) Name of principal applicant proposes to represent</td></tr><tr style="height:74.3pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) The full address of the head office at which the business of the principal *is/*is to be carried on</td><td style="width:19.38%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Telephone No.</td></tr><tr style="height:35.25pt"><td colspan="4" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(c) Nature of business conducted by principal</td></tr><tr style="height:0pt"><td style="width:215.45pt"></td><td style="width:119.5pt"></td><td style="width:61.25pt"></td><td style="width:95.25pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:52.55pt"><td style="width:41%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Surname of the holder of the licence or name in which licence held</td><td colspan="2" style="border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Other names</td></tr><tr style="height:38.15pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">*Residential address/*Registered office</td><td style="width:42.82%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Type of licence held</td></tr><tr style="height:166.65pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">*1. CessationOn the......................................................day of.................................................. 19............the holder of the licence ceased—*(a) as the holder of a dealers licence, to carry on the business to which that licence relates.*(b) as the holder of an investment advisers licence, to act as, or hold himself out to be, an investment adviser.*(c) as the holder of a representatives licence, to be employed or act in connection with the business carried on by the *dealer/*investment adviser named in that licence,*and hereby requests the Commission to revoke the licence under section 59 of the Securities Industry Act 1980.</td></tr><tr style="height:91.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">*2. Change of NameOn the..................................................day of.................................................. 19........the name of the holder of the licence was changed from............................................................................to.....................................................................</td></tr><tr style="height:91.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">*3. Change of Particulars: as Affecting a Dealer or Investment Adviser*(a) On the................................................day of.................................................19........:..................................................................................................................................ceased to be *a director/*directors/*secretary of the holder of the licence.*(b) On the................................day of................................................19........:..................................................................................................................................*was/*were appointed *a director/*directors/*secretary of the holder of the licence.(Answer questions "Yes" or "No" in space provided. If "Yes" attach annexure giving full particulars)</td></tr><tr style="height:0pt"><td style="width:211.4pt"></td><td style="width:83.45pt"></td><td style="width:220.8pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:47.25pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(i) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration to deal or trade in securities as defined in section 4 of the Securities Industry Act 1930 or act as investment adviser?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:21.1pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(ii) been licensed, registered or otherwise authorized by law to carry on any trade, business or profession in any place?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:36.7pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(iii) been refused the right or restricted in its or his right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:13.45pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(iv) been a member or partner in a member firm of a stock exchange?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:18pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(v) been suspended from membership of any stock exchange or otherwise disciplined by a stock exchange?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:12.7pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(vi) been refused membership of any stock exchange?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:18pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(vii) carried on business under any name other than the name or names shown in this application?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:20.4pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(viii) been known by any name other than the name or names shown in this application?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:28.55pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(ix) been convicted of any offence other than a traffic offence in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:37.7pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(x) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (If "Yes", using annexure, give full details, including whether judgment is unsatisfied.)</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:28.3pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(xi) been declared bankrupt or compounded with or made an assignment for the benefit of his creditors, in the Territory or elsewhere?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:28.3pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(xii) been engaged in the management of any corporations other than those referred to in the application for the grant of the licence?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:20.4pt"><td style="width:80.98%; padding-right:2pt; padding-left:2pt; vertical-align:top">(xiii) been refused a fidelity or surety bond in the Territory or elsewhere?</td><td style="width:19.02%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:62.55pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*(c) the address of the principal place of business at which the holder of the licence carries on the business to which that licence relates was changed from.................................................... ............................................................................................to............................................................</td></tr><tr style="height:34.2pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*(d) the address(es) of the place(s) (other than the principal place of business) at which the business to which the licence relates is carried on *was/*were changed</td></tr><tr style="height:20.4pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">from.......................................................................................................................................................................................................................to...........................................................................................................................................................................................................................</td></tr><tr style="height:20.4pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*(e) (where the business to which the licence relates is carried on under a name or style other than the name of the holder of that licence) the name or style under which the business is carried on was changed from...........................................................................................................................to...............................................................................................</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100.26%; border-collapse:collapse"><tbody><tr style="height:42.45pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*(f) ceased to be a partner in the firm of...............................and became a partner in the firm of............................................................</td></tr><tr style="height:84.95pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*4. Change of Particulars: as Affecting a RepresentativeOn the................................................... day of.................................................................. 19........:*(a) the address(es) of the principal place(s) of business of the *dealer(s)/*investment adviser(s) named in the licence as *a person/*persons on whose behalf the holder of that licence may act were changed from—</td></tr><tr style="height:66.3pt"><td style="width:52.26%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Name(s) of the *dealer(s)/*investment adviser(s) named in licence</td><td style="width:47.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Previous address of principal place of business</td></tr><tr style="height:20.15pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">to—</td></tr><tr style="height:59.1pt"><td style="width:52.26%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Name(s) of the *dealer(s)/*investment adviser(s) named in licence</td><td style="width:47.74%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Present address of principal place of business</td></tr><tr style="height:59.1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">*(b) (to be used where the business of any dealer or investment adviser named in the licence as a person on whose behalf the holder of that licence may act is carried on under a name or style other than the name of that dealer or investment adviser) the name or style under which the business of.............................................................</td></tr><tr style="height:59.1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">...................................................................................................................................................(insert name of *dealer/*investment adviser)is carried on was changed from............................................................................................... ............................................................................to...................................................................Dated this.............................................................day of..........................................................19............</td></tr><tr style="height:59.1pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">Signature of licence holder..................................................................._____________* Strike out whichever is inapplicable</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:39.1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Licensee's name</td></tr><tr style="height:39.1pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Address</td></tr><tr style="height:39.1pt"><td style="width:80.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Type of licence held: *dealers/*investment advisers (*Strike out whichever is inapplicable)</td><td style="width:19.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Licence No.</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">1. (a) Name or names under which business is carried on</td></tr><tr style="height:50.4pt"><td style="width:80.36%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">(b) The full address of the principal place at which the business of the licensee is carried on</td><td style="width:19.64%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Telephone No.</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(c) The full address of all other places whether within the Territory or elsewhere at which the business of the licensee is carried on</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(d) Address of place at which the licensee's Register under Part VII of the Securities Industry Act 1980 is kept</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(e) This statement relates to the period from......../......../........to......../......../........</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">2. State in detail any change in the nature of the activity for which the licence is held which took place during the period to which this statement relates</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">3. (a) Set out name and address of each person with whom the licensee is carrying on business in partnershipLicensee's interest in partnership (expressed as a percentage of total capital in the partnership)........................%</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:50.4pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Set out name and address of each person who directly or indirectly exercises or has power to exercise a controlling influence over the management and policies of the business other than persons referred to in paragraph (a)</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(c) Set out name and address of each person who directly or indirectly has any share in profits of the business other than persons referred to in paragraph (a)</td></tr><tr style="height:125.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">4. During the period to which this statement relates has the licensee—(a) been appointed a director of any corporation incorporated in the Territory or elsewhere?.....................................(Answer "Yes" or "No")If "Yes", using an annexure give details of:(i) names of corporations(ii) places of incorporation(iii) dates of appointment</td></tr><tr style="height:152.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) acquired a relevant interest as determined in accordance with section 5 of the Securities Industry Act 1980 in one or more shares in any corporation incorporated in the Territory or elsewhere amounting to not less than 10% of the aggregate of the nominal amount of all the issued shares in the corporation?.....................................(Answer "Yes" or "No")If "Yes", using an annexure give details of:(i) names of corporations(ii) places of incorporation(iii) the relevant interests</td></tr><tr style="height:50.4pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">5. (Answer questions "Yes" or "No" in space provided; if "Yes" attach annexures giving all relevant particulars.)During the period to which this statement relates has the licensee—Answer</td></tr><tr style="height:36.95pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(a) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration to deal or trade in securities as defined in section 4 of the Securities Industry Act 1980 or act as investment adviser?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:24.7pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) been licensed, registered or otherwise authorized to carry on any trade, business or profession in any place?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:26.15pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(c) been refused the right or restricted in his right to carry on any trade, business or profession for which a specific licence, registration or other authority is required in any place?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:15.85pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(d) been refused membership of any stock exchange?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:19.45pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(e) carried on business under any name other than the name or names given in this statement?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:20.9pt"><td style="width:76.06%; padding-right:2pt; padding-left:2pt; vertical-align:top">(f) been known by any name other than the name or names given in this statement?</td><td style="width:23.94%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:28.55pt"><td style="width:75.8%; padding-right:2pt; padding-left:2pt; vertical-align:top">(g) been convicted of an offence, other than a traffic offence, in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?</td><td style="width:24.2%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:37.45pt"><td style="width:75.8%; padding-right:2pt; padding-left:2pt; vertical-align:top">(h) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (if "Yes", using an annexure, give full details, including whether judgment is unsatisfied.)</td><td style="width:24.2%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:22.55pt"><td style="width:75.8%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(i) been refused a fidelity or surety bond in the Territory or elsewhere?</td><td style="width:24.2%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:bottom">..............</td></tr><tr style="height:53.55pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Dated this..................................................................day of......................................................19..........Signature of licensee.........................</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:32.35pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Licensee's name</td></tr><tr style="height:32.35pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">Registered office</td></tr><tr style="height:32.35pt"><td style="width:74.3%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top">Type of licence held: *Dealers/*Investment advisers</td><td style="width:25.7%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top">Licence number</td></tr><tr style="height:82.2pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">1. (a) Name or names under which business is carried on(b) The full address of the principal place at which the business of the licensee is carried on</td></tr><tr style="height:71.95pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(c) The full address of all other places whether within the Territory or elsewhere at which the business of the licensee is carried on</td></tr><tr style="height:69.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(d) Address of place at which applicant's Register under Part VII of the Securities Industry Act 1980 is kept</td></tr><tr style="height:69.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(c) Set out as an annexure details of each director and secretary showing full name, residential address, date of birth, office held and date of appointment</td></tr><tr style="height:69.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">(f) This statement relates to the period from......../......../........to......../......../........</td></tr><tr style="height:69.25pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">2. State in detail any change in the nature of the activity for which licence is held that took place during the period to which this statement relates</td></tr><tr style="height:84.55pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top">3. Set out name and address of each person, not being a director, who directly or indirectly exercises or has power to exercise a controlling influence over the management and policies of the licensee</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:39.85pt"><td style="width:78.68%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(a) licensed or registered in any place other than in the Territory under any law which requires licensing or registration to deal or trade in securities as defined in sub-section 4 (1) of the Securities Industry Act 1980 or act as investment adviser?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:20.15pt"><td style="width:78.68%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(b) licensed, registered or otherwise authorized to carry on any trade, business or profession in any place?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:46.8pt"><td style="width:78.68%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(c) refused the right or restricted in its or his right to carry on any trade, business or profession for which a licence, registration or other authority is required in any place?</td><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:32.9pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top">7. (Answer questions "Yes" or "No" in space provided. If "Yes" attach annexures giving all relevant particulars.)</td></tr><tr style="height:32.9pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:top">During the period to which this statement relates, has any director or secretary of the licensee—Answer</td></tr><tr style="height:18.7pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">(a) carried on business under any name other than the name or names given in this statement?</td><td style="width:21.08%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:24pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">(b) been known by any name other than the name or names given in this statement?</td><td style="width:21.08%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:18.7pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">(c) been suspended from or refused membership of or otherwise disciplined by any stock exchange?</td><td style="width:21.08%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:36.7pt"><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">(d) been convicted of any offence, other than a traffic offence, in the Territory or elsewhere or are there any proceedings now pending that may lead to such a conviction?</td><td style="width:21.08%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:0pt"><td style="width:386.45pt"></td><td style="width:1.05pt"></td><td style="width:103.95pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:42.7pt"><td style="width:78.84%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(e) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (if "Yes", using an annexure, give full details, including whether judgment is unsatisfied.)</td><td style="width:21.16%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:35.55pt"><td style="width:78.84%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(f) been refused a fidelity or surety bond in the Territory or elsewhere?</td><td style="width:21.16%; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">............</td></tr><tr style="height:71.95pt"><td colspan="2" style="border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Dated this..................................................................day of.....................................................19............Signature of *Dircctor/*Secretary/*Manager...................................*Strike out whichever is inapplicable</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:29.05pt"><td colspan="2" style="border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top">Licensee's name</td><td style="width:18.18%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:top">Licence number</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Address</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">Type of licence held:*Dealer's representatives licence/*Investment representatives licence (*Strike out whichever is inapplicable)</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">1. (a) Occupation for which representative's licence is held:</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Set out details of principal or principals:</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(c) Address of place at which licensee's Register under Part VII of the Securities Industry Act 1980 is kept:</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">(d) This statement relates to the period from......../......../........to......../......../........</td></tr><tr style="height:29.05pt"><td colspan="3" style="border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top">2. (Answer questions "Yes" or "No" in space provided. If "Yes", attach annexures giving all relevant particulars.)Answer</td></tr><tr style="height:36pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">During the period to which this statement relates, has the licensee—(a) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration to deal or trade in securities as defined in sub-section 4 (1) of the Securities Industry Act 1980 or act as investment adviser?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:24.7pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(b) been licensed, registered or otherwise authorized to carry on any trade, business or profession, in any place?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:26.4pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(c) been refused the right or restricted in his right to carry on any trade, business or profession for which a licence, registration or other authority is required, in any place?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:20.9pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(d) carried on business under any name other than the name or names given in this statement?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:20.4pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(e) been known by any name other than the name or names given in this statement?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:31.45pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(f) been convicted of any offence, other than a traffic offence, in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:75.15pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:bottom">(g) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (if "Yes", using an annexure, give full details, including whether judgment is unsatisfied.)</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">............</td></tr><tr style="height:19.35pt"><td style="width:78.7%; padding-right:2pt; padding-left:2pt; vertical-align:top">(h) been refused a fidelity or surety bond in the Territory or elsewhere?</td><td colspan="2" style="padding-right:2pt; padding-left:2pt; vertical-align:top">............</td></tr><tr style="height:22.95pt"><td colspan="3" style="padding-right:2pt; padding-left:2pt; vertical-align:bottom">Dated this....................................................................day of.......................................................19........Signature of licensee............................</td></tr><tr style="height:0pt"><td style="width:386.75pt"></td><td style="width:15.35pt"></td><td style="width:89.35pt"></td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><tbody><tr style="height:27.35pt"><td style="width:59.92%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:10.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Notes</td><td style="width:16.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:middle">Last year 19.......</td><td style="width:13.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:middle">This year 19.......</td></tr><tr style="height:7.9pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:top"></td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">$</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">$</td></tr><tr style="height:15.85pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Current Liabilities—</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom"></td></tr><tr style="height:18.7pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Bank overdraft and other bank facilities...........</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">5</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:15.1pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Bills of Exchange..........................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">2</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:20.9pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Amounts owed to—........................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">3</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:18.7pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Partners...............................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:13.45pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Dealers...............................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:21.1pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Clients................................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:26.15pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Partners' immediate families, family companies and trusts</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:23.3pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Employees, employees' immediate families, family companies and trusts</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:18pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Other associated persons....................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:18pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Loans and Deposits.........................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">4, 5</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:21.1pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Sundry Creditors..........................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:16.3pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Sundry Provisions..........................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">6</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:24pt"><td style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Other current liabilities—specify................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">5</td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:161.75pt"><td rowspan="2" style="width:59.92%; border-right:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Total Current Liabilities...................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:13.52%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom"></td></tr><tr style="height:45.55pt"><td style="width:10.08%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:16.48%; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr><tr style="height:35.3pt"><td style="width:59.92%; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:2pt; vertical-align:bottom">Net Current Assets.......................</td><td style="width:10.08%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom"></td><td style="width:16.48%; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:1.62pt; padding-left:1.62pt; vertical-align:bottom">..........</td><td style="width:13.52%; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:1.62pt; vertical-align:bottom">........</td></tr></tbody></table> ``` <table cellspacing="0" cellpadding="0" style="border-collapse:collapse"><tbody><tr style="height:22.55pt"><td style="width:167pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Security</td><td style="width:95pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Number</td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Balance Sheet Valuation</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Basis of Valuation</td></tr><tr style="height:3.4pt"><td style="width:167pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">2 Bills of exchange</td><td style="width:95pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:4.95pt"><td colspan="2" style="width:266pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Last year</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">This year</td></tr><tr style="height:9.45pt"><td colspan="2" style="width:266pt; padding-right:2pt; padding-left:2pt; vertical-align:top">(a) Current assets—to mature within:</td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">$</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">$</td></tr><tr style="height:10.55pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">30 days ....................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:8.15pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">90 days ....................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:7.7pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">180 days ...................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:13.45pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">Current assets—over 180 days .....................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:3.4pt"><td colspan="2" style="width:266pt; padding-right:2pt; padding-left:2pt; vertical-align:top">(b) Current liabilities—to mature within:</td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">Last year</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">This year</td></tr><tr style="height:3.4pt"><td colspan="2" style="width:266pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:77pt; padding-right:2pt; padding-left:2pt; vertical-align:top"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">$</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle">$</td></tr><tr style="height:8.9pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">30 days ....................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:9.1pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">90 days ....................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:10.3pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">180 days ...................................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr><tr style="height:7.7pt"><td colspan="3" style="width:347pt; padding-right:2pt; padding-left:2pt; vertical-align:top">Current liabilities—over 180 days ...................</td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td><td style="width:63.5pt; padding-right:2pt; padding-left:2pt; vertical-align:middle"></td></tr></tbody></table> ```

(a) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration in relation to dealing in securities as defined in sub-section 4 (1) of the Securities Industry Act 1980 or acting as investment adviser?	.............
(b) been licensed, registered or otherwise authorized by law to carry on any trade, business or profession in any place?	.............
(c) been refused the right or restricted in its or his right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?	.............

(b) been suspended from membership of any stock exchange or otherwise disciplined by a stock exchange?	.............
(c) been refused membership of any stock exchange?	.............
(d) been known by any name other than the name or names shown in this application?	.............
(e) been convicted of any offence other than a traffic offence in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?	.............
(f) had judgment including findings in relation to fraud, misrepresentation or dishonesty given against him in any civil proceedings in the Territory or elsewhere? (If "Yes", using an annexure, give full details, including whether judgment is unsatisfied.)	.............
(g) been declared bankrupt or compounded with or made an assignment for the benefit of his creditors, in the Territory or elsewhere?	.............
(h) been engaged in the management of any corporation other than those referred to in answer to question 5?	.............
(i) been refused a fidelity or surety bond in the Territory or elsewhere?	.............

(a) been licensed or registered in any place other than in the Territory under any law which requires licensing or registration to deal or trade in securities as defined in section 4 of the Securities Industry Act 1980 or act as investment adviser?	...........
(b) been licensed, registered, or otherwise authorized by law to carry on any trade, business or profession in any place?	...........
(c) been refused the right or restricted in his right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?	...........
(d) been a member or partner in a member firm of any stock exchange?	...........
(e) been suspended from membership of any stock exchange or otherwise disciplined by a stock exchange?	...........
(f) been refused membership of any stock exchange?	...........
(g) carried on business under any name other than the name or names shown in this application in paragraph 1 (a)?	...........
(h) been known by any name other than the name or names shown in this application in paragraph 1 (a)?	...........
(i) been convicted of any offence, other than a traffic offence, in the Territory or elsewhere or are there any proceedings now pending which may lead to such a conviction?	...........
(j) had judgment including findings in relation to fraud, misrepresentation, or dishonesty given against him in any civil proceedings, in the Territory or elsewhere? (If "Yes", attach annexure giving full details, including whether judgment is unsatisfied.)	...........
(k) been refused a fidelity or surety bond, in the Territory or elsewhere?	...........

Balance Sheet as at 30th June, 19.........	Notes	Last year 19.......	This year 19.......
		$	$
Proprietors' Funds ...........................	..	..........	........
Represented by:
Current Assets—
Govt and Semi-Govt securities (market value this year $............................., last year $.................................)	..	..........	........
Certificates of deposit at a Bank..............	..	..........	........
Securities listed on a Stock Exchange (market value this year $....................., last year $........................)	1	..........	........
Bills of Exchange........................	2	..........	........
Amount owed by—......................	3	..........	........
Partners.............................	..	..........	........
Dealers (after providing for doubtful debts this year $.................., last year $........................)	..	..........	........
Clients (after providing for doubtful debts this year $..................., last year $........................)	..	..........	........
Partners' immediate families, family companies and trusts (after providing for doubtful debts this year $..................., last year $........................)	..	..........	........
Employees, employees' immediate families, family companies and trusts (after providing for doubtful debts this year $............., last year $.....)	..	..........	........
Other associated persons (after providing for doubtful debts this year $..................................., last year $.........................)	..	..........	........
Loans and Deposits—.....................	4
Cash at bank and in hand (excluding trust account balances)	..	..........	........
Trust Account-	..
Cash at bank and in hand..................	..	..........	........
Deposit with stock exchange...............	..	..........	........
Sundry debtors and prepayments..............	..	..........	........
Other current assets—specify................	..	..........	........
Total Current Assets..................	..	..........	........

Non-Current Assets—	Notes	Last year 19.......	This year 19.......
Investments—		$	$
Securities quoted on a Stock Exchange (market value this year $................................................., last year $..........................)—at cost	1	..........	........
Securities not quoted on a Stock Exchange—at cost	..	..........	........
Furniture, fittings, equipment, motor vehicles, etc.— at cost, less provision for depreciation (provision for depreciation this year $............................., last year $........................)	..	..........	........
Freehold Property—at cost, less provision for depreciation on building (provision for depreciation this year $........................, last year $........................)	..	..........	........
Amounts owed by—	3	..........	........
Partners...............................	..	..........	........
Partners' immediate families, family companies and trusts		..........	........
Employees, employees' immediate families, family companies and trusts		..........	........
Other associated persons......................	..	..........	........
Loans and Deposits.........................	4	..........	........
Other non-current assets—specify...............
Total Non-Current Assets.................
Non-Current Liabilities—
Bank loans.............................	5	..........	........
Other loans and deposits....................	4, 5	..........	........
Partners...............................	..	..........	........
Partners' immediate families, family companies and trusts	..	..........	........
Employees, employees' immediate families, family companies and trusts	..	..........	........
Other associated persons....................	3	..........	........
Other non-current liabilities—specify............	5	..........	........
Total Non-Current Liabilities..............		..........	........
Net Non-Current Assets..................		..........	........
Total Net Assets.......................		..........	........
Contingent liabilities and capital commitments.....	7	..........	........

Profit and Loss Account for the year ended 30th June, 19...........	Last year 19…	This year 19…
	$	$
Revenue—
Profits (losses) from trading in securities .....................	......	......
Brokerage ..........................................	......	......
Underwriting Commission ...............................	......	......
Profits (losses) from trading other than in securities ..............	......	......
Dividends ..........................................	......	......
Interest ...........................................	......	......
Other..............................................	......	......
Total Revenue...............................	......	......
Expenses—
Bad debts written off ..................................	......	......
Amount provided for doubtful debts ........................	......	......
Interest ...........................................	......	......
Salaries (including all bonuses but excluding partners' salaries) .......	......	......
Other expenses ......................................	......	......
Total Expenses................................	......	......
Operating Profit Before Income Tax—	......	......
Less—	......	......
Income Tax Expense/Provision applicable thereto ..............	......	......
Operating Profit ......................................	......	......
(1) Extraordinary Items (net of Income Tax where applicable) ........	......	......
Operating Profit and Extraordinary Items for the year ............	......	......

5. Set out any additional information (including any formal qualifications or training of the applicant and the name of the institution that conducted the relevant course) considered relevant to this application.......................................................................................................................................................................................................................................................................................................................................................................................................
Attach written acknowledgment signed by the abovenamed principal(s) evidencing his/their intention to employ or engage applicant as a dealer's representative/investment representative.
Dated this............................................................day of....................................................... 19................
Signature of applicant..........................
*Strike out whichever is inapplicable

.................................................. (1) hereby gives noticethat on the.......................................................day of................................................................19.........
RESIGNATIONnotice was received of the resignation of.......................................................................as auditor(s) of.................................................................................................................to take effect from................................................................19........(2)and................................................................theirappointed as auditor(s) in––––—place.*his
REMOVAL........................................................the auditor(s) ofwere...........................................................................................................——–––removed from office andwas...................................................................theirappointed as auditor(s) in ————place.*his
Dated this..................................................................day of.........................................................19........Signature of dealer.............................___________
* Strike out whichever is inapplicable(1) Name of dealer(2) Insert date from which resignation takes effect

Sch 2

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