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Department of Insurance and Securities Regulation: District Of Columbia Adviser Affidavit

District Of Columbia Adviser Affidavit

Please be advised that I, (Principal/Officer's name)
of the Investment Adviser (Adviser/Firm's name)
on behalf of its applicant(s) (Adviser/Firm's name)

Certify that:

    - The applicant has not transacted any business in the District of Columbia, and will not provide investment advice until registered with the Securities Bureau of the District of Columbia.

    - If a firm has transacted any advisory business in the District of Columbia from September 24, 1993 to present, provide the following information:

    1. name, address and telephone number of each client;

    2. date of each agreement with clients involved;

    3. a description of service provided to each client along with the total amount of assets managed or involved and the total amount of fees received.

Signature:___________________________________________________________________

State of
County of

Subscribed and sworn before me this __________ day of __________________ 2000.

_______________________________________________
Notary Public

My Commission Expires _________________________