| Securities Lawyer's Deskbook
published by The University of Cincinnati College of Law |
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(Amendment No....) .................................................................................................................. |
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(Name of Issuer) |
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.................................................................................................................. |
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(Title of Class of Securities) |
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(CUSIP Number) |
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.................................................................................................................. |
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(Date of Event Which Requires Filing of this Statement) |
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CUSIP No.
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| (1) |
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| (2) |
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| (3) |
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| (4) |
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| Number of shares beneficially owned by each reporting person with: | (5) |
| (6) |
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| (7) |
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| (8) |
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| (9) |
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| (10) |
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| (11) |
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| (12) |
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| (1) |
| (2) |
| (3) |
| (4) |
| (5)-(9), (11) |
| (10) |
| (12) |
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Symbol |
| Broker Dealer |
BD |
| Bank |
BK |
| Insurance Company |
IC |
| Investment Company |
IV |
| Investment Adviser |
IA |
| Employee Benefit Plan or Endowment Fund |
EP |
| Parent Holding Company/Control Person |
HC |
| Savings Association |
SA |
| Church Plan |
CP |
| Corporation |
CO |
| Partnership |
PN |
| Individual |
IN |
| Non-U.S. Institution |
FI |
| Other |
OO |
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By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were acquired and are held in the ordinary course of business and were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
By signing below I certify that, to the best of my knowledge and belief, the foreign regulatory scheme applicable to [insert particular category of institutional investor] is substantially comparable to the regulatory scheme applicable to the functionally equivalent U.S. institution(s). I also undertake to furnish to the Commission staff, upon request, information that would otherwise be disclosed in a Schedule 13D.
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
Dated |
Signature |
Name/Title |
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