SECURITIES SUPPLEMENT
Instructions: Complete this supplement if any securities practice was indicated on the application.
1. State percentage of applicant’s securities practice for the past five years which involves:
a. Securities registered under the Securities Act of 1933 %
b. Municipal Bonds %
c. Private Placements and State Registrations %
d. Syndications, Tax Shelters, Limited Partnerships %
e. Bonds %
f. Other Securities Work (describe) %
2. Does the applicant firm conduct a due diligence investigation when representing clients as to
the offering or sale of securities? Yes No
3. During the past five years, has the applicant firm been involved in, or had the knowledge of, any
facts which would indicate an involvement in an investigation of administration action by the SEC
or any state agency regulating securities? If yes, give details. Yes No
4. Does the applicant firm have a cold review performed on all offerings by an attorney not involved
on the project? Yes No
5. Has any lawyer of the applicant firm participated in any business venture with any securities
client of the firm? If yes, give details. Yes No
6. Has any lawyer of the applicant firm participated in any offering or securities transaction in any
capacity other than as a lawyer providing only legal services? If yes, give details. Yes No
7. Has any lawyer of the applicant firm acted as a promoter or seller for a securities client, or
helped locate or solicit investors? If yes, give details. Yes No
8. Has any lawyer of the applicant firm been a director, officer, trustee or manager of any entity of
any securities client? If yes, give details. Yes No
9. Has any lawyer of the applicant firm invested in any client’s original securities offering? If yes,
give details. Yes No
10. For securities work, has the applicant firm ever accepted stock or other ownership or equity
interest in lieu of a cash fee? If yes, give details. Yes No
11. For securities work, has the applicant firm ever accepted contingent fees or had any payment
contingent upon closing of a particular transaction? If yes, give details. Yes No
12. Has the applicant firm performed securities work or been involved with any offering that was
unsuccessful, was not taken up, or was withdrawn? If yes, give details. Yes No
LP100-F (12/1998) Page 1 of 2
13. Has the applicant firm advised or issued an opinion letter stating that any offering of securities
was exempt from federal or state regulation? Yes No
14. Has the applicant firm handled multi-state offerings? Yes No
15. Has any client or entity for whom the applicant firm has provided legal services relating to
securities gone insolvent, been in bankruptcy or closed or ceased operations? Yes No
16. Does the applicant firm have an express prohibition against trading in client securities? Yes No
17. Has any member of the applicant firm, present or former, have past or present involvement in
the formation of any limited partnership, or acted in the capacity of syndicator, promoter,
general partner or managing general partner of any limited partnership for which the firm has or
is providing legal services? If yes, give details. Yes No
18. Please complete the following section for all securities transactions worked on by the applicant firm in the past five
years. Continue on separate sheet if necessary.
Issuer The name of the organization issuing the securities.
Type of Business The business activity of the issuer e.g. Electronics, Real Estate.
$ Offering Size The maximum dollar amount sold or anticipated to be sold.
Date If filed, the date of filing. Otherwise, an estimated date.
Underwriter The name of the organization underwriting the securities.
Accountant The name of the accountant involved in the issue.
Security Type Form of security offered e.g. common stock, municipal bonds, bonds, Ltd. Partnership.
Investment Grade Please name grade and source, if applicable.
Indicate your client as I (issuer), U (underwriter), P (Purchaser) or S (Special) counsel such as work on a tax opinion
Client
which is referred to or relied upon in the preparation of a prospectus or other offering document.
Issuer Type of Business $ Offering Size Date
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Underwriter Accountant Security Type Investment Grade Client
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Narrative
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This supplement becomes part of the application, which is a part of the policy.
Date of Application Name of Firm or Sole Practitioner
Applicant’s Signature/Title – owner, officer or partner
LP100-F (12/1998) Page 2 of 2