REGISTERED SECURITIES AGENT

APPLICANT CERTIFICATION

I, _______________________________________, CRD number ____________, hereby certify to the Administrator of the Oklahoma Department of Securities that I have carefully reviewed the Oklahoma Uniform Securities Act of 2004, 71 O.S., 1-101 through 1-701, as well as the rules and regulations adopted thereunder, and I fully understand my responsibilities thereunder as a registered securities agent.

I so certify and make this filing with the Administrator in connection with my application as a securities agent:

Dated this _____day of _____________. 20___.

______________________________________________

(Signature)

STATE OF.......................................................... )
) SS
COUNTY OF...................................................... )
Subscribed and sworn before me this _____ day of ____________, 20 ____,

_______________________________________

My Commission Expires:____________________

Notary Public

MANAGEMENT CERTIFICATION

I, _________________________________________, an officer, director, partner or sole proprietor of _____________________________________________________________________, hereby certify to the Administrator of the Oklahoma Department of Securities that the above applicant for registration as a registered securities agent has been provided adequate instruction with respect to his/her responsibilities under the Oklahoma Uniform Securities Act of 2004, and the rules and regulations adopted and promulgated pursuant thereto.

Dated this _____day of _____________. 20___.

______________________________________________

(Signature)

______________________________________________

(Title)

STATE OF.......................................................... )
) SS
COUNTY OF...................................................... )
Subscribed and sworn before me this _____ day of ____________, 20 ____,

_______________________________________

My Commission Expires:____________________

Notary Public

OBD-18 7/2004