OMB APPROVAL

Not subject to 

OMB Clearance 

(44 U.S.C 3501, et. seq.)

UNITED STATES

SECRUITIES AND EXCHANGE COMMISSION

Washington, D.C. 20459

FORM 10-M

IRREVOCABLE APPOINTMENT OF AGENT FOR SERVICE OF PROCESS, 

PLEADINGS AND OTHER PAPERS BY NON-RESIDENT

GENERAL PARTNER* OF BROKER OR DEALER

___________________________________________________________________________________________________________ 

This Form Shall be Filed in Duplicate Original

___________________________________________________________________________________________________________

1. I, _________________________________________________________, of____ ________________________________________ 

(Name) (Address in full)

hereby designate and appoint, without power of revocation, the United States Securities and Exchange Commission as my agent upon 

whom may be served all process, pleadings and other papers in any civil suit or action brought against me individually or as a partner of 

any partnership engaged in business as a broker or dealer, in any appropriate court in any place subject to the jurisdiction of the United 

States, with respect to any cause of action which:

(a) accrues during the period beginning when the registration as a broker or dealer of any partnership of which I am a general partner 

becomes effective pursuant to Section 15 of the Securities Exchange Act of 1934 and the rules and regulations thereunder and 

ending either when such registration is cancelled or revoked, or when the Commission receives a notice to withdraw from such 

registration, whichever is earlier.

(b) arises out of any activity, in any place subject to the jurisdiction of the United States, occurring in connection with the conduct 

of business of a broker or dealer, and

(c) is founded, directly or indirectly, upon the provisions of the Securities Act of 1933, the Securities Exchange Act of 1934, the 

Trust Indenture Act of 1939, the Investment Company Act of 1940, the Investment Advisers Act of 1940, or any rule or regulation 

under any of said Acts; and

2. I hereby consent, stipulate and agree, without power of revocation,

(a) that any such civil suit or action may be commenced against me individually or as a partner of any partnership engaged in 

business as a broker or dealer, by the service of process upon the Commission and the forwarding by the Commission of a copy 

thereof by registered mail to me at the lass address of record filed by me with the Commission.

(b) that all service of process, pleadings or other papers upon the Commission and the forwarding of a copy thereof by registered 

mail to me at the last address of record filed by me with the Commission shall be taken and held in all courts to be as valid and 

binding as if due personal service had been made upon me, and

(c) that service upon the Commission may be effected by delivering copies of said process, pleadings or other papers to the Secretary 

of the Commission or to any other person designated by it for such purpose, and that the certificate of the Secretary of the 

Commission or of such other person reciting that said process, pleadings or other papers were received by the Commission and 

that a copy thereof was forwarded to me at the last address of record filed by me with the Commission shall constitute evidence 

of such service upon me.

IN WITNESS WHEREOF, I have executed this irrevocable power of attorney, consent, stipulation and agreement at 

____________________________________________________________________________________________________________,

this ___________________________day of _________________________, A.D., ____________.

 

 (SEAL)

 __________________________________________

___________________

* This form should be appropriately revised for use by a “managing agent” of a broker or dealer, Paragraph (d) of the rule defines a 

“managing agent” to mean any person, including a trustee, who directs or manages or who participates in the directing or managing of 

the affairs of any unincorporated organization or association which is not a partnership.

SEC 879 (6-12)
NOTE: The person executing this irrevocable power of attorney, consent, stipulation and agreement should appear before a person 

authorized to administer acknowledgments in the jurisdiction in which it is executed and acknowledged that he executed it as his free and 

voluntary act. The acknowledgment should be in the form prescribed by the law of the jurisdiction in which it is executed. The form of 

acknowledgment suggested below should be used only if it is consistent with the requirements of the law of such jurisdiction.

The failure of any acknowledgment to meet applicable requirements shall not affect the validity or effect of the foregoing irrevocable 

power of attorney, consent, stipulation and agreement.

Province (or State) of _________________________

County of __________________________________

I, _______________________________________________ , __________________________________________________________

 (Name) (Official position of person administering acknowledgement)

in and for (said County in) the Province (or State) aforesaid, do hereby certify that ________________________________________

 

___________________________________________________________________________, personally appeared before me this day and 

 (Name of person appointing sealed the above agent for service, etc.)

signed the above instrument as his free and voluntary act for the uses and purposes therein set forth.

Given under my hand and seal this ______________________day of _____________________, A.D.,__________.

 ______________________________________________

(Seal) (Signature of Official)

 ______________________________________________

My Commission (or office) expires: (Official Position)

_____________________________________

 (Date)

}ss

SEC 879 (6-12)