Not subject to 

OMB Clearance

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

UNITED STATES OMB APPROVAL

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20459

FORM 7-M

IRREVOCABLE APPOINTMENT OF AGENT FOR SERVICE OF PROCESS,

PLEADINGS AND OTHER PAPERS BY INDIVIDUAL NON-RESIDENT

BROKER OR DEALER

THIS FORM SHALL BE FILED IN DUPLICATE ORIGINAL

1. I, ______________________________________________________________________________________________________,

(Name)

of ____________________________________________________________________________________________________________,

(Residence address in full)

doing business as _________________________________________________________________________________________________,

(Name under which business is conducted)

at _____________________________________________________________________________________________________________,

(Business 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 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 my registration as a broker or dealer becomes effective pursuant to Section 15 of the 

Securities Exchange Act of 1934 and the rules and regulations thereunder and ending either when 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 my business as a broker or dealer, and

(c) is founded, directly or indirectly, upon 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 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 last 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 by the Commission 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)

 _____________________________________

SEC 876 (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 acknowledge that he executed it as his free 

and voluntary act. The acknowledgment should be in the form prescribed by 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)

__________________________________________________________________________________________, in and for (said County in)

 (Official position of person administering acknowledgement)

the Province (or State) aforesaid, do hereby certify that _________________________________________________________________

personally appeared before me this day and signed and sealed the above instrument as his free and voluntary at for the uses and purposes 

therein set forth.

Given under my hand and seal this _______________________ day of ___________________________________A.D., __________.

 _________________________________________

 (Signature of Official)

(Seal)

 _________________________________________

 (Official Position)

My Commission (or office) expires:

______________________________

 (Date)

}ss

SEC 876 (6-12)