California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 2 - Corporate Securities › Article 13 - General Provisions › Subarticle 2 - Miscellaneous Provisions › Section 260.507 - Form of Application for Approval of Repurchase Offer Facing Page

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An application for approval as to form of an offer to
						repurchase a security in accordance with Subdivision (b) of Section
						25507 of the Code shall have as
						the first page thereof a facing page in the following form containing the
						information therein specified:
(Department of Business Oversight Use Only)
Fee Paid
								$___________________________
Receipt No.___________________________
DEPARTMENT OF BUSINESS OVERSIGHT
File
								No.___________________________
(Insert file number
								of previous filings of applicant before the Department, if any)
FEE:___________________________
(To be completed by
								applicant)
Date of
								application:___________________________
DEPARTMENT OF BUSINESS OVERSIGHT STATE OF
						CALIFORNIA FACING PAGE
APPLICATION FOR APPROVAL AS TO FORM OF AN OFFER TO
						REPURCHASE A SECURITY UNDER SUBDIVISION (b) OF SECTION
						25507 OF THE CORPORATE SECURITIES
						LAW OF 1968.
1. Name of
					 issuer.
2. Address of principal
					 executive office of issuer.
Number and
								Street
City
State
Zip Code
3. The name and address of each person making
					 the offer set forth in Exhibit D of Item 9.
4. Name and address of person to whom
					 correspondence regarding this application should be addressed.
5. State whether issuer is a corporation,
					 partnership, trust or other entity and the state of incorporation or
					 jurisdiction under which organized.
6.
(a)
(b)
(c)
(d)
Type of security
Number of shares
								or units covered by the offer.
Aggregate value of consideration
								received.
If a cash offer aggregate amount to be offered.
___________________________
___________________________
___________________________
___________________________
___________________________
___________________________
$___________________________
$___________________________
INSTRUCTIONS
Completion of Application. The application should be
						continued in typewritten or printed form in the English language, on one side
						only of either legal or letter size paper which should be attached to the
						facing page when submitted. Provide the information required by Items 7 through
						9 below. Identify each statement by reference to the item number. Any item
						which is inapplicable should be listed by the number of the item, followed
						simply by the word "inapplicable." At each item where relevant refer to and
						incorporate by reference any attached exhibits or documents and any documents
						currently on file with the Department. Such reference should indicate the page
						or portion of the document where the information is located. Sign and verify
						the last page in the manner shown in the instructions below.
7. Describe the transaction or distribution
					 of securities in connection with which the repurchase offer is to be made,
					 including, but not limited to, the following:
a. If offers are to be made to less than all
					 of the persons who received securities in connection with such transaction or
					 distribution, the names and addresses of the persons to whom offers will not be
					 made. In the absence of unusual circumstances, the Commissioner will not
					 ordinarily approve a repurchase offer if concurrent offers are not being made
					 to all persons to whom liability may exist. If a request is made for a
					 variance, a detailed explanation of the facts and circumstances must be
					 submitted, including an explanation of the basis for excluding each person
					 proposed to be omitted.
b. If the
					 consideration paid for the securities was other than cash, a description of
					 such consideration and a statement of the method and basis by which the
					 valuation of the consideration was determined in connection with the repurchase
					 offer, and information demonstrating that such valuation is bona fide and fair
					 to the offeree.