California Code of Regulations › Title 10 - Investment › Chapter 3 - Commissioner of Financial Protection and Innovation › Subchapter 2 - Corporate Securities › Article 2 - Exemptions from Qualification › Section 260.102.19 - Notice of Transaction for Purchase or Option Plans or Agreements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An issuer who
				  effects a transaction under Section
				  25102(o) of the
				  Code shall file a notice of transaction with the Commissioner not later than 30
				  days after the initial issuance of a security in California (Section
				  25008 of the Code) in that
				  transaction. The notice shall be accompanied by the fee prescribed by Section
				  25608(y)
				  of the Code.
(b) Each issuer (other
				  than a California corporation) must also file a consent to service of process
				  (Form 260.165), unless it already has a consent to service of process on file
				  with the Commissioner.
(c) The
				  following form is to be used for transactions covered by Section
				  25102(o)
				  of the Code:
(Department of Business Oversight Use
							 Only)
DEPARTMENT OF BUSINESS OVERSIGHT FILE NO., if any:
___________________________Fee Paid $
___________________________
(Insert File Number(s) of
							 Previous
___________________________Receipt No.
Filings Before the Department, If Any)
FEE: $__________
(See Corporations Code Section
					 25608(y) and
					 Section 25608(e).
The fee is based on the current market value of the
					 securities, or in the case of options, the underlying securities.)
COMMISSIONER OF BUSINESS OVERSIGHT STATE OF CALIFORNIA
Notice of Issuance of Securities Pursuant to Subdivision
					 (o) of Section
					 25102 of the Corporations
					 Code
___________________________
1. Name of Issuer:
___________________________
2. State of Incorporation or Organization:
___________________________
3. Address of Principal Place of Business:
_____________________________________________________________________________
Number and
							 Street
City
State
Zip Code
4.
				  The security is issued pursuant to a : (Check One)
( ) Purchase Plan Agreement.
___________________________
Name of Security:
___________________________
Number of Securities:
___________________________
Price Per Security: $
( ) Option Plan or Agreement.
___________________________
Name and Number of Options:
___________________________
Name and Number of the Underlying Securities:
___________________________
Exercise Price Per Security: $
( ) "Flexible" Purchase/Option Plan or Agreement.
___________________________
Name of Security/Option:
___________________________
Number of Securities/Options:
___________________________
Name and Number of the Underlying Securities:
___________________________
Price Per Security: $
___________________________
5. Aggregate current market value of
				  securities sought to be sold: $
___________________________
6. Date of Notice:
( )
Check if Issuer has
							 a
___________________________
consent to service of process on file with
							 the Commissioner.
Name of Issuer
___________________________
Authorized Signature on Behalf of
							 Issuer
___________________________
Print Name and Title of
							 Signatory
Name, Address and Phone Number of Contact Person:
___________________________
___________________________
___________________________
Instructions: Each issuer (other than a California
					 corporation) filing a notice under Section
					 25102(o) must
					 file a consent to service of process (Form 260.165), unless it already has a
					 consent to service on file with the Commissioner.