Authority: IC 23-19-6-5

Affected: IC 23-19-3-3; IC 23-19-3-4

Sec. 3. Every application for registration shall be on the form prescribed by the commissioner or on the "Uniform Application to Register Securities" currently in use and shall contain the following information:

1. (1) The type of registration requested (qualification or coordination).
2. (2) The name and address of the applicant and, if the issuer is not the applicant, the interest of the applicant in the offering.
3. (3) The name and address of the issuer.

4. (4) A:

   1. (A) description of the securities to be offered in Indiana, including the number of shares or units of each kind of security;
   2. (B) statement of the kinds of security;
   3. (C) price per unit for each kind of security; and
   4. (D) total offering price for each kind of security.
5. (5) The underwriting discounts or commissions to be paid per share or unit.
6. (6) The states other than Indiana in which a registration statement or similar document has been or will be filed in connection with the offering.

7. (7) A statement as to the existence at any time of any:

   1. (A) order;
   2. (B) judgment; or
   3. (C) decree;
8. as to the offering entered by any state or federal regulatory authorities or court and a statement as to any jurisdiction in which an application for registration of the offering has been withdrawn.

(Securities Division; 710 IAC 4-3-3; filed Jun 28, 2010, 2:36 p.m.: 20100728-IR-710100044FRA; readopted filed May 12, 2016, 1:47 p.m.: 20160608-IR-710160136RFA; readopted filed Nov 30, 2022, 4:01 p.m.: 20221228-IR- 710220301RFA)