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Fillable Printable Form N-54A

Fillable Printable Form N-54A

Form N-54A

Form N-54A

UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM N-54A
NOTIFICATION OF ELECTION TO BE SUBJECT TO SECTIONS 55
THROUGH 65 OF THE INVESTMENT COMPANY ACT OF 1940 FILED
PURSUANT TO SECTION 54(a) OF THE ACT
The undersigned business development company hereby noties the Securities and Exchange Commission that it elects, pursuant
to the provisions of section 54(a) of the Investment Company Act of 1940 (the “Act”), to be subject to the provisions of sections
55 through 65 of the Act and, in connection with such notication of election, submits the following information:
Name:
Address of Principal Business Ofce (No. & Street, City, State, Zip Code):
Telephone Number (including area code):
Name and address of agent for service of process:
Check one of the following:
[ ] The company has led a registration statement for a class of equity securities pursuant to section 12 of the Securities
Exchange Act of 1934. Give the le number of the registration statement or, if the le number is unknown or has not yet
been assigned, give the date on which the registration statement was led:
_____________________________________________________________________
[ ] The company is relying on rule 12g-2 under the Securities Exchange Act of 1934 in lieu of ling a registration statement
for a class of equity securities under that Act.
The le number of the registration as an investment company pursuant to section 8(a) of the Act, if any, of the company:
_____________________________________________
The le number of the registration as an investment company pursuant to section 8(a) of the Act, if any, of any subsidiary of the
company: ______________________________
The undersigned company certies that it is a closed-end company organized under the laws of ___________ (state) and with its
principal place of business in ___________ (state); that it will be operated for the purpose of making investments in securities
described in section 55(a)(1) through (3) of the Investment Company Act of 1940; and that it will make available signicant
managerial assistance with respect to issuers of such securities to the extent required by the Act.
Pursuant to the requirements of the Act, the undersigned company has caused this notication of election to be subject to
sections 55 through 65 of the Investment Company Act of 1940 to be duly signed on its behalf in the city of_______________
____________ and state of ___________ on the _____day of____________, 20___.
[SEAL] Signature
(Name of Company)
By
(Name of director, ofcer, or general partner
signing on behalf of the company)
Title
Attest: __________________________________
(Name)
__________________________________
(Title)
OMB Number: 3235-0237
Expires: March 31, 2018
Estimated average burden
hours per response 0.5
OMB APPROVAL
SEC1937 (10-03)
Persons who respond to the collection of information contained in this
form are not required to respond unless the form displays a currently
valid OMB control number.
INSTRUCTIONS FOR FORM N-54A
Read instructions carefully before preparing the notication of election. A notication of election may be returned as not
acceptable for ling unless it is prepared, executed, and led substantially in accordance with these instructions. This form is
not to be used as a blank form to be lled in, but only as a guide in the preparation of a notication of election. The form should
be led on paper 8 1/2 x 11 inches in size.
(a) This form shall be used as the notication of election to be subject to sections 55 through 65 of the Act led with the
Commission pursuant to section 54(a) of the Act.
(b) Signature.
An original and seven copies of each notication of election shall be led. The seven copies of the notication of election
may have facsimile or typed signatures. If the company is a business development company having a board of directors, the
original notication of election shall be signed on behalf of the company by a director, ofcer, or trustee. If the company is a
partnership, the original notication shall be signed by a general partner.
(c) Filing.
The notication of election and all inquiries and communications with respect thereto shall be forwarded to the Securities
and Exchange Commission, Washington, D.C. 20549.
(d) Fee.
There is no fee charged for ling the notication of election.
(e) Rule 12g-2.
Only companies with a class of equity securities that would have been required to be registered pursuant to section 12(g)(1)
of the Securities Exchange Act of 1934 except for the exemption from registration under section 12(g)(2)(B), and that is held
of record by at least 300 persons, may rely on rule 12g-2. All other companies must register a class of equity securities under
section 12 of the Securities Exchange Act of 1934 before or simultaneously with the ling of this notication of election.
(f) Name.
In selecting a name a company should consider the following: (a) section 35(d) of the Act; (b) the current list of companies
registered under the Act (in order to ascertain if the name is similar to that of any existing company); and (c) its corporate
policies.
(g) SEC’s Collection of Information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays
a currently valid control number. Filing of this Form is mandatory. The principal purpose of this collection of information is to
notify the Commission that the undersigned business development company elects to be subject to the provisions of sections 55
through 65 of the Act. The commission estimates that the burden for completing the Form will be approximately 0.5 hours per
ling. Any person may direct to the Commission any comments concerning the accuracy of the burden estimate of this Form
and any suggestions for reducing this burden. This collection of information has been reviewed by the Ofce of Management
and Budget in accordance with the clearance requirements of 44 U.S.C. § 3507. The responses to the collection of information
will not be kept condential.
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