EX-10.3 4 d840235dex103.htm EX-10.3 EX-10.3

Exhibit 10.3

Statement of Purpose for an Extension

of Credit by a Creditor  (Federal Reserve Form T–4)

 

 

 

 

Name of Creditor: Pershing LLC • OMB No. 7100-0019 • Approval expires June 30, 2024

 

This form is required by law (15 U.S.C. 78g and 78w; 12 CFR 220).

The Federal Reserve may not conduct or sponsor, and an organization (or a person) is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time to gather and maintain data in the required form and to review instructions and complete the information collection.

 

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, N.W., Washington, DC 20551; and to the Office of Management and Budget, Paperwork Reduction Project (7100-0019), Washington, DC 20503.

 

 

 

Instructions

This form must be completed only if the purpose of the credit being extended is not to purchase, carry, or trade in securities and the credit is in excess of that otherwise permitted under Regulation T. (See § 220.6(e)(2)). If space is inadequate, attach separate sheet.

 

 

 PART I  

    

Step 1. Account Information

 

 

Non-Purpose Loan Account Number

3ZT047968

 

Step 2. To be Completed by the Customer(s)

LOGO    New loan. Amount of the credit being requested $                                       

LOGO    Non-purpose loan transfer (if applicable)

LOGO    Pershing delivering non-purpose loan account                                      

LOGO    External delivering firm name                                             

LOGO  Credit line increase. New credit line amount $3,300,000.00                                 
Purpose of credit  
The purpose of the credit is described in details as follows

LOGO    Liquidity/Expenses

 

LOGO    Other                                              

Delivery

Are any of the securities listed in Part II to be delivered, or have any such securities been delivered from a bank, broker, dealer, or other person on a “delivery against payment” basis?

LOGO  Yes  LOGO  No

 

LOGO

 

 

 

© 2021 Pershing LLC. Pershing LLC, member FINRA, NYSE, SIPC, is a wholly owned subsidiary of

The Bank of New York Mellon Corporation (BNY Mellon). Trademark(s) belong to their respective owners.

 

PAGE 1 OF 3

FRM-LA-T4-08-21


Statement of Purpose for an Extension of

Credit by a Creditor (Federal Reserve  Form T–4)

   Non-Purpose Loan Account Number    3ZT047968

Step 3. Signature(s)

I (We) have read this form and certify that to the best of my (our) knowledge and belief the information given is true, accurate, and complete. Unless otherwise noted in the respective section on page two, the collateral supporting the extension of credit is maintained in the brokerage account referenced above. The borrower acknowledges that no part of this credit will be used to purchase, carry, or trade in securities.

This form should not be signed if blank. A borrower who falsely certifies the purpose of a credit on this form or otherwise willfully or intentionally evades the provisions of Regulation T will also violate Federal Reserve Regulation X, “Borrowers of Securities Credit.”

 

Primary Account Owner

 

    

Print Name

  

Date

 ANDREW SIMS

  

05-29-2024

Signature

/s/ Andrew Sims

    

Additional Account Owner

 

    

Print Name

  

Date

MARC HEDRICK

  

05-29-2024

Signature

/s/ Marc Hedrick

    

Additional Account Owner

 

    

Print Name

 

  

Date

Signature

X

    

Please Complete if a Trust, Corporation, Partnership, or Other Entity

 

    

Print Name of Entity

  

Date

PLUS THERAPEUTICS INC

  

05-29-2024

Title

    

CFO

    

Signature

/s/ Andrew Sims

    

 

 

© 2021 Pershing LLC. Pershing LLC, member FINRA, NYSE, SIPC, is a wholly owned subsidiary of

   PAGE 2 OF 3

The Bank of New York Mellon Corporation (BNY Mellon). Trademark(s) belong to their respective owners.

   FRM-LA-T4-08-21