Alberta Gazette — 31 January (i)

0131 i

Alberta — Gazette

Alberta Gazette — 31 January (i)

0131 i

Alberta — Gazette

THE ALBERTA GAZETTE,

PART I, JANUARY 31, 2003

The Alberta Gazette

PART 1

_______________________________________________________________________

_______________________________________________________________________

Vol. 99 EDMONTON, FRIDAY, JANUARY 31, 2003 No. 2

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APPOINTMENTS

PROVINCIAL COURT ACT

Supernumerary Judge Re-appointed

January 1, 2003

The Honourable Judge Hurbert Benjamin Casson of Edmonton

The above re-appointments are for a two year

term._______________________________________________________________________

RESIGNATIONS AND RETIREMENTS

PROVINCIAL COURT ACT

Death of Provincial Court Judge

December 16, 2002

Honourable Judge Pierre-Michel Dube, of Edmonton

_______________

Resignation of Non-Presiding Justice of the Peace

February 1, 2003

Martin, Kelly Leigh, of St. Paul

_______________________________________________________________________

GOVERNMENT NOTICES

AGRICULTURE, FOOD AND RURAL DEVELOPMENT

FORM 15

(Irrigation Districts Act)

(Section 88)

NOTICE TO IRRIGATION SECRETARIAT:

CHANGE OF AREA OF AN IRRIGATION DISTRICT

On behalf of the Bow River Irrigation District, I hereby request that the

Irrigation Secretariat forward a certified copy of this notice to the

Registrar of Land Titles for the purposes of registration under

section 23

of the Land Titles Act and arrange for notice to be published in the

Alberta Gazette.

The following parcels of land should be ADDED to the irrigation district

and the appropriate notation added to the certificate of title:

Short Legal Description

Title Number

Linc

N.W. 6-15-18-W4M

011 337 625

I certify that the procedures required under

Part 4 of the Irrigation

Districts Act have been completed and the area of the Bow River Irrigation

District should be changed according to the above list.

Len Ring, Manager.

Irrigation Secretariat.

_______________________________________________________________________

FORM 15

(Irrigation Districts Act)

(Section 88)

NOTICE TO IRRIGATION SECRETARIAT:

CHANGE OF AREA OF AN IRRIGATION DISTRICT

On behalf of the Western Irrigation District, I hereby request that the

Irrigation Secretariat forward a certified copy of this notice to the

Registrar of Land Titles for the purposes of registration under

section 23

of the Land Titles Act and arrange for notice to be published in the

Alberta Gazette.

The following parcels of land should be ADDED to the irrigation district

and the appropriate notation added to the certificate of title:

Short Legal Description

Title Number

Linc

SW 34-26-25-W4

001 197 096

0023 204 589

NW 34-26-25-W4

001 197 096

0023 204 571

SE 33-26-25-W4

961 211 222

0021 855 417

NE 33-26-25-W4

001 197 102+1

SW 33-26-25-W4

961 211 222

0021 855 409

I certify that the procedures required under

Part 4 of the Irrigation

Districts Act have been completed and the area of the Western Irrigation

District should be changed according to the above list.

Laurie Hodge, Office Manager.

Irrigation Secretariat.

ENERGY

UNIT AGREEMENT

(Mines and Minerals Act)

Notice is hereby given, pursuant to

section 146 of the Mines and Minerals

Act, that the Minister of Energy on behalf of the Crown has executed

counterparts of the agreement entitled "Unit Agreement - Kakwa Main Unit"

with respect to M6 R5 T63: 19N; 30 and M6 R6 T63: 24; 25 and that the

enlargement became effective on August 1, 2002.

FINANCE

INSURANCE NOTICE

(Insurance Act)

CLARICA LIFE INSURANCE COMPANY / SUN LIFE ASSURANCE

COMPANY OF CANADA

Effective December 31, 2002, Clarica Life Insurance Company amalgamated

with Sun Life Assurance Company of Canada. The continuing company is Sun

Life Assurance Company of Canada.

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions._______________

LONDON GUARANTEE INSURANCE COMPANY / ST. PAUL

GUARANTEE INSURANCE COMPANY

Effective January 1, 2003 London Guarantee Insurance Company changed its

name to St. Paul Guarantee Insurance Company.

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions._______________

MARYLAND CASUALTY COMPANY

Notice is hereby given that Maryland Casualty Company has withdrawn from

the Province of Alberta as at December 31, 2002.

Dated at Edmonton, Alberta, December 17, 2002

1-2 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions. _______________

PHOENIX LIFE INSURANCE COMPANY

Notice is hereby given that Phoenix Life Insurance Company withdrew from

the Province of Alberta as at December 31, 2002.

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions. _______________

ALBERTA SCHOOL BOARDS INSURANCE

Alberta School Boards Insurance has taken out a licence in the Province of

Alberta, and is authorized to transact the following classes of insurance:

Liability and Property

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions.

GENESIS RECIPROCAL INSURANCE EXCHANGE

Genesis Reciprocal Insurance Exchange has taken out a licence in the

Province of Alberta, and is authorized to transact the following classes of

insurance:

Liability and Property

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial Institutions.

_______________

PBC HEALTH BENEFITS SOCIETY

PBC Health Benefits Society has taken out a licence in the Province of

Alberta, and is authorized to transact the following classes of insurance:

Accident and Sickness

2-3 A. Hagan, Deputy Superintendent of Insurance

and Financial

Institutions._______________________________________________________________________

INFRASTRUCTURE

SALE OR DISPOSITION OF LAND

(Government Organization Act)

Name of Purchaser: Walton International Group Inc.

Consideration: $1,919,145.60

Land Description: Meridian 4 Range 24 Township 54

Section 2. All that

portion of the north east quarter lying south west of the Transportation

and Utility Corridor on Plan 8821928 and north east of Subdivision Plan

7722209, containing 65.66 acres more or less. Excepting thereout plan

0221202 - right of way - 6.65 acres more or less. Excepting thereout all

mines and minerals. Located in the City of Edmonton.

Plan 7722209, Block 2, containing 57.08 acres more or less. Excepting

thereout

a) plan 9320734 - descriptive - 16.41 acres more or less;

b) plan

0221202 - right of way - 0.19 acres more or less (area "A"). Excepting

thereout all mines and minerals. Located in the City of Edmonton.

Meridian 4 Range 24 Township 54

Section 11. All that portion of the south

west quarter described as follows: commencing at the south west corner of

the said quarter section; thence northerly along the west boundary thereof

660 feet; thence easterly and parallel to the south boundary of the said

quarter

section 1320 feet; thence southerly and parallel to the said west

boundary to its intersection with the said south boundary; thence westerly

along the boundary to the point of commencement and lying south east of the

Transportation and Utility Corridor on Plan 8821928, containing 2.96 acres

more or less. Excepting thereout plan 0221202 - right of way - 0.20 acres

more or less (area "A"). Excepting thereout all mines and minerals. Located

in the City of Edmonton.

Meridian 4 Range 24 Township 54

Section 11. All that portion of the south

west quarter lying south west of the Transportation and Utility Corridor

shown on Plan 8821928 and east of a line drawn parallel to the west

boundary from a point on the south boundary 1320 feet easterly from the

south west corner of the said quarter section, containing 9.34 acres more

or less. Excepting thereout plan 0221202 - right of way - 3.53 acres more

or less (area "A"). Excepting thereout all mines and minerals. Located in

the City of Edmonton.

Name of Purchaser: 947259 Alberta Ltd.

Consideration: $435,000

Land Description: Railway right-of-way containing 79.91 acres more or less

as shown outlined in red on filed Plan 5814NY. Excepting thereout

a) plan

1712RS - right of way - 0.14 acres more or less;

b) plan 1850RS - road -

4.85 acres more or less;

c) plan 9722052 - road - 1.11 acres more or less;

d) plan 9822349 - descriptive - 10.08 acres more or less. Excepting

thereout all mines and minerals. Located in the City of Grande Prairie.

Name of Purchaser: Planet Wide Investments Inc.

Consideration: $650,000

Land Description: Meridian 4 Range 29 Township 25

Section 12. That portion

of south east quarter which lies north west of the right of way on Plan

9110968 containing 3.36 acres more or less. Excepting thereout all mines

and minerals. Located in the City of Calgary.

Meridian 4 Range 29 Township 25

Section 12. That portion of north east

quarter which lies west of the right of way on Plan 9110968 containing 9.74

acres more or less. Excepting thereout all mines and minerals. Located in

the City of Calgary.

Name of Purchaser: MacEwan West Developments Ltd.

Consideration: $1,800,000

Land Description: Plan 3746MC Block A containing 78.63 acres more or less.

Excepting thereout plan 8822409 - right of way - 41.54 acres more or less.

Excepting thereout all mines and minerals. Located in the City of Edmonton.

Name of Purchaser: Evelyn Schneider and Peregrine Leasing Inc.

Consideration: $495,750

Land Description: Right of Way of the Alberta Resources Railway Corporation

containing 46.15 acres more or less as shown outlined red on Railway Plan

5814NY. Excepting thereout

a) plan 4863TR - road - 8.39 acres more or less;

b) plan 9520679 - railway - 8.00 acres more or less;

c) plan 0024011 - road

- 0.85 acres more or less. Excepting thereout all mines and minerals.

Located in the City of Grande Prairie.

Name of Purchaser: Stephen K. Ghory and Sharon L. Ghory

Consideration: $95,000

Land Description: Plan 515EO Block 2 Lot 20. Excepting thereout all mines

and minerals. Located in the City of Cold Lake.

Name of Purchaser: MacEwan West Ltd.

Consideration: $144,500

Land Description: Meridian 4 Range 24 Township 51

Section 30-R. All that

portion of the north west quarter lying south and east of

Transportation/Utility Corridor right of way plan 8822409; containing 2.89

acres more or less. Excepting thereout all mines and minerals. Located in

the City of Edmonton.

_______________________________________________________________________

JUSTICE

PUBLIC TRUSTEE OFFICE

UNCLAIMED BALANCES

For the Period November 1, 2002 to December 31, 2002

(Public Trustee Act)

Beneficiary Name

Amount Remitted

Date Remitted

Estate Name

BRUNETTE, Stella

$4,224.61

11/15/2002

SESTOPALI, Elisabeth

MIKSI, Geza Tibor, Missing Spouse of

$6,026.29

12/20/2002

MIKSI, Geza Tibbor, Spouse of

TKACHYK, John missing beneficiary

$686.09

11/08/2002

TKACHYK, John

_______________________________________________________________________

SAFETY CODES

MUNICIPAL ACCREDITATION

(Safety Codes Act)

Pursuant to

section 26 of the Safety Codes Act, it is hereby ordered that

- Town of Rimbey, Accreditation No. M000160, Order No. O00001407,

December 19, 2002

authorized to administer the Safety Codes Act within their jurisdiction for

Plumbing, all parts of the Canadian Plumbing Code, Alberta Amendments and

Regulations, excluding any or all things, processes or activities owned by

or under the care and control of corporations accredited by the Safety

Codes Council.

_______________

Pursuant to

section 26 of the Safety Codes Act, it is hereby ordered that

- Town of Rimbey, Accreditation No. M000160, Order No. O00001408,

December 19, 2002

authorized to administer the Safety Codes Act within their jurisdiction for

Electrical, excluding any or all things, processes or activities owned by

or under the care and control of corporations accredited by the Safety

Codes Council.

_______________

Pursuant to

section 26 of the Safety Codes Act, it is hereby ordered that

- Town of Rimbey, Accreditation No. M000160, Order No. O00001409,

December 19, 2002

authorized to administer the Safety Codes Act within their jurisdiction for

Gas, all parts of the Canadian Gas Association, Propane and Natural Gas

Codes, Alberta Amendments and Regulations, excluding Propane and Natural

Gas Highway Vehicle Conversions, excluding any or all things, processes or

activities owned by or under the care and control of corporations

accredited by the Safety Codes Council.

ALBERTA SECURITIES COMMISSION

ALBERTA SECURITIES COMMISSION RULES (GENERAL)

AMENDMENT RULE

1 The Alberta Securities Commission Rules (General) are amended by this

Rule.

2 Sections 47, 48, and 53 are repealed.

3 Form 3 is amended

(

a) in

section 10(

a) by striking out "Form 4" and substituting

"Form 33-109F4";

(

b) by repealing

section 10(

b) and substituting the following:

(

b) for each person who is a non-registered individual of the

applicant and not referred to in clause (a), a completed Form 33-109F4, and

(

c) by adding the following after

section 11:

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of

and used by the securities regulatory authorities set out below for the

administration and enforcement of certain provisions of the securities

legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario,

Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and

Labrador, Northwest Territories, Yukon Territory and Nunavut.

If you have any questions about the collection and use of this information,

you may contact the securities regulatory authority in any jurisdiction in

which the required information is filed, at the address or telephone number

provided in

Schedule "A".

(

d) by adding the following

Schedule to Form 3:

SCHEDULE "A"

Notice and collection and use of personal information

Contact Information

Alberta

Alberta Securities Commission,

4th Floor, 300 B 5th Avenue S.W.

Calgary, AB T2P 3C4

Attention: Information Officer

Telephone: (403) 297-6454

British Columbia

British Columbia Securities Commission

P.O. Box 10142, Pacific Centre

701 West Georgia Street

Vancouver, BC V7Y 1L2

Attention: Freedom of Information Officer

Telephone: (604) 899-6500 or (800) 373-6393 (in BC)

Manitoba

The Manitoba Securities Commission

1130-405 Broadway

Winnipeg, MB R3C 3L6

Attention: Director - Legal

Telephone: (204) 945-4508

New Brunswick

Securities Administration Branch

PO Box 5001

606, 133 Prince William Street

Saint John, NB E2L 4Y9

Attention: Deputy Administrator, Capital Markets

Telephone: (506) 658-3021

Newfoundland and Labrador

Securities Commission of Newfoundland and Labrador

P.O. Box 8700, 2nd Floor, West Block

Confederation Building

St. John's, NF A1B 4J6

Attention: Director of Securities

Tel: (709) 729-4189

Nova Scotia

Nova Scotia Securities Commission

2nd Floor, Joseph Howe Building

1690 Hollis Street

P.O. Box 458

Halifax, NS B3J 3J9

Attention: FOI Officer

Telephone: (902) 424-7768

Northwest Territories

Government of the Northwest Territories

P.O. Box 1320

Yellowknife, NWT X1A 2L9

Attention: Deputy Registrar of Securities

Telephone: (867) 920-8984

Nunavut

Legal Registries Division

Department of Justice

Government of Nunavut

P.O. Box 1000 Station 570

Iqaluit, NU X0A 0H0

Attention: Deputy Registrar of Securities

Telephone: (867) 975-6190

Ontario

Ontario Securities Commission

Suite 1903, Box 55

20 Queen Street West

Toronto, ON M5H 3S8

Attention: FOI Coordinator

Telephone: (416) 593-8314

Prince Edward Island

Securities Registry

Office of the Attorney General B Consumer, Corporate and Insurance Services

Division

P.O. Box 2000

Charlottetown, PE C1A 7N8

Attention: Deputy Registrar of Securities

Telephone: (902) 368-4569

Qu‚bec

Commission des valeurs mobiliŠres du Qu‚bec

Stock Exchange Tower

P.O. Box 246, 22nd Floor

800 Victoria Square

Montr‚al, PQ H4Z 1G3

Attention: Responsable de l'accŠs … l'information

Telephone: (514) 940-2150 or

(800) 361-5072 (in Qu‚bec)

Saskatchewan

Saskatchewan Securities Commission

800 B1920 Broad Street

Regina, SK S4P 3V7

Attention: Director

Telephone: (306) 787-5842

Yukon

Department of Community Services Yukon

P.O. Box 2703

Whitehorse, YU Y1A 2C6

Attention: Registrar of Securities

Telephone: (867) 667-5225

4 This rule comes into force on February 21, 2003.

_______________________________________________________________________

MULTILATERAL INSTRUMENT 31-102

NATIONAL REGISTRATION DATABASE

TABLE OF CONTENTS

PART TITLE PAGE

PART 1

DEFINITIONS AND

INTERPRETATION

1.1

Definitions 1

1.2

Interpretation 2

PART 2 INFORMATION TO BE SUBMITTED IN NRD FORMAT

2.1 Registration Information 2

PART 3 MAKING NRD SUBMISSIONS

3.1 NRD Submissions 2

3.2 Ongoing Firm Filer Requirements 3

PART 4 PAYMENT OF FEES THROUGH NRD

4.1 Payment of Submission Fees 3

4.2 Payment of Annual Registration Fees 3

4.3 Payment of NRD User Fees - Annual 4

PART 5 TEMPORARY HARDSHIP EXEMPTION

5.1 Temporary Hardship Exemption 4

PART 6 EXEMPTION

6.1 Exemption 5

PART 7 TRANSITION

7.1

Definitions 5

7.2 NRD Enrolment for Transition Firms 5

7.3 NRD Submissions before NRD Access Date 5

7.4 Accuracy of Business Location Information 5

7.5 Individuals Included in the Data Transfer 5

7.6 Individuals not Included in the Data Transfer 7

7.7 Changes to Form 4 Information - Registered Individuals 7 7.8 Changes to Form 4 Information - Non-registered Individuals 7

7.9 Pending Application to Change Individual's Registration

Category 8

7.10 Currency of Form 33-109F4 8

7.11 Termination or Cessation of Relationship 8

PART 8 EFFECTIVE DATE

8.1 Effective Date 9

MULTILATERAL INSTRUMENT 31-102

NATIONAL REGISTRATION DATABASE

PART 1

DEFINITIONS AND

INTERPRETATION

1.1

Definitions - In this Instrument

"authorized firm representative" or "AFR" means, for a firm filer, an

individual with his or her own NRD user ID and who is authorized by the

firm filer to submit information in NRD format for that firm filer and

individual filers with respect to whom the firm filer is the sponsoring

firm;

"chief AFR" means, for a firm filer, an individual who is an AFR and

has accepted an appointment as a chief AFR by the firm filer;

"firm filer" means a person or company that is required under

securities legislation to make an NRD submission in accordance with this

Instrument and that is registered as, or has applied for registration as, a

dealer, adviser, or underwriter;

"individual filer" means an individual that is required under

securities legislation to make an NRD submission in accordance with this

Instrument;

"MI 33-109" means Multilateral Instrument 33-109 Registration

Information;

"National Registration Database" or "NRD" means the online electronic

database of registration information regarding NRD filers and includes the

computer system providing for the transmission, receipt, review and

dissemination of that registration information by electronic means;

"NRD account" means an account with a member of the Canadian Payments

Association from which fees may be paid with respect to NRD by electronic

pre-authorized debit;

"NRD administrator" means CDS INC. or a successor appointed by the

securities regulatory authority to operate NRD;

"NRD filer" means an individual filer or a firm filer;

"NRD format" means the electronic format for submitting information

through the NRD website;

"NRD number" means the unique number first generated by NRD to

identify an NRD filer, a non-registered individual, or a business location;

"NRD submission" means information that is submitted under securities

legislation or securities directions in NRD format, or the act of

submitting information under securities legislation or securities

directions in NRD format, as the context requires;

"NRD website" means the website operated by the NRD administrator for

NRD submissions;

1.2

Interpretation - Terms defined in MI 33-109 and used in this

Instrument have the respective meanings ascribed to those terms in MI

33-109.

PART 2 INFORMATION TO BE SUBMITTED IN NRD FORMAT

2.1 Registration Information - A person or company that is required to

submit any of the following to the securities regulatory authority or

regulator must make the submission in NRD format:

1. Form 33-109F1;

2. Form 33-109F2;

3. Form 33-109F3;

4. Form 33-109F4 or a change to any information previously

submitted in respect of Form 33-109F4.

PART 3 MAKING NRD SUBMISSIONS

3.1 NRD Submissions

(1) An NRD filer that is required under securities legislation to

submit information in NRD format must make that NRD submission

(

a) through the NRD website,

(

b) using the NRD number of the NRD filer, non-registered

individual, or business location, and

(

c) in accordance with this Instrument.

(2) A requirement in securities legislation relating to the format

in which a document or other information to be submitted must be printed,

or specifying the number of copies of a document that must be submitted,

does not apply to an NRD submission required to be made in accordance with

this Instrument.

(3) An NRD filer making an NRD submission must make the NRD

submission through an AFR.

3.2 Ongoing Firm Filer Requirements - A firm filer must

(

a) be enrolled with the NRD administrator to use NRD;

(

b) have one and no more than one chief AFR enrolled with the

NRD administrator;

(

c) maintain one and no more than one NRD account;

(

d) notify the NRD administrator of the appointment of a

chief AFR within 5 business days of the appointment;

(

e) notify the NRD administrator of any change in the name of

the firm's chief AFR within 5 business days of the change; and

(

f) submit any change in the name of an AFR, other than the

firm's chief AFR, in NRD format within 5 business days of the change.

PART 4 PAYMENT OF FEES THROUGH NRD

4.1 Payment of Submission Fees

(1) If a fee is required with respect to an NRD submission, a firm

filer must pay the required fee by electronic pre-authorized debit through

NRD.

(2) A payment under subsection (1) must be made from the firm

filer's NRD account.

4.2 Payment of Annual Registration Fees

(1) If a firm filer is required to pay an annual registration fee,

the firm filer must pay the required fee by electronic pre-authorized debit

through NRD.

(2) A payment under subsection (1) must be made from the firm

filer's NRD account.

4.3 Payment of NRD User Fees - Annual

(1) If a firm filer is required to pay an annual NRD user fee, the

firm filer must pay the required fee by electronic pre-authorized debit

through NRD.

(2) A payment under subsection (1) must be made from the firm

filer's NRD account.

PART 5 TEMPORARY HARDSHIP EXEMPTION

5.1 Temporary Hardship Exemption

(1) If unanticipated technical difficulties prevent an NRD filer

from making a submission in NRD format within the time required under

securities legislation, the NRD filer is exempt from the requirement to

make the submission within the required time period, if the NRD filer makes

the submission in paper format or NRD format no later than 5 business days

after the day on which the information was required to be submitted.

(2) Form 33-109F5 is the paper format for submitting a notice of a

change to Form 33-109F4 information.

(3) If unanticipated technical difficulties prevent an individual

filer from submitting an application in NRD format, the individual filer

may submit the application in paper format.

(4) If an NRD filer makes a paper format submission under this

section, the NRD filer must include the following legend in capital letters

at the top of the first page of the submission:

IN ACCORDANCE WITH

SECTION 5.1 OF MULTILATERAL INSTRUMENT

31-102 NATIONAL REGISTRATION DATABASE (NRD), THIS [SPECIFY DOCUMENT] IS

BEING SUBMITTED IN PAPER FORMAT UNDER A TEMPORARY HARDSHIP EXEMPTION.

(5) If an NRD filer makes a paper format submission under this

section, the NRD filer must resubmit the information in NRD format as soon

as practicable and in any event within 10 business days after the

unanticipated technical difficulties have been resolved.

PART 6 EXEMPTION

6.1 Exemption

(1) The regulator or the securities regulatory authority may grant

an exemption from this Instrument, in whole or in part, subject to such

conditions or restrictions as may be imposed in the exemption.

(2) Despite subsection (1), in Ontario only the regulator may grant

such an exemption.

PART 7 TRANSITION

7.1

Definitions - In this Part

"NRD access date" means, for an NRD firm filer, the date the NRD firm

filer receives notice that it has access to NRD to make NRD submissions;

and

"transition firm" means every dealer, adviser and underwriter that

(

a) is a registered firm on February 3, 2003, or

(

b) is not a registered firm on February 3, 2003 and has

applied for registration before March 31, 2003.

7.2 NRD Enrolment For Transition Firms - A transition firm must enroll to

use NRD by the later of

(

a) February 7, 2003, and

(

b) the date that the firm has applied for registration.

7.3 NRD Submissions before NRD Access Date - Despite any requirement in

this Instrument to submit information in NRD format, a transition firm may

submit information in paper format before the NRD access date.

7.4 Accuracy of Business Location Information - If the information

recorded on NRD for a business location of a transition firm is missing or

inaccurate on the NRD access date, the transition firm must submit a

completed Form 33-109F3 in NRD format in respect of that business location

within 30 business days of the NRD access date.

7.5 Individuals Included in the Data Transfer

(1) Except as provided in subsection (2), in respect of individuals

who were recorded on NRD as registered or non-registered individuals of a

transition firm on the NRD access date, the transition firm must submit

completed Forms 33-109F4 in NRD format for

(a) 5 percent of those individuals by the end of April 2004,

(b) 10 percent of those individuals by the end of May 2004,

(c) 15 percent of those individuals by the end of June 2004,

(d) 20 percent of those individuals by the end of July 2004,

(e) 25 percent of those individuals by the end of August

2004,

(f) 30 percent of those individuals by the end of September

2004,

(g) 35 percent of those individuals by the end of October

2004,

(h) 40 percent of those individuals by the end of November

2004,

(i) 45 percent of those individuals by the end of December

2004,

(j) 50 percent of those individuals by the end of March 2005,

(k) 55 percent of those individuals by the end of April 2005,

(l) 60 percent of those individuals by the end of May 2005,

(m) 65 percent of those individuals by the end of June 2005,

(n) 70 percent of those individuals by the end of July 2005,

(o) 75 percent of those individuals by the end of August

2005,

(p) 80 percent of those individuals by the end of September

2005,

(q) 85 percent of those individuals by the end of October

2005,

(r) 90 percent of those individuals by the end of November

2005,

(s) 95 percent of those individuals by the end of December

2005, and

(

t) all of those individuals by the end of March 2006.

(2) Despite subsection (1), a transition firm is not required to

submit a completed Form 33-109F4 in respect of an individual if another

firm has submitted a completed Form 33-109F4 in respect of the individual.

(3) A transition firm that is exempt under subsection (2) from the

requirement to submit a completed Form 33-109F4 in respect of an individual

must submit the individual's employment location information in NRD format

by the end of March 2006.

7.6 Individuals not Included in the Data Transfer

(1) Except as provided in subsection (2), a transition firm must

submit a completed Form 33-109F4 in NRD format within 30 business days of

the NRD access date for each individual who was not recorded on NRD on the

NRD access date as a registered or non-registered individual of the firm

and for whom the transition firm was the sponsoring firm on the NRD access

date.

(2) Despite subsection (1), a transition firm is not required to

submit a completed Form 33-109F4 in respect of an individual if another

firm has submitted a completed Form 33-109F4 in respect of the individual.

(3) A transition firm that is exempt under subsection (2) from the

requirement to submit a completed Form 33-109F4 in respect of an individual

must submit the individual's employment location information in NRD format

within 30 business days of the NRD access date.

7.7 Changes to Form 4 Information - Registered Individuals - A registered

individual who has submitted a completed Form 33-109F5 under

section 8.5 of

MI 33-109, must submit a completed Form 33-109F4 in NRD format by the later

of 15 business days after

(

a) the NRD access date of the individual's sponsoring firm,

and

(

b) the date that the individual submitted the Form 33-109F5.

7.8 Changes to Form 4 Information - Non-registered Individuals

(1) Except as provided in subsection (2), a transition firm that

has submitted a completed Form 33-109F5 for a non-registered individual

under

section 8.7 of MI 33-109, must submit a completed Form 33-109F4 for

the individual in NRD format by the later of 15 business days after

(

a) the NRD access date, and

(

b) the date that the firm submitted the Form 33-109F5.

(2) Despite subsection (1), a transition firm is not required to

submit a completed Form 33-109F4 in respect of an individual if another

firm has submitted a completed Form 33-109F4 in respect of the individual.

(3) A transition firm that is exempt under subsection (2) from the

requirement to submit a completed Form 33-109F4 in respect of an individual

must submit the individual's employment location information in NRD format

by the later of 15 business days after

(

a) the NRD access date, and

(

b) the date that the firm submitted the Form 33-109F5.

7.9 Pending Application to Change Individual's Registration Category

(1) If an individual submitted an application in paper format to

change his or her category of registration and the category of registration

applied for is not recorded with the individual's record on NRD on the NRD

access date, the individual must

(

a) submit a completed Form 33-109F4 in NRD format within 30

business days after the NRD access date of his or her sponsoring firm, and

(

b) resubmit the application to change his or her category of

registration by submitting a completed Form 33-109F2 in NRD format within 1

business day of submitting the Form 33-109F4 under paragraph (a).

(2) Despite

section 7.10, a Form 33-109F4 submitted under

subsection (1) must contain the individual's categories of registration as

they were recorded on NRD on the NRD access date.

7.10 Currency of Form 33-109F4 - For greater certainty, except as provided

under subsection 7.9(2), a completed Form 33-109F4 that is submitted under

this Part must be current on the date that it is submitted despite any

prior submission in paper format.

7.11 Termination of Relationship - Despite a requirement under this Part

to submit a completed Form 33-109F4, a transition firm is not required to

submit a Form 33-109F4 in respect of an individual if the firm has

submitted a completed Form 33-109F1 in respect of the individual in paper

format before the firm's NRD access date or in NRD format after the firm's

NRD access date.

PART 8 EFFECTIVE DATE

8.1 Effective Date

(1) Part 1,

section 7.1 and

section 7.2 come into force on

February 3, 2003.

(2) Except for

Part 1,

section 7.1 and

section 7.2, this Instrument

comes into force on March 31, 2003.

_______________________________________________________________________

MULTILATERAL INSTRUMENT 33-109

REGISTRATION INFORMATION

TABLE OF CONTENTS

PART TITLE PAGE

PART 1

DEFINITIONS

1.1

Definitions 1

1.2

Interpretation 2

PART 2 APPLICATION FOR REGISTRATION

2.1 Dealer, Adviser and Underwriter Registration 2

2.2 Individual Registration 2

2.3 Commodity Futures Act Registrants 3

PART 3 CHANGES TO REGISTERED FIRM INFORMATION

3.1 Changes to Form 3 Information 3

3.2 Changes to Business Locations 4

3.3 Addition of Non-registered Individuals 4

PART 4 CHANGES TO REGISTERED INDIVIDUAL INFORMATION

4.1 Changes to Form 33-109F4 Information 4

4.2 Application to Change or Surrender Individual Registration Categories 4

4.3 Termination of Relationship 4

PART 5 CHANGES TO NON-REGISTERED INDIVIDUAL INFORMATION

5.1 Changes to Form 33-109F4 Information 5

5.2 Termination of Relationship 5

PART 6 DUE DILIGENCE AND RECORD-KEEPING

6.1 Sponsoring Firm Obligations 5

PART 7 EXEMPTION

7.1 Exemption 6

PART 8 TRANSITION TO NRD

8.1

Definitions 6

8.2 Changes to Form 3 Information 6

8.3 Changes to Business Location 7

8.4 Addition of Non-registered Individuals 7

8.5 Changes to Form 4 Information - Registered Individuals 7

8.6 Termination of Relationship - Registered Individuals 7

8.7 Changes to Form 4 Information - Non-registered Individuals 7

8.8 Termination of Relationship - Non-Registered Individuals 8

PART 9 EFFECTIVE DATE

9.1 Effective Date 8

FORM 33-109F1 NOTICE OF TERMINATION

FORM 33-109F2 CHANGE OR SURRENDER OF INDIVIDUAL CATEGORIES

FORM 33-109F3 BUSINESS LOCATIONS OTHER THAN HEAD OFFICE

FORM 33-109F4 REGISTRATION INFORMATION FOR AN INDIVIDUAL

FORM 33-109F5 CHANGE OF REGISTRATION INFORMATION

MULTILATERAL INSTRUMENT 33-109

REGISTRATION INFORMATION

PART 1

DEFINITIONS

1.1

Definitions - In this Instrument

"Form 3" means the required form for an application for registration

as dealer, adviser, or underwriter in the local jurisdiction;

"Form 4" means the form that was required for an application for

registration for an individual in the local jurisdiction before February

21, 2003;

"non-registered individual" means, for a registered firm or for a

person or company that is applying for registration, an individual who is

not registered to trade or advise on behalf of the firm and who

(

a) is a director, partner, officer, or branch manager of the

firm, or

(

b) in Alberta, British Columbia, and Ontario,

(

i) is a director, partner, officer, or branch manager

of the firm, or

(ii) beneficially owns, directly or indirectly, or

exercises control or direction over, 10 percent or more of the voting

securities of the firm;

"MI 31-102" means Multilateral Instrument 31-102 National

Registration Database;

"NRD submission number" means the unique number generated by NRD to

identify each NRD submission;

"registered firm" means a person or company that is registered as a

dealer, adviser, or underwriter;

"registered individual" means, for a registered firm, an individual

who is registered to trade or advise on behalf of the registered firm;

"sponsoring firm" means,

(

a) for a registered individual, the registered firm on whose

behalf the individual trades or advises,

(

b) for an individual applying for registration, the

registered firm, or the person or company applying to become a registered

firm, on whose behalf the individual proposes to trade or advise,

(

c) for a non-registered individual of a registered firm, the

registered firm, or

(

d) for a non-registered individual of a person or company

that is applying for registration, the person or company that is applying

for registration.

1.2

Interpretation - Terms defined in MI 31-102 and used in this

Instrument have the respective meanings ascribed to those terms in MI

31-102.

PART 2 APPLICATION FOR REGISTRATION

2.1 Dealer, Adviser and Underwriter Registration - Except as provided in

subsection 2.3(1), an applicant for registration as a dealer, adviser, or

underwriter must submit to the regulator,

(

a) in paper format, a completed Form 3;

(

b) in accordance with MI 31-102, a completed Form 33-109F3

for each business location of the applicant, other than the applicant's

head office; and

(

c) in accordance with MI 31-102, a completed Form 33-109F4

for each non-registered individual of the applicant who has not applied to

become a registered individual with the applicant under subsection 2.2(1).

2.2 Individual Registration

(1) Except as provided in subsection (2) and subsection 2.3(2), an

individual who applies for registration under securities legislation must

make the application by submitting to the regulator in accordance with MI

31-102 a completed Form 33-109F4.

(2) Despite subsection (1), a non-registered individual of a

registered firm who applies to become a registered individual with the firm

must make the application by submitting to the regulator in accordance with

MI 31-102 a completed Form 33-109F2.

2.3 Commodity Futures Act Registrants

(1) In Manitoba and Ontario, if an applicant for registration under

section 2.1 is registered under the Commodity Futures Act, the applicant

(

a) is not required to submit a completed Form 33-109F3 under

subsection 2.1(

b) for any business location of the applicant that is

recorded on NRD; and

(

b) is not required to submit a completed Form 33-109F4 under

subsection 2.1(

c) for a non-registered individual if the applicant submits

to the regulator, in accordance with MI 31-102, a completed Form 33-109F2

for the individual.

(2) In Manitoba and Ontario, despite subsection 2.2(1), if an

individual applies for registration under securities legislation and is

recorded on NRD with his or her sponsoring firm as registered under the

Commodity Futures Act, the individual must make the application by

submitting to the regulator, in accordance with MI 31-102, a completed Form

33-109F2.

PART 3 CHANGES TO REGISTERED FIRM INFORMATION

3.1 Changes to Form 3 Information

(1) A registered firm must notify the regulator of a change to any

information previously submitted in Form 3, or under this subsection,

within 5 business days of the change.

(2) Except as provided in subsection (3), for the purposes of

subsection (1), a notice of change must be made by submitting a completed

Form 33-109F5 in paper format.

(3) Despite subsection (2), a notice of change under this

section

is not required to be in Form 33-109F5 if the change relates to

(

a) the addition of an officer, partner, or director to the

registered firm, and if a completed Form 33-109F4 in respect of the

officer, partner, or director is submitted under

section 2.2 or 3.3;

(

b) the resignation or termination of an officer, partner or

director of the registered firm, and if a completed Form 33-109F1is

submitted under

section 4.3 or 5.2; or

(

c) a business location other than head office, and if a

completed Form 33-109F3 is submitted under

section 3.2.

3.2 Changes to Business Locations

(1) A registered firm must notify the regulator of the opening of a

business location, other than a new head office, by submitting in

accordance with MI 31-102 a completed Form 33-109F3 within 5 business days

of the opening.

(2) A registered firm must notify the regulator of a change to any

information previously submitted in Form 33-109F3 by submitting in

accordance with MI 31-102 a completed Form 33-109F3 within 5 business days

of the change.

3.3 Addition of Non-registered Individuals - A registered firm must

submit to the regulator in accordance with MI 31-102 a completed Form

33-109F4 for a non-registered individual within 5 business days of the

individual becoming a non-registered individual of the registered firm.

PART 4 CHANGES TO REGISTERED INDIVIDUAL INFORMATION

4.1 Changes to Form 33-109F4 Information

(1) Except as provided in subsection (2), a registered individual

must notify the regulator in accordance with MI 31-102 of a change to any

information previously submitted in Form 33-109F4, or under this

subsection, within 5 business days of the change.

(2) Despite subsection (1), a registered individual must notify the

regulator in accordance with MI 31-102 of a change to information

previously submitted in Item 3 or Item 8 of Form 33-109F4, or under this

subsection, within 1 year of the change.

4.2 Application to Change or Surrender Individual Registration Categories

- A registered individual of a registered firm who applies to change or

surrender his or her registration category with the firm must make the

application by submitting to the regulator in accordance with MI 31-102 a

completed Form 33-109F2.

4.3 Termination of Relationship - A registered firm must, within 5

business days of a termination of an employment, partner, or agency

relationship with a registered individual, notify the regulator of the

termination of the relationship by submitting in accordance with MI 31-102

a completed Form 33-109F1.

PART 5 CHANGES TO NON-REGISTERED INDIVIDUAL INFORMATION

5.1 Changes to Form 33-109F4 Information

(1) Except as provided in subsections (2), (3), and (4), a

registered firm must notify the regulator in accordance with MI 31-102 of a

change to any information previously submitted in Form 33-109F4, or under

this subsection, for a non-registered individual within 5 business days of

the change.

(2) Despite subsection (1) and except as provided in subsection

(4), a registered firm must notify the regulator in accordance with MI

31-102 of a change to information previously submitted in Item 3 of Form

33-109F4, or under this subsection, for a non-registered individual within

1 year of the change.

(3) Despite subsection (1) and except as provided in subsection

(4), a registered firm must notify the regulator of a change to any

information regarding a category of non-registered individual listed in

Item 6 of Form 33-109F4 for a non-registered individual by submitting in

accordance with MI 31-102 a completed Form 33-109F2 within 5 business days

of the change.

(4) Despite subsections (1), (2), and (3), a registered firm is not

required to notify the regulator of a change to information if another firm

has notified the regulator of the change in accordance with MI 31-102 and

within the required time.

5.2 Termination of Relationship - A registered firm must, within 5

business days of an individual ceasing to be a non-registered individual of

the registered firm, notify the regulator in accordance with MI 31-102 of

the termination of the relationship by submitting a completed Form

33-109F1.

PART 6 DUE DILIGENCE AND RECORD-KEEPING

6.1 Sponsoring Firm Obligations

(1) A sponsoring firm must make reasonable efforts to ensure that

information submitted by

(

a) the firm for a non-registered individual or

(

b) a registered individual, or an individual applying for

registration, for whom the firm is the sponsoring firm

is true and complete.

(2) A sponsoring firm must retain all documents used by the firm to

satisfy its obligation under subsection (1),

(

a) in the case of a non-registered individual, for a period

of 7 years after the individual ceases to be a non-registered individual;

(

b) in the case of a registered individual, or an individual

applying for registration, for a period of 7 years after the individual

ceases to be a registered individual with the firm.

(3) Without limiting the generality of subsection (2), if a

registered individual, or an individual applying for registration, appoints

an agent for service, the sponsoring firm must keep the original

Appointment of Agent for Service executed by the individual for the period

of time set out in paragraph (2)(b).

(4) A sponsoring firm that retains a document under subsection

(2) or (3) in respect of an NRD submission must record the NRD submission

number on the document.

PART 7 EXEMPTION

7.1 Exemption

(1) The regulator or the securities regulatory authority may grant

an exemption from this Instrument, in whole or in part, subject to such

conditions or restrictions as may be imposed in the exemption.

(2) Despite subsection (1), in Ontario only the regulator may grant

such an exemption.

PART 8 TRANSITION TO NRD

8.1

Definitions - In this Part

"NRD access date" means, for an NRD firm filer, the date the NRD firm

filer receives notice that it has access to NRD to make NRD submissions;

and

"NRD freeze period" means the period that begins on the day specified

in a notice of the securities regulatory authority and ends on the day that

is 5 business days after the NRD access date.

8.2 Changes to Form 3 Information - A notice of change under

section 3.1

is not required during the NRD freeze period if the change relates to

(

a) the addition of an officer, partner, or director to the

registered firm, and if a completed Form 33-109F4 in respect of the

officer, partner, or director is submitted in accordance with MI 31-102

within 30 business days of the NRD access date;

(

b) the resignation or termination of an officer, partner or

director of the registered firm, and if a completed Form 33-109F1 is

submitted in accordance with MI 31-102 within 30 business days of the NRD

access date; or

(

c) a business location other than head office, and if a

completed Form 33-109F3 is submitted in accordance with MI 31-102 within 30

business days of the NRD access date.

8.3 Changes to Business Location - A registered firm is exempt from the

requirement to make a submission under

section 3.2 during the NRD freeze

period, if the firm makes the submission in accordance with MI 31-102

within 30 business days of the NRD access date.

8.4 Addition of Non-registered Individuals - A registered firm is exempt

from the requirement to make a submission under

section 3.3 during the NRD

freeze period, if the firm makes the submission in accordance with MI

31-102 within 30 business days of the NRD access date.

8.5 Changes to Form 4 Information - Registered Individuals

(1) This

section applies to a registered individual who has not

submitted in accordance with MI 31-102 a completed Form 33-109F4.

(2) A registered individual must notify the regulator of a change

to any information previously submitted in Form 4, or under this

subsection, by submitting a completed Form 33-109F5 in paper format within

5 business days of the change.

(3) A registered individual who has submitted a completed Form

33-109F5 under subsection (2), must submit in accordance with

section 7.7

of MI 31-102 a completed Form 33-109F4.

8.6 Termination of Relationship - Registered Individuals - A registered

firm is exempt from the requirement to make a submission under

section 4.3

during the NRD freeze period, if the firm makes the submission in

accordance with MI 31-102 within 30 business days of the NRD access date.

8.7 Changes to Form 4 Information - Non-registered Individuals

(1) This

section applies to a registered firm that has not

submitted in accordance with MI 31-102 a completed Form 33-109F4 for a

non-registered individual.

(2) A registered firm must notify the regulator of a change to any

information previously submitted in Form 4 for a non-registered individual,

or under this subsection, by submitting a completed Form 33-109F5 in paper

format within 5 business days of the change.

(3) A registered firm that has submitted a completed Form 33-109F5

for a non-registered individual under subsection (2), must submit in

accordance with

section 7.8 of MI 31-102 a completed Form 33-109F4 for the

non-registered individual.

8.8 Termination of Relationship - Non-registered Individuals - A

registered firm is exempt from the requirement to make a submission under

section 5.2 during the NRD freeze period, if the firm makes the submission

in accordance with MI 31-102 within 30 business days of the NRD access

date.

PART 9 EFFECTIVE DATE

9.1 Effective Date - This Instrument comes into force on February 21,

_______________________________________________________________________

FORM 33-109F1

NOTICE OF TERMINATION

Enter the following information using the online version of this submission

at the NRD web site (www.nrd.ca). If the NRD filer is relying on the

temporary hardship exemption in MI 31-102 this form is required to be

delivered to the regulator in paper format.

1. Individual

Name of individual: _____________________________________________________

NRD number of individual: _______________________________________________

2. Business location

Address of business location: ___________________________________________

NRD number of business location: _____________

3. Termination

Effective date of termination: _________________________

Indicate whether the individual:

was dismissed for cause _______________________

was dismissed in good standing _______________________

resigned in good standing _______________________

is deceased _______________________

Include details regarding any:

unresolved client complaints:

internal discipline matters:

restrictions for violation of regulatory requirements:

financial obligations the individual has to clients:

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of

and used by the securities regulatory authorities set out below for the

administration and enforcement of certain provisions of the securities

legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario,

Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and

Labrador, Northwest Territories, Yukon Territory and Nunavut.

If you have any questions about the collection and use of this information,

you may contact the securities regulatory authority in any jurisdiction in

which the required information is filed, at the address or telephone number

provided in

Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at

the time and in the light of the circumstances in which it is submitted, is

misleading or untrue.

CERTIFICATION

The following certification is to be used when submitting this form in NRD

format:

I am making this submission as agent for the NRD filer. By checking

this box I certify that all statements of fact in this submission were

provided to me by the NRD filer.

The following certification is to be used when submitting this form in

paper format:

I, the undersigned, certify that I have read and that I understand

the questions in the notice and the Warning set out above. I also certify

that all statements of fact made in the answers to the questions are true.

____________________________________________ ________________

Signature of authorized officer or partner

Date

____________________________________________

Firm name

SCHEDULE "A"

Notice and collection and use of personal information

Contact Information

Alberta

Alberta Securities Commission,

4th Floor, 300 B 5th Avenue S.W.

Calgary, AB T2P 3C4

Attention: Information Officer

Telephone: (403) 297-6454

British Columbia

British Columbia Securities Commission

P.O. Box 10142, Pacific Centre

701 West Georgia Street

Vancouver, BC V7Y 1L2

Attention: Freedom of Information Officer

Telephone: (604) 899-6500 or (800) 373-6393 (in BC)

Manitoba

The Manitoba Securities Commission

1130-405 Broadway

Winnipeg, MB R3C 3L6

Attention: Director - Legal

Telephone: (204) 945-4508

New Brunswick

Securities Administration Branch

PO Box 5001

606, 133 Prince William Street

Saint John, NB E2L 4Y9

Attention: Deputy Administrator, Capital Markets

Telephone: (506) 658-3021

Newfoundland and Labrador

Securities Commission of Newfoundland and Labrador

P.O. Box 8700, 2nd Floor, West Block

Confederation Building

St. John's, NF A1B 4J6

Attention: Director of Securities

Tel: (709) 729-4189

Nova Scotia

Nova Scotia Securities Commission

2nd Floor, Joseph Howe Building

1690 Hollis Street

P.O. Box 458

Halifax, NS B3J 3J9

Attention: FOI Officer

Telephone: (902) 424-7768

Northwest Territories

Government of the Northwest Territories

P.O. Box 1320

Yellowknife, NWT X1A 2L9

Attention: Deputy Registrar of Securities

Telephone: (867) 920-8984

Nunavut

Legal Registries Division

Department of Justice

Government of Nunavut

P.O. Box 1000 Station 570

Iqaluit, NU X0A 0H0

Attention: Deputy Registrar of Securities

Telephone: (867) 975-6190

Ontario

Ontario Securities Commission

Suite 1903, Box 55

20 Queen Street West

Toronto, ON M5H 3S8

Attention: FOI Coordinator

Telephone: (416) 593-8314

Prince Edward Island

Securities Registry

Office of the Attorney General B Consumer, Corporate and Insurance Services

Division

P.O. Box 2000

Charlottetown, PE C1A 7N8

Attention: Deputy Registrar of Securities

Telephone: (902) 368-4569

Qu‚bec

Commission des valeurs mobiliŠres du Qu‚bec

Stock Exchange Tower

P.O. Box 246, 22nd Floor

800 Victoria Square

Montr‚al, PQ H4Z 1G3

Attention: Responsable de l'accŠs … l'information

Telephone: (514) 940-2150 or

(800) 361-5072 (in Qu‚bec)

Saskatchewan

Saskatchewan Securities Commission

800 B1920 Broad Street

Regina, SK S4P 3V7

Attention: Director

Telephone: (306) 787-5842

Yukon

Department of Community Services Yukon

P.O. Box 2703

Whitehorse, YU Y1A 2C6

Attention: Registrar of Securities

Telephone: (867) 667-5225

_______________________________________________________________________

FORM 33-109F2

CHANGE OR SURRENDER OF INDIVIDUAL CATEGORIES

Enter the following information using the online version of this submission

at the NRD web site (www.nrd.ca). If the NRD filer is relying on the

temporary hardship exemption in MI 31-102 this form is required to be

delivered to the regulator in paper format.

1. Individual

Name of individual: _____________________________________________________

NRD number of individual: _______________________________________________

2. Individual categories

Indicate the individual categories that the individual is adding or

removing:

3. Details of surrender

If the individual is surrendering his or her registration include details

regarding any:

unresolved client complaints:

internal discipline matters:

restrictions for violation of regulatory requirements that

occurred at any time during the individual's employment with the firm:

financial obligations the individual has to clients:

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of

and used by the securities regulatory authorities set out below for the

administration and enforcement of certain provisions of the securities

legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario,

Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and

Labrador, Northwest Territories, Yukon Territory and Nunavut.

By submitting this information you consent to the collection by the

securities regulatory authority of the personal information provided above,

police records, records from other government or non-governmental

regulatory authorities or self-regulatory organizations, credit records and

employment records about you as may be necessary for the securities

regulatory authority to complete its review of the information submitted

above including your continued fitness for registration, if applicable, in

accordance with the legal authority of the securities regulatory authority

for the duration of the period which you remain registered or approved by

the securities regulatory authority. The sources the securities regulatory

authority may contact include government and private bodies or agencies,

individuals, corporations and other organizations.

If you have any questions about the collection and use of this information,

you may contact the securities regulatory authority in any jurisdiction in

which the required information is filed, at the address or telephone number

provided in

Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at

the time and in the light of the circumstances in which it is submitted, is

misleading or untrue.

CERTIFICATION:

The following certification is to be used when submitting this form in NRD

format:

I am making this submission as agent for the individual to whom this

submission relates. By checking this box I certify that all statements of

fact in this submission were provided to me by the individual.

Both of the following certifications are to be used when submitting this

form in paper format:

I, the undersigned, certify that I have read and that I understand the

questions in this form and the Warning set out above.

I also certify that all statements of fact provided in this application are

true.

_______________________________________________ _______________

Signature of applicant or non-registered individual

Date

I, the undersigned, certify on behalf of the sponsoring firm that the

individual will be engaged by the sponsoring firm as a registered

individual or a non-registered individual. I certify that I have, or a

branch manager or another officer or partner has, discussed the questions

set out in this form and I am satisfied that the individual fully

understands the questions.

________________________________________________ _______________

Signature of authorized officer or partner

Date

________________________________________________

Firm name

SCHEDULE "A"

Notice and collection and use of personal information

Contact Information

Alberta

Alberta Securities Commission,

4th Floor, 300 B 5th Avenue S.W.

Calgary, AB T2P 3C4

Attention: Information Officer

Telephone: (403) 297-6454

British Columbia

British Columbia Securities Commission

P.O. Box 10142, Pacific Centre

701 West Georgia Street

Vancouver, BC V7Y 1L2

Attention: Freedom of Information Officer

Telephone: (604) 899-6500 or (800) 373-6393 (in BC)

Manitoba

The Manitoba Securities Commission

1130-405 Broadway

Winnipeg, MB R3C 3L6

Attention: Director - Legal

Telephone: (204) 945-4508

New Brunswick

Securities Administration Branch

PO Box 5001

606, 133 Prince William Street

Saint John, NB E2L 4Y9

Attention: Deputy Administrator, Capital Markets

Telephone: (506) 658-3021

Newfoundland and Labrador

Securities Commission of Newfoundland and Labrador

P.O. Box 8700, 2nd Floor, West Block

Confederation Building

St. John's, NF A1B 4J6

Attention: Director of Securities

Tel: (709) 729-4189

Nova Scotia

Nova Scotia Securities Commission

2nd Floor, Joseph Howe Building

1690 Hollis Street

P.O. Box 458

Halifax, NS B3J 3J9

Attention: FOI Officer

Telephone: (902) 424-7768

Northwest Territories

Government of the Northwest Territories

P.O. Box 1320

Yellowknife, NWT X1A 2L9

Attention: Deputy Registrar of Securities

Telephone: (867) 920-8984

Nunavut

Legal Registries Division

Department of Justice

Government of Nunavut

P.O. Box 1000 Station 570

Iqaluit, NU X0A 0H0

Attention: Deputy Registrar of Securities

Telephone: (867) 975-6190

Ontario

Ontario Securities Commission

Suite 1903, Box 55

20 Queen Street West

Toronto, ON M5H 3S8

Attention: FOI Coordinator

Telephone: (416) 593-8314

Prince Edward Island

Securities Registry

Office of the Attorney General B Consumer, Corporate and Insurance Services

Division

P.O. Box 2000

Charlottetown, PE C1A 7N8

Attention: Deputy Registrar of Securities

Telephone: (902) 368-4569

Qu‚bec

Commission des valeurs mobiliŠres du Qu‚bec

Stock Exchange Tower

P.O. Box 246, 22nd Floor

800 Victoria Square

Montr‚al, PQ H4Z 1G3

Attention: Responsable de l'accŠs … l'information

Telephone: (514) 940-2150 or

(800) 361-5072 (in Qu‚bec)

Saskatchewan

Saskatchewan Securities Commission

800 B1920 Broad Street

Regina, SK S4P 3V7

Attention: Director

Telephone: (306) 787-5842

Yukon

Department of Community Services Yukon

P.O. Box 2703

Whitehorse, YU Y1A 2C6

Attention: Registrar of Securities

Telephone: (867) 667-5225

_______________________________________________________________________

FORM 33-109F3

BUSINESS LOCATIONS OTHER THAN HEAD OFFICE

Enter the following information using the online version of this submission

at the NRD web site (www.nrd.ca). If the NRD filer is relying on the

temporary hardship exemption in MI 31-102 this form is required to be

delivered to the regulator in paper format.

Please select one box:

This form is being submitted to notify the regulator of the opening

of this business location. Complete the entire form.

This form is being submitted to notify the regulator of the closing

of this business location. Complete the entire form.

This form is being submitted to notify the regulator of -the change

of information previously submitted in respect of this business location.

Complete the entire form and describe the information that has changed (for

example, "telephone number" or "type of business location"):

1. Type of business location

_________ branch

_________ sub-branch

2. Supervisor or branch manager

NRD number of the designated supervisor or branch manager:

___________________

Name of designated supervisor or branch manager:

____________________________

3. Business location information

Business address: ________________________________________________________

Telephone number: ( )_________________

Facsimile number: ( )_________________

Mailing address (if different from business address):

___________________________

Notice of Collection and Use of Personal Information

The personal information required under this form is collected on behalf of

and used by the securities regulatory authorities set out below for the

administration and enforcement of certain provisions of the securities

legislation in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario,

Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland and

Labrador, Northwest Territories, Yukon Territory and Nunavut.

If you have any questions about the collection and use of this information,

you may contact the securities regulatory authority in any jurisdiction in

which the required information is filed, at the address or telephone number

provided in

Schedule "A".

WARNING:

It is an offence to submit information that, in a material respect and at

the time and in the light of the circumstances in which it is submitted, is

misleading or untrue.

CERTIFICATION

The following certification is to be used when submitting this form in NRD

format:

I am making this submission as agent for the NRD filer. By checking

this box I certify that all statements of fact in this submission were

provided to me by the NRD filer.

The following certification is to be used when submitting this form in

paper format:

I, the undersigned, certify that I have read and that I understand

the questions in this notice and the Warning set out above. I also certify

that all statements of fact made in the answers to the questions are true.

________________________________________________ _______________

Signature of authorized officer or partner

Date

________________________________________________

Firm name

SCHEDULE "A"

Notice and collection and use of personal information

Contact Information

Alberta

Alberta Securities Commission,

4th Floor, 300 B 5th Avenue S.W.

Calgary, AB T2P 3C4

Attention: Information Officer

Telephone: (403) 297-6454

British Columbia

British Columbia Securities Commission

P.O. Box 10142, Pacific Centre

701 West Georgia Street

Vancouver, BC V7Y 1L2

Attention: Freedom of Information Officer

Telephone: (604) 899-6500 or (800) 373-6393 (in BC)

Manitoba

The Manitoba Securities Commission

1130-405 Broadway

Winnipeg, MB R3C 3L6

Attention: Director - Legal

Telephone: (204) 945-4508

New Brunswick

Securities Administration Branch

PO Box 5001

606, 133 Prince William Street

Saint John, NB E2L 4Y9

Attention: Deputy Administrator, Capital Markets

Telephone: (506) 658-3021

Newfoundland and Labrador

Securities Commission of Newfoundland and Labrador

P.O. Box 8700, 2nd Floor, West Block

Confederation Building

St. John's, NF A1B 4J6

Attention: Director of Securities

Tel: (709) 729-4189

Nova Scotia

Nova Scotia Securities Commission

2nd Floor, Joseph Howe Building

1690 Hollis Street

P.O. Box 458

Halifax, NS B3J 3J9

Attention: FOI Officer

Telephone: (902) 424-7768

Northwest Territories

Government of the Northwest Territories

P.O. Box 1320

Yellowknife, NWT X1A 2L9

Attention: Deputy Registrar of Securities

Telephone: (867) 920-8984

Nunavut

Legal Registries Division

Department of Justice

Government of Nunavut

P.O. Box 1000 Station 570

Iqaluit, NU X0A 0H0

Attention: Deputy Registrar of Securities

Telephone: (867) 975-6190

Ontario

Ontario Securities Commission

Suite 1903, Box 55

20 Queen Street West

Toronto, ON M5H 3S8

Attention: FOI Coordinator

Telephone: (416) 593-8314

Prince Edward Island

Securities Registry

Office of the Attorney General B Consumer, Corporate and Insurance Services

Division

P.O. Box 2000

Charlottetown, PE C1A 7N8

Attention: Deputy Registrar of Securities

Telephone: (902) 368-4569

Qu‚bec

Commission des valeurs mobiliŠres du Qu‚bec

Stock Exchange Tower

P.O. Box 246, 22nd Floor

800 Victoria Square

Montr‚al, PQ H4Z 1G3

Attention: Responsable de l'accŠs … l'information

Telephone: (514) 940-2150 or

(800) 361-5072 (in Qu‚bec)

Saskatchewan

Saskatchewan Securities Commission

800 B1920 Broad Street

Regina, SK S4P 3V7

Attention: Director

Telephone: (306) 787-5842

Yukon

Department of Community Services Yukon

P.O. Box 2703

Whitehorse, YU Y1A 2C6

Attention: Registrar of Securities

Telephone: (867) 667-5225

_______________________________________________________________________

FORM 33-109F4 REGISTRATION INFORMATION FOR AN INDIVIDUAL

SUBMISSION TO NRD

Enter the following information using the online version of this submission

at the NRD web site (www.nrd.ca). If the NRD filer is relying on the

temporary hardship exemption in MI 31-102 this form is required to be

delivered to the regulator in paper format.

INSTRUCTIONS FOR FILING IN PAPER FORMAT

1. This form is to be used by every individual seeking registration from

a securities regulatory authority or a self-regulatory organization or who

is a non-registered individual with a registered firm or a firm seeking

registration.

2. This form is also to be used by any sole proprietor submitting an

application for registration as a dealer, broker, adviser or underwriter to

a securities regulatory authority.

3. Failure to answer all applicable questions may cause delays in the

processing of the application form.

4. This form must be legible.

5. To complete the application, individuals should seek advice from an

authorized officer of the sponsoring firm or from a legal adviser.

6. The number of originally signed copies of the form to be filed with

the self-regulatory organization and/or securities regulatory authority or

similar authority varies from province to province. If unsure of the

procedure, please consult the Registration Department of the

self-regulatory organization to which you are applying or the applicable

securities regulatory authority, or similar authority.

Item 1 - Name

1. Legal name

_______________________________________________________________

Last name First name Second name Third name

(if applicable) (if

applicable)

2. Other names

Are you currently, or have you previously been, known by a name other than

the name provided above?...............................................

Yes No

If "Yes", complete

Schedule "A".

Item 2 - Residential address

Current address

Provide all residential addresses, including any foreign residential

addresses, for the past 10 years.

Current residential address: _________________________________________

(number, street, city, province, territory or state, country,

postal code)

Telephone number: ( ) _______ Resided at this address since:

_______

(YYYY/MM)

If you have resided at this address for less than 10 years, complete

Schedule "B".

Item 3 - Personal information

Personal description

Date of birth: ________________ (YYYY/MM/DD)

Place of birth: ______________________ (city, province, territory or state,

country)

Gender: Female Male

Colour of eyes:

Colour of hair:

Height: imperial units: _________ OR metric units: ___________

Weight: imperial units: _________ OR metric units: ___________

Item 4 - Citizenship

Citizenship information

What is your citizenship?

Canadian

Other, specify: _____________________________________________

If you are a citizen of a country other than Canada, complete the following

for that other citizenship. You are only required to provide the following

information for one citizenship.

Passport number: ______________ Country of citizenship: _____________

Date of issue: ______________

(YYYY/MM/DD)

Place of issue: ______________________________________________ (city, province, territory or state, country)

Item 5 - Registration jurisdictions

Jurisdictions

Indicate, by checking the appropriate box, each province or territory to

which you are submitting this form:

Alberta Northwest Territories Prince Edward Island

British Columbia Nova Scotia Qu‚bec

Manitoba Nunavut Saskatchewan

New Brunswick Ontario Yukon Territory

Newfoundland and Labrador

Item 6 - Individual categories

Categories

Indicate, by checking the appropriate box in

Schedule "C", each

registration category for which you are applying. If you are a

non-registered individual and you are not applying for registration,

indicate each category that describes your position with your sponsoring

firm.

Item 7 - Address and agent for service

1. Address for service

You must have one address for service in each province or territory in

which you are now, or are applying to become, a registered individual or

non-registered individual. A post office box is not an acceptable address

for service. Complete

Schedule "D" for each additional address for service

you are providing.

Address for service: _______________________________________________

(number, street, city, province or

territory, postal code)

Telephone number: ( ) ___________ Fax number: ( ) ____________

E-mail address: ___________________________________________________

2. Agent for service

If you have appointed an agent for service, provide the following

information for the agent. The address for service provided above must be

the address of any agent named below.

Name of agent for service: __________________________________________

Contact person: ___________________________________________________

Last name First name

Item 8 - Proficiency

1. Course or examination information

Complete

Schedule "E" to indicate each course and examination that you have

successfully completed or for which you have received an exemption.

If you are not required under securities legislation or the rules of a

self-regulatory organization to satisfy any course

or examination requirements you are not required to complete this item.

2. Student numbers

If you have a student number with one of the following institutions,

provide it below:

Canadian Securities Institute (CSI): ___________________________________

Investment Funds Institute of Canada (IFIC): ___________________________

Institute of Canadian Bankers (ICB): __________________________________

Association for Investment Management and Research (AIMR): ____________

Canadian Association of Insurance and Financial Advisors (CAIFA): ________

3. Exemption refusal

Has any securities regulatory authority or self-regulatory organization

refused to grant you an exemption from a course, examination or experience

requirement?............................................................

Yes No

If "Yes", complete

Schedule "F".

Item 9 - Location of employment

Location of employment

Provide the following information for the location of the sponsoring firm

at which you will be working. If you will be working out of more than one

location, provide the following information for the location out of which

you will be doing most of your business.

NRD number: _____________

Business address: ____________________________________________

(number, street, city, province, territory or state, country,

postal code)

Telephone number: ( ) ____________ Fax number: ( )_____________

Check here if the mailing address of the location is the same as the

business address provided above. Otherwise, complete the following:

Mailing address:__________________________________________________

(number, street, city, province, territory or state, country,

postal code)

Item 10 - Current employment

Employment information

On

Schedule "G", provide the information requested for your current

business and employment activities, including those with your sponsoring

firm.

Check here if you are not required under securities legislation to

provide this information.

Item 11 - Previous employment

Employment information

On

Schedule "H", provide the information requested for your previous

business and employment activities for the 10-year period before the date

of this application. Include any periods of self-employment or

unemployment during this period. Do not include summer employment while

you were a full-time student.

In addition, provide the information requested for all of your securities

or exchange contracts (including commodity futures contracts and commodity

futures options) business and employment activities during and prior to the

ten-year period.

Check here if you are not required under securities legislation to

provide this information.

Check here if the information required by this

section has been

provided in Item 10.

Item 12 - Resignations and terminations

Resignation and termination information

Have you ever resigned or been terminated following allegations, made by a

client, sponsoring firm, self-regulatory organization, securities

regulatory authority or any other regulatory authority that you:

a) violated investment related statutes, regulations, rules or industry

standards of conduct?

........................................................... Yes No

b) failed to supervise in connection with investment related statutes,

regulations, rules or industry standards of conduct? ....... Yes No

c) committed fraud or the wrongful taking of property?

..........................................................................

Yes No

If "Yes", to any of the above questions, complete

Schedule "I".

Item 13 - Regulatory disclosure

1. Securities regulatory authorities

a) Other than a registration that has been recorded on NRD under the NRD

number you are using to make this submission, are you now, or have you ever

been, registered or licensed to trade in or advise on securities or

exchange contracts (including commodity futures contracts and commodity

futures options) in any province, territory, state or country?.. Yes No

If "Yes", complete

Schedule "J",

section 1(a).

b) Are you now, or have you ever been, a partner, director, officer, or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of any firm which has been

registered or licensed, or is now registered or licensed, to trade in or

advise on securities or exchange contracts (including commodity futures

contracts and commodity futures options) in any province, territory, state

or country?................................................................

Yes No

If "Yes", complete

Schedule "J",

section 1(b).

c) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been refused

registration or a license to trade in or advise on securities or exchange

contracts (including commodity futures contracts and commodity futures

options) in any province, territory, state or

country?............................. Yes No

If "Yes", complete

Schedule "J",

section 1(c).

d) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been denied the

benefit of any exemption from registration provided by securities

legislation or legislation governing exchange contracts (including

commodity futures contracts and commodity futures options) in any province,

territory, state or

country?................................................................

Yes No

If "Yes", complete

Schedule "J",

section 1(d).

e) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been subject to

a cease trade order, a cease distribution order, a suspension or

termination order, any disciplinary proceedings or any order resulting from

disciplinary proceedings pursuant to securities legislation or legislation

governing exchange contracts (including commodity futures contracts and

commodity futures options) in any province, territory, state or country?..

Yes No

If "Yes", complete

Schedule "J",

section 1(e).

2. Self-regulatory organizations

a) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been a member or

participating organization of any stock exchange or other self-regulatory

organization in any province, territory, state or

country?........................ Yes No

If "Yes", complete

Schedule "J",

section 2(a).

b) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been refused

membership or entry as a participating organization in any stock exchange

or other self-regulatory organization in any province, territory, state or

country?...............................................................

Yes No

If "Yes", complete

Schedule "J",

section 2(b).

c) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been subject to

a suspension, expulsion or termination order, or been subject to any

disciplinary proceedings or any order resulting from disciplinary

proceedings conducted by any stock exchange or other self-regulatory

organization in any province, territory, state or

country?............................ Yes No

If "Yes", complete

Schedule "J",

section 2(c).

3. Non-securities regulation

a) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been registered

or licensed under any legislation which requires registration or licensing

to deal with the public in any capacity other than to trade in or advise on

securities or exchange contracts (including commodity futures contracts and

commodity futures options) in any province, territory, state or country?..

Yes No

If "Yes", complete

Schedule "J",

section 3(a).

b) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been refused

registration or a licence under any legislation which requires registration

or licensing to deal with the public in any capacity other than to trade in

or advise on securities or exchange contracts (including commodity futures

contracts and commodity futures options) in any province, territory, state

country?.................................................................

Yes No

If "Yes", complete

Schedule "J",

section 3(b).

c) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been subject to

a suspension or termination order, or disciplinary proceedings or any order

resulting from disciplinary proceedings conducted under any legislation

which requires registration or licensing to deal with the public in any

capacity other than to trade in or advise on securities or exchange

contracts (including commodity futures contracts and commodity futures

options) in any province, territory, state or

country?...................................................... Yes No

If "Yes", complete

Schedule "J",

section 3(c).

Item 14 - Criminal disclosure

Criminal, provincial and territorial offences

With respect to questions (

b) and (

d) below, if you or your firm have

pleaded guilty or been found guilty of an offence, that offence must be

reported even if an absolute or conditional discharge has been granted with

respect to the offence. You are not required to disclose any offence for

which a pardon has been granted under the Criminal Records Act (Canada)

unless the pardon has been revoked. You are not required to disclose

speeding or parking violations.

a) Is there currently an outstanding charge against you alleging an

offence that was committed in any province, territory, state, or country?..

Yes No

If "Yes", complete

Schedule "K",

section (a).

b) Have you, since attaining the age of 18, ever been convicted of,

pleaded guilty to or no contest to an offence that was committed in any

province, territory, state, or

country?......................................... Yes No

If "Yes", complete

Schedule "K",

section (b).

c) Have charges been laid, alleging an offence that was committed in any

province, territory, state, or country against any firm (other than your

sponsoring firm or a firm that is or was registered in a Canadian

jurisdiction and identified in response to Item 13(1)(b)) in which you are

or were at the time of that event a partner, director, officer or holder

of voting securities carrying more than 10 percent of the votes carried by

all outstanding voting securities?......................................

Yes No

If "Yes", complete

Schedule "K",

section (c).

d) Has any firm (other than your sponsoring firm or a firm that is or

was registered in a Canadian jurisdiction and identified in response to

Item 13(1)(b)), when you were a partner, director, officer or holder of

voting securities carrying more than 10 percent of the votes carried by all

outstanding voting securities of that firm, been convicted of, pleaded

guilty to or no contest to an offence that was committed in any province,

territory, state, or country?.........................................

Yes No

If "Yes", complete

Schedule "K",

section (d).

Item 15 - Civil disclosure

Current and past civil proceedings

a) Have you, or has any firm (other than your sponsoring firm or a firm

that is or was registered in a Canadian jurisdiction and identified in

response to Item 13(1)(b)), when you were a partner, director, officer or

holder of voting securities carrying more than 10 percent of the votes

carried by all outstanding voting securities of that firm, been a defendant

or respondent in any civil proceeding in which fraud, theft, deceit,

misrepresentation, or similar conduct is, or was,

alleged?............................... Yes No

If "Yes", complete

Schedule "L",

section (a).

b) Other than what you disclosed in Item 15(a), were you, at the time

the events that led to the civil proceeding occurred, a partner, director

or officer or a holder of securities carrying more than 10 percent of the

votes of all outstanding voting securities of a firm (other than your

sponsoring firm or a firm that is or was registered in a Canadian

jurisdiction and identified in response to Item 13(1)(b)) that is or was a

defendant or respondent in any civil proceeding in which fraud, theft,

deceit, misrepresentation, or similar conduct is or was alleged?.......

Yes No

If "Yes", complete

Schedule "L",

section (b).

Item 16 - Financial disclosure

1. Bankruptcy

Under the law of any province, territory, state, or country have you, or

has any firm (other than your sponsoring firm or a firm that is or was

registered in a Canadian jurisdiction and identified in response to Item

13(1)(b)), when you were a partner, director, officer or holder of voting

securities carrying more than 10 percent of the votes carried by all

outstanding voting securities of that firm:

a) had a petition in bankruptcy issued against you or the firm or made a

voluntary assignment in bankruptcy?............................. Yes

b) made a proposal under any legislation relating to bankruptcy or

insolvency?...........................................................

Yes No

c) been subject to proceedings under any legislation relating to the

winding up, dissolution or companies' creditors arrangement?.........

Yes No

d) been subject to or instituted any proceedings, arrangement or

compromise with creditors (including having a receiver, receiver-manager,

administrator or trustee appointed by or at the request of creditors,

either privately, or through court process, or by order of a regulator, to

hold your

assets)?........................................................... Yes

If "Yes" to any of the above questions, complete

Schedule "M",

section 1.

2. Debt Obligations

Have you ever failed to meet a financial obligation of $500 or more as it

came due, or has any firm (other than your sponsoring firm or a firm that

is or was registered in a Canadian jurisdiction and identified in response

to Item 13(1)(b)), when you were a partner, director, officer or holder of

voting securities carrying more than 10 percent of the votes carried by all

outstanding voting securities of that firm, failed to meet a financial

obligation as it came

due?.......................................................................... Yes No

If "Yes", complete

Schedule "M",

section 2.

3. Surety bond or fidelity bond

Have you ever applied for a surety or fidelity bond and been

refused?..................................................................... Yes No

If "Yes", complete

Schedule "M",

section 3.

4. Garnishments, unsatisfied judgments or directions to pay

Are there currently, or have there been, outstanding against you any of the

following:

a) garnishments,

b) unsatisfied judgments, or

c) directions to pay;

issued by a federal, provincial, territorial or state authority?.......

Yes No

If "Yes", complete

Schedule "M",

section 4.

Item 17 - Related securities firms

Related securities firms and holdings

Are you a partner, director, or officer of a firm (other than your

sponsoring firm) whose principal business is trading in or advising on

securities or exchange contracts (including commodity futures contracts and

commodity futures options) or are you a holder of 10 percent or more of the

voting securities of any firm (including your sponsoring firm) whose

principal business is trading in or advising on securities or exchange

contracts (including commodity futures contracts and commodity futures

options)?.... Yes No

If "Yes", complete

Schedule "N".

Agent for Service

By submitting this form you certify that in each jurisdiction in which you

have appointed an agent for service you have properly executed the

appointment of agent for service required by the regulator or the

securities legislation of that jurisdiction.

Submission to Jurisdiction

By submitting this application you irrevocably and unconditionally submit

to the non-exclusive jurisdiction of the judicial, quasi-judicial and

administrative tribunals of each jurisdiction to which you have submitted

this application and any administrative proceeding in that jurisdiction, in

any action, investigation or administrative, criminal, quasi-criminal,

penal or other proceeding (each, a "Proceeding") arising out of or relating

to or concerning your activities as a registrant or an officer, partner or

director of a registrant under the securities legislation of the

jurisdiction, and irrevocably waive any right to raise as a defence in any

Proceeding any alleged lack of jurisdiction to bring that Proceeding.

Notice of collection and use of personal information

The personal information required under this form is collected on behalf of

and used by the securities regulatory authorities set out below for

purposes of the administration and enforcement of certain provisions of the

securities legislation in British Columbia, Alberta, Saskatchewan,

Manitoba, Ontario, Qu‚bec, Nova Scotia, New Brunswick, Prince Edward

Island, Newfoundland and Labrador, Northwest Territories, Yukon Territory,

and Nunavut.

By submitting this application you consent to the collection by the

securities regulatory authority to which this application is being

submitted of the personal information contained in the application, police

records, records from other government or non-governmental regulatory

authorities or self-regulatory organizations, credit records and employment

records about you as may be necessary for the securities regulatory

authority to complete its review of your application or continued fitness

for registration in accordance with the legal authority of the securities

regulatory authority for the duration of the period which you remain

registered or approved by the securities regulatory authority. The sources

the securities regulatory authority may contact include government and

private bodies or agencies, individuals, corporations and other

organizations.

The principal purpose for which this collection of personal information is

to be used is to assess your suitability for registration and to assess

your continued fitness for registration in accordance with the applicable

securities legislation.

If you have any questions about the collection and use of this information,

you may contact the securities regulatory authority in any jurisdiction in

which the required information is filed, at the address or telephone number

set out in

Schedule "O". In Qu‚bec, questions may also be addressed to

the Commission d'accŠs … l'information du Qu‚bec (1-888-528-7741, web site:

www.cai.gouv.qc.ca).

WARNING: It is an offence to submit information that, in a material respect

and at the time and in the light of the circumstances in which it is

submitted, is misleading or untrue.

Certification

The following certification is to be used when submitting this form in NRD

format:

I am making this submission as agent for the individual to whom this

submission relates. By checking this box I certify that all statements

of fact in this submission were provided to me by the individual.

Both of the following certifications are to be used when submitting this

form in paper format:

I, the undersigned, certify that I have read and that I understand the

questions in this form and the Warning set out above.

I also certify that all statements of fact provided in this application are

true.

__________________________________________ ________________

Signature of applicant or non-registered individual Date

I, the undersigned, certify on behalf of the sponsoring firm that the

individual will be engaged by the sponsoring firm as a registered

individual or a non-registered individual. I certify that I have, or a

branch manager or another officer or partner has, discussed the questions

set out in this form with the individual and I am satisfied that the

individual fully understands the questions.

__________________________________________ _________________

Signature of authorized officer or partner Date

__________________________________________

Firm name

SCHEDULE "A"

Name

Item 1

Other names

________________________________________________________________

Last name First name Second name Third name

(if applicable) (if applicable)

Provide the reasons for the use of this name (for example, marriage,

divorce, court order, commonly used name).

When did you use this name? From: _____________To: ______________

(YYYY/MM) (YYYY/MM)

________________________________________________________________

Last name First name Second name Third name

(if applicable) (if applicable)

Provide the reasons for the use of this name (for example, marriage,

divorce, court order, commonly used name).

When did you use this name? From: _____________To: ______________

(YYYY/MM) (YYYY/MM)

________________________________________________________________

Last name First name Second name Third name

(if applicable) (if applicable)

Provide the reasons for the use of this name (for example, marriage,

divorce, court order, commonly used name).

When did you use this name? From: _____________To: ______________

(YYYY/MM) (YYYY/MM)

SCHEDULE "B"

Residential address

Item 2

Previous addresses

A postal code (or ZIP code) and a telephone number are not required for any

previous address.

Residential address: _______________________________________________

(number, street, city, province, territory or

state, country)

When did you live at this address? From:__________ To: __________

(YYYY/MM) (YYYY/MM)

Residential address: _______________________________________________

(number, street, city, province, territory or

state, country)

When did you live at this address? From:__________ To: __________

(YYYY/MM) (YYYY/MM)

Residential address: _______________________________________________

(number, street, city, province, territory or

state, country)

When did you live at this address? From:__________ To: __________

(YYYY/MM) (YYYY/MM)

Residential address: _______________________________________________

(number, street, city, province, territory or

state, country)

When did you live at this address? From:__________ To: __________

(YYYY/MM) (YYYY/MM)

Residential address: _______________________________________________

(number, street, city, province, territory or

state, country)

When did you live at this address? From:__________ To: __________

(YYYY/MM) (YYYY/MM)

SCHEDULE "C"

Individual categories

Item 6

Categories

Indicate, by checking the appropriate box, each category for which you are

applying.

Alberta

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director

Shareholder

Branch Manager

Officer (Advising)

Officer (Non-Advising)

Junior Officer (Advising)

Partner (Advising)

Partner (Non-Advising)

British Columbia

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director (Trading)

Director (Non-Trading)

Compliance Officer

Shareholder

Branch Manager

Officer (Advising)

Officer (Non-Advising)

Partner (Advising)

Partner (Non-Advising)

Director (Advising)

Director (Non-Advising)

Advising Employee

Manitoba

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director (Trading)

Director (Non-Trading)

Branch Manager

Advising Officer

Advising Partner

Advising Director

Non-Advising Officer

Non-Advising Partner

Non-Advising Director

Advising Employee

Associate Advising Officer

Associate Advising Partner

Associate Advising Director

Associate Advising Employee

Non-trading

Officer

Partner

Futures Contract Portfolio Manager

Associate Futures Contracts Portfolio Manager

Floor Trader

Floor Broker

Local

Adviser

New Brunswick

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director

Shareholder

Compliance Officer

Officer (Advising)

Officer (Non-Advising)

Junior Officer (Advising)

Partner (Advising)

Partner (Non-Advising)

Newfoundland and Labrador

Salesperson

Officer (Trading)

Officer (Non-Trading)

Director

Shareholder

Partner (Trading)

Partner (Non-Trading)

Branch Manager

Officer (Advising)

Officer (Non-Advising)

Director

Shareholder

Partner (Advising)

Partner (Non-Advising)

Branch Manager

Northwest Territories

Salesperson

Officer (Trading)

Officer (Non-Trading)

Director

Partner (Trading)

Partner (Non-Trading)

Sole Proprietor

Shareholder

Branch Manager

Representative (Advising)

Officer (Advising)

Officer (Non-Advising)

Partner (Advising)

Partner (Non-Advising)

Nova Scotia

Salesperson

Officer (Trading)

Officer (Non-Trading)

Sole Proprietor (Trading)

Director

Partner (Trading)

Partner (Non- Trading)

Officer (Advising)

Officer (Non-Advising)

Associate Partner

Partner (Advising)

Partner (Non-Advising)

Sole Proprietor (Advising)

Nunavut

Salesperson

Officer (Trading)

Officer (Non-Trading)

Director

Partner (Trading)

Partner (Non-Trading)

Sole Proprietor

Shareholder

Branch Manager

Representative (Advising)

Officer (Advising)

Officer (Non-Advising)

Partner (Advising)

Partner (Non-Advising)

Ontario

Except as indicated the following categories are available under the

Securities Act and the Commodity Futures Act.

Floor Trader

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Sole Proprietor (Trading)

Director

Advising Representative

Associate Advising Representative (Securities Act category only)

Officer (Advising)

Officer (Non-Advising)

Associate Officer (Securities Act category only)

Partner (Advising)

Partner (Non-Advising)

Associate Partner (Securities Act category only)

Sole Proprietor (Advising)

Shareholder

Prince Edward Island

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director

Shareholder

Branch Manager

Compliance Officer

Counselling Officer (Officer)

Counselling Officer (Partner)

Counselling Officer (Other)

Officer (Non-Advising)

Partner (Non-Advising)

Qu‚bec

Dealer

Salesperson (representative)

Officer

Partner

Director

Director (Non-Industry)

Branch Manager

Adviser

Representative (Advising)

Officer

Partner

Director

Director (Non-Industry)

Branch Manager

Saskatchewan

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director

Employee (Advising)

Officer (Advising)

Officer (Non-Advising)

Partner (Advising)

Partner (Non-Advising)

Yukon

Salesperson

Officer (Trading)

Officer (Non-Trading)

Partner (Trading)

Partner (Non-Trading)

Director

Sole Proprietor (Trading)

Branch Manager

Shareholder

Officer (Advising)

Officer (Non-Advising)

Partner (Advising)

Partner (Non-Advising)

Sole Proprietor (Advising)

Investment Dealers Association of Canada

Partner (Industry)

Partner (Non-Industry)

Director (Industry)

Director (Non-Industry)

Officer (Trading)

Officer (Non-Trading)

Industry Investor

Non-Industry Investor

Chief Compliance Officer

Ultimate Designated Person

Alternate Designated Person

Designated Registered Options Principal

Alternate Registered Options Principal

Designated Registered Futures Options Principal

Alternate Registered Futures Options Principal

Sales Manager

Branch Manager

Co-Branch Manager

Assistant Branch Manager

Futures Contract Options Supervisor

Investment Representative (Mutual Funds)

Investment Representative (Retail)

Investment Representative (Non-Retail)

Investment Representative Options (Retail)

Investment Representative Options (Non-Retail)

Registered Representative (Mutual Funds)

Registered Representative (Retail)

Registered Representative (Non-Retail)

Registered Representative Options (Retail)

Registered Representative Options (Non-Retail)

Registered Futures Contract Representative Options

(Retail)

Registered Futures Contract Representative Options

(Non-Retail)

Trader - CATS

Trader - TradeCDNX

Trader - Commodity Floor Trader

Associate Portfolio Manager - Securities

Associate Portfolio Manager - Security Options

Associate Portfolio Manager - Commodity Futures Options

Portfolio Manager - Securities

Portfolio Manager - Security Options

Portfolio Manager - Commodity Futures Options

Investment Futures Contract Representative Options (Retail)

Investment Futures Contract Representative Option

(Non-Retail)

SCHEDULE "D"

Address and Agent for Service

Item 7

Address for Service

1. Address for service

You must have one address for service in each province or territory in

which you are now, or are applying to become, a registered individual or

non-registered individual. A post office box is not an acceptable address

for service.

Address for service: ______________________________________________

(number, street, city, province or territory,

postal code)

Telephone number: ( ) ___________ Fax number: ( )___________

E-mail address: ____________________________

2. Agent for service

If you have appointed an agent for service, provide the following

information for the agent. The address for service provided above must be

the address of the agent named below.

Name of agent for service: _________________________________________

(if applicable)

Contact person: ___________________________________________________

Last name First name

SCHEDULE "E"

Proficiency

Item 8

Course or examination information

Indicate each course and examination that you have successfully completed

or for which you have received an exemption.

COURSE OR EXAMINATION

DATE COMPLETED

DATE EXEMPTED AND BY WHICH JURISDICTION OR REGULATOR

(YYYY/MM/DD)

30-day Training Program

90-day Training Program

ACE Trader Exam

Agricultural Markets - Risk Management Course (ARM)

Branch Compliance Officers Course

Branch Manager's Examination Course (formerly the Canadian Branch Managers

Qualifying Examination)

Canadian Commodity Futures Examination

Canadian Commodity Supervisors Examination

Canadian Funds Course (Quebec only)

Canadian Futures Exam (Part 1)

Canadian Futures Exam (Part 2)

Canadian Investment Finance Course

Part I

Canadian Investment Finance Course

Part II

Canadian Investment Funds Course

Canadian Investment Management Program (Part 1)

Canadian Investment Management Program (Parts 2)

Canadian Options Course

Canadian Securities Course

CATS Examination-Oral

CATS Examination-Written

Certified Financial Planners Program

Chartered Financial Analyst Charter

Chartered Financial Analyst Course (Level

I) Chartered Financial Analyst Course (Level II)

Chartered Financial Analyst Course (Level III)

Commodity Futures Exam (Part 1)

Commodity Futures Exam (Part 2)

Conduct and Practices Handbook Course

Derivatives Fundamentals Course

Derivatives Operational Management Course

Effective Management Seminar

Energy Markets - Risk Management Course

Ensis Growth Fund Understanding Labour Sponsored Investment Funds (Full

Course)

Examination based on Manual for Registered Representatives (RR Exam)

Fellow of the Canadian Securities Institute

Financial Markets Risk Management Course

Examination based on Manual for Registered Representatives (RR Exam)

Futures Floor Trader Examination (Winnipeg Stock Exchange)

Futures Licensing Course

General Securities Representative Examination (Series 7)

In-House Scholarship Training Program

Investment Funds Course

Investment Management Techniques

Labour Sponsored Investment Funds Course

National Commodity Futures Examination

New Entrants Examination

Officers' Partners' and Directors' Course

Operations Course

Options Licensing Course

Options Strategies Course

Options Supervisors Course

Partners, Directors and Senior Officers Qualifying Examination

Personal Financial Planning Diploma

Portfolio Management Techniques

Principles of Mutual Funds Investment Course

Professional Financial Planning Course

Professional Options Trader Examination

Real Estate Agent's Pre-Licensing Course

Registered Options Principal's Qualifying Examination

Technical Analysis Course (TAC)

Trader Training Course

VCT Trader Exam

Wealth Management Techniques

Other, specify:

Other, specify:

Other, specify:

Other, specify:

SCHEDULE "F"

Proficiency

Item 8

Exemption refusal

Complete the following for each exemption that was refused.

Which securities regulatory authority or self-regulatory organization

refused to grant the exemption?

State the name of the course, examination or experience requirement:

State the reason given for not being granted the exemption:

Which securities regulatory authority or self-regulatory organization

refused to grant the exemption?

State the name of the course, examination or experience requirement:

State the reason given for not being granted the exemption:

SCHEDULE "G"

Current employment

Item 10

Employment information

Provide the information requested for each of your current business and

employment activities, including those with your sponsoring firm.

Unemployed

Full-time student

Employed or self-employed

From: _____________________

(YYYY/MM/DD)

You are only required to fill in the following if you have indicated above

that you are employed or self-employed.

Name of business or employer:

________________________________________________________________

Address of business or employer:

________________________________________________________________

(number, street, city, province, territory or state,

country)

Name and title of immediate supervisor: __________________________

Describe the type of business or employment and your duties. If you are

seeking a type of registration for which specified experience is required,

provide details of that experience below (for example, level of

responsibility, value of accounts under direct supervision, and research

experience):

Indicate the number of hours per week you will be devoting to this business

or employment: _________________

If the business or employment described above is with the sponsoring firm

and if you are working less than 30 hours per week for the firm, explain

why you are working less than 30 hours per week for the firm:

If the business or employment described above is not with the sponsoring

firm, disclose any potential for confusion by clients and any potential for

conflicts of interest arising from your proposed activities as a registrant

and the business or employment described above (include whether the

business is listed on an exchange):

SCHEDULE "H"

Previous employment

Item 11

Employment information

Provide the information requested for your previous business and employment

activities for the 10-year period before the date of this application.

Include any periods of self-employment or unemployment during this period.

Do not include summer employment while you were a full-time student.

In addition, provide the information requested in respect of all of your

securities or exchange contracts (including commodity futures contracts and

commodity futures options) business and employment activities during and

prior to the ten-year period.

Unemployed

Full-time student

Employed or self-employed

From: ________________ To: ________________

(YYYY/MM/DD) (YYYY/MM/DD)

You are only required to fill in the following if you have indicated above

that you are, or were, employed or self-employed.

Name of business or employer:

________________________________________________________________

Address of business or employer:

________________________________________________________________

(number, street, city, province, territory or state,

country)

Name and title of immediate supervisor: _______________________________

Describe the type of business or employment and your duties. If you are

seeking a type of registration for which specified experience is required,

provide details of that experience below (for example, level of

responsibility, value of accounts under direct supervision, and research

experience):

SCHEDULE "I"

Resignations and terminations

Item 12

Resignation and Termination information

For each resignation or termination indicate below, (1) the name of the

firm from which you resigned or were terminated, (2) whether you resigned

or were terminated, (3) the date you resigned or were terminated, and

(4) the circumstances relating to your resignation or termination (including

whether the allegations were made by a client, sponsoring firm,

self-regulatory organization or regulatory authority).

SCHEDULE "J"

Regulatory disclosure

Item 13

1. Securities regulatory authorities

a) For each registration or licence, indicate below (1) the securities

regulatory authority with which you are, or were, registered or licensed,

(2) the type or category of registration or licence, and (3) the dates

between which you held the registration or licence.

b) For each registration or licence, indicate below (1) the name of the

firm, (2) the securities regulatory authority with which the firm is, or

was, registered or licensed, (3) the type or category of registration or

licence, and (4) the dates between which you held the registration or

licence.

c) For each registration or licence refused, indicate below (1) the

party that was refused the registration or licence, (2) the securities

regulatory authority that refused the registration or licence, (3) the type

or category of registration or licence refused, (4) the date of the

refusal, and (5) the reasons for the refusal.

d) For each exemption from registration denied, indicate below (1) the

party that was denied the exemption, (2) the securities regulatory

authority that denied the exemption, (3) the date the exemption was denied,

and (4) any other information that you think is relevant or that is

requested by the regulator.

e) For each order or disciplinary proceeding, indicate below (1) the

party against whom the order was made or the proceeding taken, (2) the

securities regulatory authority that issued the order or that is, or was,

conducting the proceeding, (3) the date any notice of proceeding was

issued, (4) the date any order or settlement was made, (5) a

summary of any

notice, order or settlement (including any sanctions imposed), and (6) any

other information that you think is relevant or that is requested by the

regulator.

2. Self-regulatory organizations

a) For each membership or participation, indicate below (1) the party

that is, or was, a member or participating organization, (2) the

self-regulatory organization with which the party is, or was, a member or

participating organization, (3) the type or category of membership or

participation, and (4) the dates between which the party was a member or

participating organization.

b) For each membership or participation refused, indicate below (1) the

party that was refused membership or participation, (2) the self-regulatory

organization that refused the membership or participation, (3) the type or

category of membership or participation refused, (4) the date of the

refusal, and (5) the reasons for the refusal.

c) For each order or disciplinary proceeding, indicate below (1) the

party against whom the order was made or the proceeding taken, (2) the

self-regulatory organization that issued the order or that is, or was,

conducting the proceeding, (3) the date any notice of proceeding was

issued, (4) the date any order or settlement was made, (5) a

summary of any

notice, order or settlement (including any sanctions imposed), and (6) any

other information that you think is relevant or that is requested by the

regulator.

3. Non-securities regulation

a) For each registration or licence, indicate below (1) the party is, or

was, registered or licensed, (2) with which regulatory authority, or under

what legislation, the party is, or was, registered or licensed, (3) the

type or category of registration or licence, and (4) the dates between

which the party held the registration or licence.

b) For each registration or licence refused, indicate below (1) the

party that was refused registration or licensing, (2) with which regulatory

authority, or under what legislation, the registration or licence was

refused, (3) the type or category of registration or licence refused,

(4) the date of the refusal, and (5) the reasons for the refusal.

c) For each order or disciplinary proceeding, indicate below (1) the

party against whom the order was made or the proceeding taken, (2) the

regulatory authority that made the order or that is, or was, conducting the

proceeding, or under what legislation the order was made or the proceeding

is being, or was, conducted, (3) the date any notice of proceeding was

issued, (4) the date any order or settlement was made, (5) a

summary of any

notice, order or settlement (including any sanctions imposed), and (6) any

other information that you think is relevant or that is requested by the

regulator.

SCHEDULE "K"

Criminal disclosure

Item 14

Criminal, provincial and territorial offences

a) For each charge, indicate below (1) the charge, (2) the date of the

charge, (3) any trial or appeal dates, and (4) the court location.

b) For each conviction, indicate below (1) the offence, (2) the date of

the conviction, and (3) the disposition (state any penalty or fine and the

date any fine was paid).

c) For each charge, indicate below (1) the name of the firm, (2) the

charge, (3) the date of the charge, (4) any trial or appeal dates, and

(5) the court location.

d) For each conviction, indicate below (1) the name of the firm, (2) the

offence, (3) the date of the conviction, and (4) the disposition (state any

penalty or fine and the date any fine was paid).

SCHEDULE "L"

Civil disclosure

Item 15

Current and past civil proceedings

a) For each civil proceeding, indicate below (1) the party that is, or

was, a defendant or respondent, (2) each plaintiff in the proceeding,

(3) whether the proceeding is pending, on appeal or final, (4) the jurisdiction

in which the action is being, or was, pursued, and (5) a

summary of any

disposition or settlement. (Disclosure must include those actions settled

without admission of liability.)

b) For each civil proceeding, indicate below (1) the firm that was a

defendant or respondent in the proceeding, (2) your relationship to the

firm, (3) each plaintiff in the proceeding, (4) whether the proceeding is

pending, on appeal or final, (5) the jurisdiction in which the action is

being, or was, pursued, and (6) a

summary of any disposition or settlement.

(Disclosure must include those actions settled without admission of

liability.)

SCHEDULE "M"

Financial Disclosure

Item 16

1. Bankruptcy

For each event, indicate below (1) the party about whom this disclosure is

being made, (2) any amounts currently owing, (3) the creditors, (4) the

status of the matter, (5) a

summary of any disposition or settlement, and

(6) any other information that you think is relevant or that is requested

by the regulator.

2. Solvency

For each event, indicate below (1) the party that failed to meet its

financial obligation, (2) the amount that was owing at the time the party

failed to meet its financial obligation, (3) the party to whom the amount

is, or was, owing, (4) any relevant dates (for example, when payments are

due or when final payment was made), (5) any amounts currently owing, and

(6) any other information that you think is relevant or that is requested

by the regulator.

3. Surety Bond or Fidelity Bond

For each bond refused, indicate below (1) the name of the bonding company,

(2) the address of the bonding company, (3) the date of the refusal, and

(4) the reasons for the refusal.

4. Garnishments, Unsatisfied Judgments or Directions to Pay

For each garnishment, unsatisfied judgement or direction to pay, indicate

below (1) the amount that was owing at the time the garnishment, judgement

or direction to pay was rendered, (2) the party to whom the amount is, or

was, owing, (3) any relevant dates (for example, when payments are due or

when final payment was made), (4) any amounts currently owing, and (5) any

other information that you think is relevant or that is requested by the

regulator.

SCHEDULE "N"

Related securities firms

Item 17

Section 1 - Related Securities Firms and Holdings

Indicate below (

a) the name of the firm and (

b) your relationship to the

firm.

a) Firm name: ___________________________________________________

b) Relationship to the firm and period of relationship:

Partner From: ____________ To: _____________ (if applicable)

(YYYY/MM) (YYYY/MM)

Director From: ____________ To: _____________ (if applicable)

(YYYY/MM) (YYYY/MM)

Officer From: ____________ To: _____________ (if applicable)

(YYYY/MM) (YYYY/MM)

Holder of From: ____________ To: _____________ (if

applicable)

voting (YYYY/MM) (YYYY/MM)

securities

over

10 percent

If you are a holder of 10 percent or more of the voting securities of the

firm, complete (c), (d), (e), (f), (

g) and (h).

c) State the number, value, class and percentage of securities or the

amount of partnership interest you own or propose to acquire upon approval.

If acquiring shares upon approval, state source (for example, treasury

shares, or if upon transfer, state name of transferor).

d) State the value of subordinated debentures or bonds of the firm to be

held by you or any other subordinated loan to be made by you to the firm

(if applicable):

e) If another party has provided you with funds to invest in the firm,

identify the party and state the relationship between you and that party:

f) Are the funds to be invested (or proposed to be invested) guaranteed

directly or indirectly by any person or firm?..................... Yes

If "Yes", identify the party and state the relationship between you and

that party:

g) Have you either directly or indirectly given up any rights with

respect to such securities or partnership interest, or do you, on approval

of this application, intend to give up any such rights (including by

hypothecation, pledging or depositing as collateral the securities or

partnership interest with any institution or person)?

.................................. Yes No

If "Yes", identify the party, state the relationship between you and that

party and describe the rights that have been or will be given up:

h) Is a person other than you the beneficial owner of the shares, bonds,

debentures, partnership units or other notes held by you? .... Yes No

If "Yes", complete (i), (

j) and (k).

I) Name of beneficial owner:

Document details

CollectionAlberta — Gazette
Citation0131 i
Typegazette
Volume / chapter0131 i
Languageen
Formathtml
SourcePROVINCIAL
Identifier097e90af58b53d7ba9e1ed98db86c6e9888d0f95

Source file is stored in the law ingest library (html).