Alberta Gazette — 31 January (i)
0131 i
Alberta — Gazette
THE ALBERTA GAZETTE,
PART I, JANUARY 31, 2003
The Alberta Gazette
PART 1
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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: