Unofficial Consolidation: Form 32-505F1 Information Report for United States Broker-Dealers and Advisers Servicing U.S. Clients from Ontario

Unofficial Consolidation: Form 32-505F1 Information Report for United States Broker-Dealers and Advisers Servicing U.S. Clients from Ontario

Unofficial Consolidation Forms

Ontario Securities Commission

Form 32-505F1

Unofficial consolidation current to 2015-06-05.

This document is not an official statement of law or policy and should be used for reference purposes only.

Form 32-505F1
INFORMATION REPORT FOR UNITED STATES BROKER-DEALERS
AND ADVISERS SERVICING U.S. CLIENTS FROM ONTARIO

Complete the applicable sections.

Indicate if you intend to rely on any of the following:

the dealer registration exemption in Part 2 of the Rule.

the adviser registration exemption in Part 3 of the Rule.

Indicate the jurisdiction(s) in which:

(i)           the U.S. broker-dealer has representatives that trade to, with, or on behalf of, U.S. clients, or

(ii)          the U.S. adviser has representatives who are acting as advisers to U.S. clients.

AB

BC

MB

NB

NL

NS

NT

NU

ON

PE

QC

SK

YT

_______________________________________________________________

[Name of U.S. broker-dealer or U.S. adviser]

_______________________________________________________________

[Address]

_______________________________________________________________

[Telephone number]

_______________________________________________________________

[NRD number, if applicable]

_______________________________________________________________

[Name of registered firm in a jurisdiction of Canada with which the U.S. broker-dealer or U.S. adviser is affiliated, has a business arrangement, or shares employees or offices]

_______________________________________________________________

[NRD number of above noted registered firm]

_______________________________________________________________

[Name of individual responsible for ensuring conditions to use this exemption are met]

_______________________________________________________________

[Telephone number for responsible individual]

_______________________________________________________________

[E-mail address for responsible individual]

_______________________________________________________________

[Names of representatives who are acting in Ontario as advisers to U.S. clients, or that, in Ontario, trade to, with, or on behalf of, U.S. clients. Use separate sheet if necessary]

_______________________________________________________________

[Date]