Authorized Affiliate Certificate pursuant to subsection 3.1(2.1)) of National Instrument 33-109 Registration Information

1. ____________________________ (firm name), NRD# _______________ (the registered firm) hereby delegates to ____________________________ (firm name), NRD# _______________ (the authorized affiliate) the duty to notify the regulator or, in Québec, the securities regulatory authority of a change to any information set out in any of the following items or parts of Form 33-109F6 Firm Registration:

 

• item 3.12 [Ownership chart];
• item 4.1 [Securities registration];
• item 4.3 [Membership of exchange or SRO];
• item 4.5 [Refusal of registration, licensing or membership];
• item 4.6 [Registration for other financial products];
• part 7 [Regulatory action]; or
• part 8 [Legal action].

 

2. The authorized affiliate is an affiliate of the registered firm and is registered under securities legislation with the same principal regulator as the registered firm.

 

3. The following certification of the registered firm applies to each notice of change submitted by the authorized affiliate:

 

“I have read this form and understand all matters within this form, including the questions, and to the best of my knowledge and after reasonable inquiry, all of the information provided on this form is true and complete.”

 

The registered firm represents that the above delegations and certifications are validly authorized acts of the registered firm and that the above representations and information provided in this certificate, after reasonable inquiry, are true and complete.

 

 

Name (authorized signing officer or partner of the Registered Firm)		Date