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Multilateral Instrument: NI - 33-109 - Registration Information Requirements
Multilateral Instrument: NI - 33-109 - Registration Information Requirements
REGISTRATION INFORMATION
PART 1 DEFINITIONS
1.1 Definitions - In this Instrument "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
"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,
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 - An applicant for registration as a dealer, adviser, or underwriter must submit to the regulator,
2.2 Individual Registration
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PART 3 CHANGES TO REGISTERED FIRM INFORMATION
3.1 Changes to Form 3 Information
3.2 Changes to Business Locations
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
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
5.2 Termination of Relationship - A registered firm must, within 5 business days of an individual ceasing to be an 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
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PART 7 EXEMPTION
7.1 Exemption
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PART 8 TRANSITION TO NRD
8.1 Definitions - In this Part "data transfer date" means the day on which the securities regulatory authority will commence the transfer of its record of non-registered individuals, registered individuals, and registered firms to NRD; "NRD access date" means, for an NRD firm filer, the date the NRD firm filer first has access to NRD to make NRD submissions; and "NRD freeze period" means the period that begins on the day that is 5 business days before the data transfer date 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
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
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
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 November 20, 2002. |
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). However, 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
Name of firm: __________________________
Address of relevant business location: __________________________
NRD number of relevant business location: __________________________
3. Individual categories
Indicate the registration or non-registered category of the individual as of the last date of employment:
4. Termination
Effective date of termination: _______________
Indicate whether the individual:
-
was dismissed for cause _______________
-
was dismissed in good standing _______________
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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, 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 set out below.
(In the final draft of the form a list of contact information will be included here.)
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 and that this submission is being made at the request of the NRD filer. OR |
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. |
Dated this _______________ day of _______________ , 20 ________.
Name of firm: __________________________
Authorized signature: __________________________
Print name: __________________________
Title: __________________________
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). However, 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:
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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, 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 set out below.
(In the final draft of the form a list of contact information will be included here.)
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 and that this submission is being made at the request of the NRD filer. |
OR
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 registered or non-registered individual |
Date |
Name of firm: __________________________
Authorized signature: __________________________
Print name: __________________________
Title: __________________________
Date: __________________________
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). However, 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 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, 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 set out below.
(In the final draft of the form a list of contact information will be included here.)
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 and that this submission is being made at the request of the NRD filer. |
OR
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. |
Name of firm: __________________________
Authorized signature: __________________________
Print name: __________________________
Title: __________________________
Date: _______________
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). However, 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 or approval from a securities regulatory authority or a self-regulatory organization. 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 and all attachments added thereto must be legible. 5. All attachments pertaining to any question must be made exhibits to the form and each one must be so marked. All signatures must be originals. 6. To complete the application, individuals should seek advice from an authorized officer of the sponsoring firm or from a legal adviser. 7. 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 through 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
mentioned above? __________________________ [ ] Yes [ ] No
If "Yes", complete Schedule "A".
Item 2 - Residential address
Current and previous addresses
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Item 3 - Personal information
Personal description
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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.
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Item 5 - Registration jurisdictions
Jurisdictions Indicate, by checking the appropriate box, each province or territory to which you are applying:
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Item 6 - Individual categories
Categories Indicate, by checking the appropriate box in Schedule "C", each category for which you are applying.
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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.
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.
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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. [ ] Check here if you are not required under securities legislation or the rules of a self-regulatory organization to satisfy any course or examination requirements. 2. Student numbers Provide your student numbers 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 are currently working or will be working. If you are working, or 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.
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Item 10 - Current employment
Employment information On Schedule "G", provide the information requested about 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 in respect of 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. [ ] 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:
If you have answered "Yes" to any of the above questions provide, for each resignation or termination, (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). |
Item 13 - Regulatory disclosure
1. Securities regulatory authorities
If "Yes", complete Schedule "I", section 1(a).
If "Yes", complete Schedule "I", section 1(b).
If "Yes", complete Schedule "I", section 1(c).
If "Yes", complete Schedule "I", section 1(d).
If "Yes", complete Schedule "I", section 1(e). 2. Self-regulatory organizations
If "Yes", complete Schedule "I", section 2(a).
If "Yes", complete Schedule "I", section 2(b).
If "Yes", complete Schedule "I", section 2(c). 3. Non-securities regulation
If "Yes", complete Schedule "I", section 3(a).
If "Yes", complete Schedule "I", section 3(b).
If "Yes", complete Schedule "I", 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, such 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.
If "Yes", complete Schedule "J", section (a).
If "Yes", complete Schedule "J", section (b).
If "Yes", complete Schedule "J", section (c).
If "Yes", complete Schedule "J", section (d). |
Item 15 - Civil disclosure
Current and past civil proceedings
If "Yes", complete Schedule "K", section (a).
If "Yes", complete Schedule "K", 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:
If "Yes" to any of the above questions, complete Schedule "L", 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, been unable to meet its financial obligations as they came due? __________________________ [ ] Yes [ ] No If "Yes", complete Schedule "L", 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 "L", section 3. 4. Garnishments, unsatisfied judgments or directions to pay Are there currently, or have there been, outstanding against you any of the following:
If "Yes", complete Schedule "L", section 4. |
Item 17 - Related securities firms
Related securities firms and holdings
If "Yes", complete Schedule "M".
If "Yes", complete Schedule "M". |
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, Québec, Nova Scotia, New Brunswick, Prince Edward Island, Newfoundland, 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 below. In Québec, questions may also be addressed to the Commission d'accès à l'information du Québec (1-888-528-7741, web site: www.cai.gouv.qc.ca).
(In the final draft of the form a list of contact information will be included here.)
Self-Regulatory Organizations
The principal purpose for the collection of personal information is to assess your suitability for registration or approval and to assess your continued fitness for registration or approval in accordance with the applicable securities legislation and the by-laws, regulations, rules, rulings and policies (hereinafter collectively referred to as "rules") of the self-regulatory organizations.
By submitting this application, you certify that you are conversant with the rules of the applicable self-regulatory organizations of which you are seeking registration or approval or of which your sponsoring firm is a member or participating organization. You also undertake to become conversant with the rules of any self-regulatory organizations of which you or your sponsoring firm becomes a member or participating organization. You agree to be bound by, observe and comply with these rules as they are from time to time amended or supplemented, and you agree to keep yourself fully informed about them as they are amended and supplemented. You submit to the jurisdiction of the self-regulatory organizations to which you are applying for registration or approval, or of which your sponsoring firm is now or in the future becomes a member or participating organization and, wherever applicable, their Governors, Directors and Committees. You agree that any registration or approval granted pursuant to this application may be revoked, terminated or suspended at any time in accordance with the then applicable rules of the respective self-regulatory organizations. In the event of any such revocation or termination, you must terminate all activities which require registration or approval and, thereafter, not perform services that require registration or approval for any member of the self-regulatory organizations or any approved affiliated company or other affiliate of such member without obtaining the approval of or registration with the self-regulatory organizations, in accordance with their rules.
By submitting this application, you undertake to notify the self-regulatory organizations to which you are applying for registration or approval or with which you are currently or may in the future be registered or approved of any material change to the information herein provided in accordance with their respective rules. You agree to the transfer of this application form, without amendment, to other self-regulatory organizations in the event that at some time in the future you apply to such other self-regulatory organizations for registration or approval.
You certify that you have discussed the questions in this application, together with this Agreement, with an Officer or Branch Manager of your sponsoring member firm and, to your knowledge and belief, the authorized Officer or Branch Manager was satisfied that you fully understood the questions and the terms of this Agreement. You further certify that your business activities will be limited strictly to those permitted by the category of your registration or approval.
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 and that this submission is being made at the request of the NRD filer.
OR
The following certification is to be used when submitting this form in paper format:
Certification by Individual
I, the undersigned, certify that I have read and that I understand this application 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 |
Certification of Firm
I, the undersigned, certify on behalf of the sponsoring firm that the applicant will be engaged by the sponsoring firm as registered or approved. I certify that I have discussed the questions set out in this application with the applicant or where the applicant has applied through one of our branch offices the branch manager or another officer or partner has so done and I am satisfied that the applicant fully understands the questions.
__________________________ |
_______________ |
Signature of authorized officer or partner |
Date |
SCHEDULE "A"Name
Item [ ] 1
Other names
Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).
Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).
Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name).
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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.
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SCHEDULE "C"Individual categories
Item [ ] 6
Categories
Indicate, by checking the appropriate box, each category for which you are applying. (In the final draft of the form a list of the registration categories of each jurisdiction will be included here.) |
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.
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.
|
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. (In the final draft of the form a list of courses and examinations will be included here. Further, spaces will be provided to set out dates of completion or exemption and the names of the exempting institutions) |
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 in respect of each of your current business and employment activities, including those with your sponsoring firm. [ ] Unemployed [ ] Full-time student [ ] Employed or self-employed
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: __________________________
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: ________ Indicate the NRD number of the branch where you will be conducting the majority of your 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 in respect of 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
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: __________________________
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"Regulatory disclosure
Item [ ] 13
1. Securities regulatory authorities
2. Self-regulatory organizations
3. Non-securities regulation
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SCHEDULE "J"Criminal disclosure
Item [ ] 14
Criminal, provincial and territorial offences
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SCHEDULE "K"Civil disclosure
Item [ ] 15
Current and past civil proceedings
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SCHEDULE "L"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 is, or was, unable to meet its financial obligations, (2) the amount that was owing at the time the party could not meet its financial obligations, (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 "M"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:
If you are a holder of 10 percent or more of the voting securities of the firm, complete (c), (d), (e), (f), and (g). 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 [ ] No 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:
j) Residential address: __________________________(number, street, city, province, territory or state, country, postal code)k) Occupation: |
FORM 33-109F5
CHANGE OF REGISTRATION INFORMATION
GENERAL INSTRUCTIONS
1. This notice must be submitted when notifying a regulator of changes to Form 3 or Form 4 information in accordance with MI 33-109. 2. 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 when notifying a regulator of changes to Form 33-109F4. 2. If this form is being submitting in respect of a change to a Form 3, Form 4 or Form 33-109F4 an authorized partner or officer of the firm must sign the form. |
1. Type of form
Identify the part of the Form 3, Form 4, or Form 33-109F4 for which this notice is being provided. If this notice is being provided to update an individual's Form 4 or Form 33-109F4, provide the name of the individual.
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2. Details of Change
Provide the details of the change for each item identified above:
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, 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 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 set out below.
(In the final draft of the form a list of contact information will be included here.)
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
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 registered or non-registered individual |
Date |
(No signature is required here if this form is being submitted in respect of a change to Form 3 information.)
If this form is being submitted in respect of a change to Form 3, I, the undersigned, certify that I understand the requirements and the Warning in this notice and that all statements of fact provided in this notice are true. |
Name of firm: __________________________
Authorized signature: __________________________
Print name: __________________________
Title: __________________________
Date: _______________
COMPANION POLICY 33-109CP
TO MULTILATERAL INSTRUMENT 33-109
REGISTRATION INFORMATION
PART 1 BUSINESS LOCATIONS
1.1 Business Locations - The securities regulatory authority or regulator is of the view that a business location for a registered firm, or a person or company that is applying for registration, is a location, including a residence, where a firm's registered individuals are based for the purpose of carrying out registerable activity. |
PART 2 NOTICE OF CHANGES
2.1 Bulk Transfer of Locations and Individuals
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PART 3 DUE DILIGENCE
3.1 Sponsoring Firm Obligations - The securities regulatory authority or regulator is of the view that the reasonable efforts firms are required to undertake in Part 6 of MI 33-109 include
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Appendix A
Request for NRD Bulk Transfer of Business Locations
This is an application for exemption under Multilateral Instrument 33-109.
A) |
Registered firm that will acquire the business locations |
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Name: |
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Firm NRD number: |
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B) |
Registered firm transferring the business locations |
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Name: |
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Firm NRD number: |
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Business locations that will be transferred |
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Address of business location: |
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NRD number of business location: |
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Address of business location: |
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NRD number of business location: |
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(Repeat for each business location as necessary.) |
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C) |
Date that business locations will be transferred: |