Unofficial Consolidation: Form 33-506F5 Change Of Registration Information (Sections 3.1 And 4.1)

Unofficial Consolidation: Form 33-506F5 Change Of Registration Information (Sections 3.1 And 4.1)

Forms

Ontario Securities Commission

Form 33-506F5

Unofficial consolidation current to 2018-06-12

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

Form 33-506F5
CHANGE OF REGISTRATION INFORMATION
(sections 3.1 and 4.1 )

GENERAL INSTRUCTIONS

Complete and submit this form to notify the relevant regulator(s) or, in Québec, the securities regulatory authority, or self-regulatory organization (SRO) of changes to information in the following forms:

             Form 33-506F6, except for the changes set out in section 3.1(1) of National Instrument 33-506, or

             Form 33-506F4.

How to submit this form

To report changes to information in a Form 33-506F4, submit this form at the National Registration Database website in NRD format at www.nrd.ca.

Submit this form in a format other than NRD format to report changes to information in a:

a)           Form 33-506F6, or

b)           Form 33-506F4, if the individual is relying on the temporary hardship exemption in section 5.1 of Ontario Securities Commission Rule 31-509 National Registration Database (Commodity Futures Act).

Name of firm _____________________________________________________________

Registration categories _____________________________________________________

NRD number (firm) __________________________

Item 1    Type of form

Check the form that is being updated:

Form 33-506F6

If submitting changes to Form 33-506F6, please attach a blackline of the amended sections of the form.

Form 33-506F4 Name of individual ______________________________

Item 2    Details of change

Provide the item number and details for each change to the form selected above:

Item number _______ Details _____________________________________________________

Effective date of change ________________________________

(YYYY/MM/DD)

Item 3    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 in the jurisdictions set out in Schedule A to administer and enforce certain provisions of their securities legislation or derivatives legislation or both.

The personal information required under this form is also collected by and used by the SRO set out in Schedule A to administer and enforce its by-laws, regulations, rules, rulings and policies.

By submitting this form, the individual consents to the collection by the securities regulatory authorities or applicable SRO of this personal information, and any police records, records from other government or non-governmental regulators or SROs, credit records and employment records about the individual that the securities regulatory authorities or applicable SRO may need to complete their review of the information submitted in this form relating to the individual's continued fitness for registration or approval, if applicable, in accordance with the legal authority of the securities regulatory authorities while the individual is registered with or approved by it. Securities regulatory authorities or SROs may contact government and private bodies or agencies, individuals, corporations and other organizations for information about the individual.

If you have any questions about the collection and use of this information, contact the securities regulatory authorities or applicable SRO in any jurisdiction in which the required information is submitted. See Schedule A for details. In Québec, you can also contact the Commission d'accès à l'information at 1-888-528-7741 or visit its website at www.cai.gouv.qc.ca.

Item 4    Warning

It is an offence under securities legislation and derivatives legislation, including commodity futures legislation, to give false or misleading information on this form.

Item 5    Certification

  1. Use the following certification when submitting this form in NRD format when making changes to Form 33-506F4

I confirm I have discussed the questions in this form with an officer, branch manager or supervisor of my sponsoring firm. To the best of my knowledge and belief, the officer, branch manager or supervisor was satisfied that I fully understood the questions. I will limit my activities to those permitted by my category of registration.

           I am making this submission as agent for the individual identified in this form. By checking this box, I certify that the individual provided me with all of the information on this form.

  1. Use the following certification when submitting this form in a format other than NRD format when making changes to Form 33-506F6

By signing below I certify to each regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form, either directly or through the principal regulator, that:

             I have read this form and understand the questions, and

•             all of the information provided on this form is true, and complete.

Name of authorized signing officer or partner  _______________________________

Title of authorized signing officer or partner _________________________________

Signature of authorized signing officer or partner  ____________________________

Date signed ___________________

(YYYY/MM/DD)

  1. Use the following certification when submitting this form in a format other than NRD format under the temporary hardship exemption in section 5.1 of Ontario Securities Commission Rule 31-509 National Registration Database (Commodity Futures Act) when making changes to Form 33-506F4

By signing below, I certify to the regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form, either directly or through the principal regulator, that:

             I have read this form and understand the questions; and

             all of the information provided on this form is true and complete.

Signature of individual _______________________________

Date signed _______________________

(YYYY/MM/DD)

 

 

Schedule A
Contact information for
Notice of collection and use of personal information

Alberta

Alberta Securities Commission

Suite 600, 250–5th St. SW

Calgary, AB T2P 0R4

Attention: Information Officer

Telephone: (403) 297-6454

Nunavut

Government of Nunavut

Department of Justice

P.O. Box 1000 Station 570

Iqaluit, NU X0A 0H0

Attention: Superintendent of Securities

Telephone: (867) 975-6590

 

 

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 Canada)

Ontario

Ontario Securities Commission

22nd Floor

20 Queen Street West

Toronto, ON M5H 3S8

Attention: Compliance and Registrant Regulation

Telephone: (416) 593-8314

e-mail: [email protected]

 

 

Manitoba

The Manitoba Securities Commission

500 - 400 St. Mary Avenue

Winnipeg, MB R3C 4K5

Attention: Director of Registrations

Telephone: (204) 945-2548

Fax (204) 945-0330

Prince Edward Island

Securities Office

Department of Community Affairs and Attorney General

P.O. Box 2000

Charlottetown, PE C1A 7N8

Attention: Superintendent of Securities

Telephone: (902) 368-6288

 

 

New Brunswick

Financial and Consumer Services Commission of New Brunswick / Commission des services financiers et des services aux consommateurs du Nouveau-Brunswick

Suite 300, 85 Charlotte Street

Saint John, NB E2L 2J2

Attention: Registration

Telephone: (506) 658-3060

Québec

Autorité des marchés financiers

800, square Victoria, 22e étage

C.P. 246, tour de la Bourse

Montréal (Québec) H4Z 1G3

Attention: Responsable de l'accès à l'information

Telephone: (514) 395-0337 or (877) 525-0337

 

 

Newfoundland and Labrador

Superintendent of Securities, Service NL

Government of Newfoundland and Labrador

P.O. Box 8700

2nd Floor, West Block

Confederation Building

St. John's, NL A1B 4J6

Attention: Manager of Registrations

Telephone: (709) 729-5661

Saskatchewan

Financial and Consumer Affairs Authority of Saskatchewan

Suite 601, 1919 Saskatchewan Drive

Regina, SK S4P 4H2

Attention: Deputy Director, Capital Markets

Telephone: (306) 787-5871

 

 

Nova Scotia

Nova Scotia Securities Commission

Suite 400, 5251 Duke Street

Halifax, NS B3J 1P3

Attention: Deputy Director, Capital Markets

Telephone: (902) 424-7768

Yukon

Government of Yukon

Superintendent of Securities

Department of Community Services

P.O. Box 2703 C-6

Whitehorse, YT Y1A 2C6

Attention: Superintendent of Securities

Telephone: (867) 667-5314

 

 

Northwest Territories

Government of the Northwest Territories

Department of Justice

1st Floor Stuart M. Hodgson Building

5009 – 49th Street

Yellowknife, NWT X1A 2L9

Attention: Deputy Superintendent of Securities

Telephone: (867) 920-8984

Self-regulatory organization

Investment Industry Regulatory Organization of Canada

121 King Street West, Suite 2000

Toronto, Ontario M5H 3T9

Attention: Privacy Officer

Telephone: (416) 364-6133

E-mail: [email protected].