Section 1.1, definition of "business location" was added by BC Reg 238/2014, effective January 11, 2015.

 Section 1.1, definitions of "cessation date" and "permitted individual" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

"cessation date" means the first day on which an individual ceased to have authority to act as a registered individual on behalf of their sponsoring firm or ceased to be a permitted individual of their sponsoring firm, because of the end of, or a change in, the individual's employment, partnership, or agency relationship with the firm;

"permitted individual" means an individual who is

(a) a director, chief executive officer, chief financial officer, or chief operating officer of a firm, or who performs the functional equivalent of any of those positions, or

(b) an individual who has beneficial ownership of, or direct or indirect control or direction over, 10 percent or more of the voting securities of a firm;

 Section 1.1 definitions of "cessation date" and "Form 33-109F1" BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

"cessation date" means the last day on which an individual had authority to act as a registered individual on behalf of their sponsoring firm or was a permitted individual of their sponsoring firm, because of the end of, or a change in, the individual's employment, partnership, or agency relationship with the firm;

"Form 33-109F1" means Form 33-109F1 Notice of Termination of Registered Individuals and Permitted Individuals;

 Section 1.2 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 2.1 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 2.2 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 2.3 (1) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(1)  An individual who applies for reinstatement of registration under securities legislation must submit a completed Form 33-109F4 to the regulator in accordance with NI 31-102, unless the individual submits a completed Form 33-109F7 in accordance with subsection (2).

 Section 2.3 (2) and (2) (b) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(2)  The registration of an individual suspended under section 6.1 [If individual ceases to have authority to act for firm] of NI 31-103 is reinstated on the date the individual submits a completed Form 33-109F7 to the regulator in accordance with NI 31-102 if all of the following apply:

(b) the individual's employment, partnership or agency relationship with the former sponsoring firm did not end because the individual was asked by the firm to resign, or was dismissed, following an allegation against the individual of any of the following:

(i)  criminal activity;

(ii)  a breach of securities legislation;

(iii)  a breach of a rule of an SRO;

 Section 2.3 (2) (c) and (d) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(c) after the cessation date there have been no changes to the information previously submitted in respect of any of the following items of the individual's Form 33-109F4:

(i) item 13 [Regulatory disclosure];

(ii) item 14 [Criminal disclosure];

(iii) item 15 [Civil disclosure];

(iv) item 16 [Financial disclosure];

(d) the individual is seeking reinstatement with a sponsoring firm in the same category of registration in which the individual was registered on the cessation date;

 Section 2.3 (2) (c) (i) BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

(i) item 13 [Regulatory disclosure] (other than Item 13.3 (c));

 Section 2.3 (2) (b) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(b) the individual's employment, partnership or agency relationship with the former sponsoring firm did not end because the individual was asked by the firm to resign, resigned voluntarily, or was dismissed, following an allegation against the individual of any of the following:

(i) criminal activity;

(ii) a breach of securities legislation;

(iii) a breach of a rule of an SRO;

 Section 2.3 (2) (b.1) and (b.2) were added by BC Reg 126/2022, effective June 6, 2022.

 Section 2.4 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 2.5 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 2.5 (1) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(1) A permitted individual must submit a completed Form 33-109F4 to the regulator in accordance with National Instrument 31-102 National Registration Database, no more than 10 days after becoming a permitted individual, unless the individual submits a Form 33-109F7 in accordance with subsection (2).

 Section 2.5 (2) (a) (i) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(i) no more than 10 days after becoming a permitted individual of the new sponsoring firm, and

 Section 2.5 (2) (c) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(c) the conditions described in paragraphs (b) and (c) of subsection 2.3 (2) are met.

 Section 2.6 (2) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(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 a completed Form 33-109F2 to the regulator in accordance with NI 31-102.

 Section 2.6 (1) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(1) In Manitoba and Ontario, despite subsection 2.1(b), if a firm applies for registration under section 2.1 and is registered under the Commodity Futures Act, the applicant is not required to submit a completed Form 33-109F3 under section 3.2 for any business location of the applicant that is recorded on NRD.

 Section 3.1 (1) (b) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(b) for a change previously submitted in relation to any other part of Form 33-109F6, within 7 days of the change.

 Section 3.1 (4) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(4)  A person or company that submitted a completed Schedule B [Submission to Jurisdiction and Appointment of Agent for Service] to Form 33-109F6 must notify the regulator of a change to the information previously submitted in item 3 [Name of agent for service of process] or item 4 [Address for service of process on the agent for service] of that schedule by submitting a completed Schedule B no more than 7 days after the change;

 Section 3.1 (4) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(4) A person or company that submitted a completed Schedule B [Submission to Jurisdiction and Appointment of Agent for Service] to Form 33-109F6 must notify the regulator of a change to the information previously submitted in item 3 [Name of agent for service of process] or item 4 [Address for service of process on the agent for service] of that schedule by submitting a completed Schedule B no more than 10 days after the change.

 Section 3.1 (1), (2), (3) (part), and (4) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(1) Subject to subsection (3) or (4), a registered firm must notify the regulator of a change to any information previously submitted in Form 33-109F6 or under this subsection, as follows:

(a) for a change previously submitted in relation to part 3 of Form 33-109F6, within 30 days of the change;

(b) for a change previously submitted in relation to any other part of Form 33-109F6, within 10 days of the change.

(2) A notice of change referred to in subsection (1) must be made by submitting a completed Form 33-109F5.

(3) A notice of change is not required under subsection (1) if the change relates to any of the following:

(4) A person or company that submitted a completed Schedule B [Submission to jurisdiction and appointment of agent for service] to Form 33-109F6 must notify the regulator of a change to the information previously submitted in item 3 [Name of agent for service of process] or item 4 [Address for service of process on the agent for service] of that schedule by submitting a completed Schedule B no more than 10 days after the change.

 Section 3.1 (1.1) and (2.1) were added by BC Reg 126/2022, effective June 6, 2022.

 Section 3.1 (3) (b) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(b) a termination, or a change, of a registered firm's employment, partnership or agency relationship with an officer, partner or director of the registered firm if the firm submits a completed Form 33-109F1 under subsection 4.2 (1);

 Section 3.1 (3) (e) and (f) were added by BC Reg 126/2022, effective June 6, 2022.

 Section 3.2 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

 Section 3.2 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

 Section 4.1 (1) (b) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(b) for a change of information previously submitted in any other items of Form 33-109F4, within 7 days of the change.

 Section 4.1 (3) and (4) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(3)  A notice of change under subsection (1) must be made by submitting a completed Form 33-109F5 to the regulator in accordance with NI 31-102.

(4)  Despite subsection (3), a notice of change referred to in subsection (1) must be made by submitting a completed Form 33-109F2 to the regulator in accordance with NI 31-102 if the change relates to

(a) an individual's status as a permitted individual of the sponsoring firm, or

(b) a registered individual's status as an officer, partner, director or shareholder of the sponsoring firm.

 Section 4.1 (4) (c) was added by BC Reg 121/2011, effective July 11, 2011.

 Section 4.1 (4) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(4) Despite subsection (3), a notice of change referred to in subsection (1) must be made by submitting a completed Form 33-109F2 to the regulator in accordance with National Instrument 31-102 National Registration Database if the change relates to

(a) an individual's status as a permitted individual of the sponsoring firm;

(b) the removal or the addition of a category of registration;

(c) the surrender of registration in one or more non-principal jurisdictions.

 Section 4.1 (1) and (2) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(1) Subject to subsection (2), a registered individual or permitted individual must notify the regulator of a change to any information previously submitted in respect of the individual's Form 33-109F4 as follows:

(a) for a change of information previously submitted in items 4 [Citizenship] and 11 [Previous employment] of Form 33-109F4, within 30 days of the change;

(b) for a change of information previously submitted in any other items of Form 33-109F4, within 10 days of the change.

(2) A notice of change is not required under subsection (1) if the change relates to information previously submitted in item 3 [Personal information] of Form 33-109F4.

 Section 4.1 (4) (a) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(a) an individual's status as a permitted individual of the sponsoring firm,

 Section 4.2 (1) and (4) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(1)  A registered firm must notify the regulator of the end of, or a change in, a sponsored individual's employment, partnership, or agency relationship with the firm if the individual ceases to have authority to act on behalf of the firm as a registered individual or permitted individual by submitting a Form 33-109F1 to the regulator in accordance with NI 31-102 with

(a) items 1 through 4 completed, and

(b) item 5 completed unless the reason for termination under item 4 was death or retirement of the individual or the completion or expiry of an employment or agency contract.

(2)  A registered firm must submit to the regulator the information required under

(a) subsection (1) (a), within 7 days of the cessation date, and

(b) subsection (1) (b), within 30 days of the cessation date.

(3)  A person or company must, within 7 days of a request from an individual for whom the person or company was the former sponsoring firm, provide to the individual a copy of the Form 33-109F1 that the person or company submitted under subsection (1) in respect of that individual.

(4)  If a person or company completed and submitted the information in item 5 of a Form 33-109F1 in respect of an individual who made a request under subsection (3) and that information was not included in the initial copy provided to the individual, the person or company must provide to that individual a further copy of the completed Form 33-109F1, including the information in item 5, within the later of

(a) 7 days after the request by the individual under subsection (3), and

(b) 7 days after the submission pursuant to subsection (2) (b).

 Section 4.2 (2) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(2) A registered firm must submit to the regulator the information required under

(a) subsection (1) (a), within 10 days of the cessation date, and

(b) subsection (1) (b), within 30 days of the cessation date.

 Section (4) (b) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(b) 10 days after the submission pursuant to subsection (2) (b).

 Section 4.2 (1) and (3) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(1) A registered firm must notify the regulator of the end of, or a change in, a sponsored individual's employment, partnership, or agency relationship with the firm if the individual ceases to have authority to act on behalf of the firm as a registered individual or permitted individual by submitting a Form 33-109F1 to the regulator in accordance with National Instrument 31-102 National Registration Database with

(a) items 1 through 4 completed, and

(b) item 5 completed unless the reason for termination under item 4 was death of the individual.

(3) A registered firm must, within 10 days of a request from an individual for whom the registered firm was the former sponsoring firm, provide to the individual a copy of the Form 33-109F1 that the registered firm submitted under subsection (1) in respect of that individual.

 Section 4.2 (2) (a) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(a) paragraph (1) (a), within 10 days of the cessation date, and

 Section 4.2 (4) (a) and (b) BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

(a) 10 days after the request by the individual under subsection (3), and

(b) 10 days after the submission pursuant to paragraph (2) (b).

 Section 4.3 was enacted by BC Reg 126/2022, effective June 6, 2022.

 Section 6.2 (2) (a) and (b) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(a) in a notice of agent and address for service, by submitting to the regulator a completed Schedule B to Form 33-109F6, no more than 7 days after the change;

(b) in Form 3 or in any notice of change to information in that form submitted to the regulator, as follows:

(i)  for a change of information equivalent to the information referred to in Part 3 of Form 33-109F6, within 30 days of the change;

(ii)  for a change of information equivalent to the information referred to in any other Part of Form 33-109F6, within 7 days of the change.

 Section 6.4 (1) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(1)  Despite subsection 2.3 (2), from the NRD access date to December 28, 2009 an individual who seeks reinstatement of registration under subsection 2.3 (2) must submit a completed Form 33-109F4 to the regulator in accordance with NI 31-102, if the cessation date occurred before September 28, 2009.

 Section 7.1 (3) BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

(3) Except in Ontario, an exemption referred to in subsection (1) is granted under the statute referred to in Appendix B of National Instrument 14-101 Definitions, opposite the name of the local jurisdiction.

 Form 33-109F1, text under "General Instructions" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

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) that a registered individual or permitted person has left their sponsoring firm.

 Form 33-109F1, text under "When to submit the form" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

When to submit the form

You must submit the responses to Item 1, Item 2, Item 3 and Item 4 within five business days of the effective date of termination.

If you are required to complete Item 5, you must submit those responses within 30 days of the termination date. If you are submitting the responses to Item 5, in NRD format, after Items 1 to 4 have been submitted at NRD, use the NRD submission type called "Update/Correct Termination Information" to complete Item 5 of this form.

 Form 33-109F1, item 5, instructions above "[For NRD Format only:]" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Complete Item 5 only if the individual resigned, was dismissed (whether or not for cause), or if the reason for termination under section 2 of Item 4 was "Other". In the space below:

• state the reason(s) for the resignation, dismissal or "Other" reason for termination and

• provide details if the answer to any of the following questions is "Yes".

 Form 33-109F1, item 5, option "Not applicable" under "[For NRD Format only:]" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

[ ] Not applicable: completed temporary employment contract, retired or deceased.

 Form 33-109F1, item 6 BEFORE repealed by BC Reg 121/2011, effective July 11, 2011.

Item 6 — 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 SROs set out in Schedule A to administer and enforce their respective 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 them as the case may be. 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'accè s à l'information at 1-888-528-7741 or visit its website at www.cai.gouv.qc.ca.

 Form 33-109F1, Schedule A BEFORE repealed by BC Reg 121/2011, effective July 11, 2011.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F1, paragraph after the heading "Terms" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

In this form, "cessation date" (or "effective date of termination") means the first day on which an individual ceased to have authority to act as a registered individual on behalf of their sponsoring firm or ceased to be a permitted individual of their sponsoring firm, because of the end of, or a change in, the individual's employment, partnership, or agency relationship with the firm.

 Form 33-109F1, second paragraph after the heading "When to submit the form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

If you are required to complete Item 5, you must submit those responses within 30 days of the termination date. If you are submitting the responses to Item 5, in NRD format, after Items 1 to 4 have been submitted at NRD, use the NRD submission type called "Update/Correct Termination Information" to complete Item 5 of this form.

 Form 33-109F1, Item 3 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 3 — Business location of the terminated individual

1. Address .....................................................................................

2. NRD number .............................................................................

 Form 33-109F1, Item 4 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 4 — Date and reason for termination

1. Cessation date / Effective date of termination .............................(YYYY/MM/DD)

This is the first day that the individual ceased to have authority to act in a registerable capacity on behalf of the firm or ceased to be a permitted individual.

2. Reason for termination / cessation (check one):

Resigned — voluntary [  ]

Resigned — at the firm's request [  ]

Dismissed in good standing [  ]

Dismissed for cause [  ]

Completed temporary employment contract [  ]

Retired [  ]

Deceased [  ]

Other [  ]

 Form 33-109F1, Item 5, sentence 8 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F1, Item 7 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 7 — Warning

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

 Form 33-109F1 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F1

[am. B.C. Regs. 121/2011, Sch. B, s. 14; 238/2014, App. C, s. 9.]

Notice of Termination of Registered Individuals
and Permitted Individuals

(section 4.2)

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) that a registered individual or permitted individual has left their sponsoring firm or has ceased to act in a registerable activity or as a permitted individual.

Terms

In this form, "cessation date" (or "effective date of termination") means the last day on which an individual had authority to act as a registered individual on behalf of their sponsoring firm or the last day on which an individual was a permitted individual of their sponsoring firm, because of the end of, or a change in, the individual's employment, partnership, or agency relationship with the firm.

How to submit the form

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca.

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format.

When to submit the form

You must submit the responses to Item 1, Item 2, Item 3 and Item 4 within 10 days of the effective date of termination.

If you are required to complete Item 5, you must submit those responses within 30 days of the cessation date. If you are submitting the responses to Item 5, in NRD format, after Items 1 to 4 have been submitted at NRD, use the NRD submission type called "Update/Correct Termination Information" to complete Item 5 of this form.

Item 1 – Terminating firm

1. Name .........................................................................................

2. NRD number .............................................................................

Item 2 – Terminated individual

1. Name .........................................................................................

2. NRD number .............................................................................

Item 3 – Business location of the terminated individual

1. Business location address .............................................................

2. NRD number .............................................................................

Item 4 – Date and reason for termination

1. Cessation date / Effective date of termination .............................(YYYY/MM/DD)

This is the last day that the individual had authority to act in a registerable capacity on behalf of the firm, or the last day that the individual was a permitted individual.

2. Reason for termination / cessation (check one):

Resigned – voluntary [  ]

Resigned – at the firm's request [  ]

Dismissed in good standing [  ]

Dismissed for cause [  ]

Completed temporary employment contract [  ]

Retired [  ]

Deceased [  ]

Other [  ]

If "Other", explain: ........................................................................

Item 5 – Details about the termination

Complete Item 5 except where the individual is deceased. In the space below:

• state the reason(s) for the cessation / termination and

• provide details if the answer to any of the following questions is "Yes".

[For NRD Format only:]

[  ] This information will be disclosed within 30 days of the effective date of termination.

[  ] Not applicable: individual is deceased.

Answer the following questions to the best of the firm's knowledge:

In the past 12 months:

Reasons/Details: ..........................................................................................................................................

Item 6

Repealed. [B.C. Reg. 121/2011, Sch. B, s. 14 (f).]

Item 7 – 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 8 – Certification

Certification – NRD format:

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

Certification – format other than NRD format:

By signing below, I certify to the regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form for the firm, 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 firm ..................................................................................................................................

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)

Schedule A

Repealed. [B.C. Reg. 121/2011, Sch. B, s. 14 (f).]

 Form 33-109F2, section numbers listed under Form Title BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Change or Surrender of Individual Categories

(section 4.2 or 2.2 (2) or 2.5 (2))

 Form 33-109F2, items 2 and 4 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Item 2 — Registration jurisdictions

1. Are you filing this form under the passport system / interface for registration?

Only choose "no" if you are registered in:

(a) only one jurisdiction of Canada, or

(b) more than one jurisdiction of Canada and you are requesting a change or surrender in a non-principal jurisdiction or jurisdictions, but not in your principal jurisdiction.

Yes [ ] No [ ]

2. Check each jurisdiction where you are seeking the change or surrender of individual categories of registration.

[ ] Alberta

[ ] British Columbia

[ ] Manitoba

[ ] New Brunswick

[ ] Newfoundland and Labrador

[ ] Northwest Territories

[ ] Nova Scotia

[ ] Nunavut

[ ] Ontario

[ ] Prince Edward Island

[ ] Québec

[ ] Saskatchewan

[ ] Yukon

Item 4 — Adding categories

1. What categories are you seeking to add?

......................................................................................................................................................

2. If you are seeking registration as a representative of a mutual fund dealer or of a scholarship plan dealer in Québec, are you covered by your sponsoring firm's professional liability insurance?

Yes [ ] No [ ]

If "No", state:

The name of your insurer ......................................................................................

Your policy number ..............................................................................................

 Form 33-109F2, Schedule A BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F2, Schedule B was added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F2, paragraph after the heading "General instructions" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Complete and submit this form to notify the relevant regulator(s) or, in Québec, the securities regulatory authority, or self-regulatory organization (SRO) that a registered individual or permitted individual seeks to add and/or remove individual registration categories or permitted activities.

 Form 33-109F2, Item 2, section 1 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

1. Are you filing this form under the passport system / interface for registration?

Choose "no" if you are registered in:

(a) only one jurisdiction in Canada;

(b) more than one jurisdiction in Canada and you are requesting a surrender in a non-principal jurisdiction or jurisdictions, but not in your principal jurisdiction;

(c) more than one jurisdiction in Canada and you are requesting a change only in your principal jurisdiction.

Yes [  ] No [  ]

 Form 33-109F2, Item 4, section 3 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

3. Relevant securities industry experience

If you have not been registered in the last 36 months and you passed the required examination more than 36 months ago, do you consider that you have gained 12 months of relevant securities industry experience during the 36 month period?

Yes [  ] No [  ] N/A [  ]

If you are an individual applying for IIROC approval, select "Not Applicable" above.

If "yes", complete Schedule A.

 Form 33-109F2, Item 5 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 5 — Reason for surrender

If you are seeking to remove a category or permitted activity, state the reason for the surrender in the local jurisdiction.

 Form 33-109F2, Item 6 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 6 — 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 SROs set out in Schedule A to administer and enforce their respective 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 them. 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.

 Form 33-109F2, Item 7 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 7 — Warning

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

 Form 33-109F2, Schedule A, third paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Indicate the continuing education activities which you have participated in during the last 36 months and which are relevant to the category of registration you are applying for:

 Form 33-109F2, Schedule B BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Schedule B

Contact Information for Notice of Collection
and Use of Personal Information

 Form 33-109F2, Schedule B table BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F2 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F2

[am. B.C. Regs. 121/2011, Sch. B, s. 15; 238/2014, App. C, s. 10; 209/2017, s. 4.]

Change or Surrender of Individual Categories

(section 2.2 (2), 2.4, 2.6 (2) or 4.1 (4))

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) that a registered individual or permitted individual seeks to add and/or remove individual registration categories or permitted activities or provide notice of other changes to the information on Schedule C of Form 33-109F4.

Terms

In this form, "you", "your" and "individual" mean the registered individual or permitted individual who is seeking to add and/or remove registration categories or permitted activities.

How to submit this form

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca.

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format.

Item 1 – Individual

Name of individual .........................................................................................

NRD number of individual .............................................................................

Item 2 – Registration jurisdictions

1. Are you filing this form under the passport system / interface for registration?

Choose "No" if you are registered in

(a) only one jurisdiction of Canada,

(b) more than one jurisdiction of Canada and you are requesting a surrender in a non-principal jurisdiction or jurisdictions, but not in your principal jurisdiction, or

(c) more than one jurisdiction of Canada and you are requesting a change only in your principal jurisdiction.

Yes [  ] No [  ]

Item 3 – Removing categories

What categories are you seeking to remove?

......................................................................................................................................................................

Item 4 – Adding categories

1. Categories

What categories are you seeking to add?

......................................................................................................................................................

2. Professional liability insurance
(Québec mutual fund dealers and Québec scholarship plan dealers)

If you are seeking registration as a representative of a mutual fund dealer or of a scholarship plan dealer in Québec, are you covered by your sponsoring firm's professional liability insurance?

Yes [  ] No [  ]

If "No", state:

The name of your insurer ......................................................................................

Your policy number ..............................................................................................

3. Relevant securities industry experience

If you have not been registered in the last 36 months and you passed the required examination more than 36 months ago, do you consider that you have gained 12 months of relevant securities industry experience during the 36-month period?

Yes [  ] No [  ] N/A [  ]

If you are an individual applying for IIROC approval, select "N/A".

If "Yes", complete Schedule A.

Item 5 – Reason for surrender

If you are seeking to remove a registration category or permitted activity, state the reason for the surrender in the local jurisdiction.

......................................................................................................................................................................

Item 6 – 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 B 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 B 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 them. 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 B 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 7 – 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 8 – Certification

Certification – NRD format:

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.

Certification – Format other than NRD format:

By signing below:

1. 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.

2. 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.

Signature of individual ...........................................................

Date signed ............................................... (YYYY/MM/DD)

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

1. the individual identified in this form will be engaged by the firm as a registered individual, or a non registered individual, and

2. I have, or a branch manager or supervisor or another officer or partner has, discussed the questions set out in this form with the individual. To the best of my knowledge and belief, the individual fully understands the questions.

Name of firm ..................................................................................................................................

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)

Schedule A

Relevant Securities Industry Experience (Item 4)

Describe your responsibilities in areas relating to the category you are applying for, including the title(s) you have held, as well as start and end dates:

...................................................................................................................................................................... ...................................................................................................................................................................... ......................................................................................................................................................................

What is the percentage of your time devoted to these activities?

..........%

Indicate the continuing education activities in which you have participated during the last 36 months and that are relevant to the category of registration you are applying for:

...............................................................................

...............................................................................

...............................................................................

...............................................................................

Schedule B

Contact Information for Notice of Collection and Use of Personal Information

 Form 33-109F3, Schedule A BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F3, second paragraph under heading "How to submit this form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102, you may complete and submit this form in a format other than NRD format.

 Form 33-109F3, item 1 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 1 — Type of business location

Branch or Business Location [  ]

Sub-branch [  ]

 Form 33-109F3, item 3 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 3 — Business location information

Business address ..........................................................................................................................................

Mailing address (if different from business address) ..................................................................................

Telephone number (.....) ...............

Fax number (.....) ...............

 Form 33-109F3, item 4, second paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

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

 Form 33-109F3, item 5 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 5 — Warning

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

 Form 33-109F3, item 6, second paragraph under heading "Certification — NRD format:" was added by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F3, item 6, paragraph under heading "Certification — format other than NRD format:" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

By signing below, I certify to the securities regulator or, in Québec, the securities regulatory authority, in each jurisdiction where I am submitting this form for the firm, 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.

 Form 33-109F3, Schedule A BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Schedule A

Contact Information for Notice of Collection
and Use of Personal Information

 Form 33-109F3, Schedule A table BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F3 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F3

[am. B.C. Regs. 121/2011, Sch. B, s. 16; 238/2014, App. C, s. 11; 209/2017, s. 5.]

Business Locations Other Than Head Office

(section 3.2)

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) that a business location has opened or closed, or information about a business location has changed.

Check one of the following and complete the entire form:

[  ] Opening this business location

[  ] Closing this business location

[  ] Change to the information previously submitted about this business location. Clearly specify the information that has changed.

How to submit this form

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca.

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may complete and submit this form in a format other than NRD format.

Item 1 – Type of business location

Branch or business location [  ]

Sub-branch (Mutual Fund Dealers Association of Canada members only) [  ]

Item 2 – Supervisor or branch manager

Name of designated supervisor or branch manager ....................................................................................

NRD number of the designated supervisor or branch manager ..................................................................

Item 3 – Business location information

Business location address ............................................................................................................................

(a post office box is not a valid business location address)

Mailing address (if different from business location address) .....................................................................

Telephone number (.....) ...................

Fax number (.....) ...................

E-mail address .................................................

Item 4 – 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 them. 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 5 – 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 6 – Certification

Certification – NRD format:

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

[  ] If the business location is a residence, the individual conducting business from that business location has completed a Form 33-109F4 Registration of Individuals and Review of Permitted Individuals certifying that they give their consent for the regulator or, in Québec, the securities regulatory authority to enter the residence for the administration of securities legislation and derivatives legislation, including commodity futures legislation.

Certification – format other than NRD format:

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

• I have read this form and understand the questions,

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

• if the business location specified in this form is a residence, the individual conducting business from that business location has completed a Form 33-109F4 Registration of Individuals and Review of Permitted Individuals certifying that they give their consent for the regulator or, in Québec, the securities regulatory authority to enter the residence for the administration of securities legislation and derivatives legislation, including commodity futures legislation.

Name of firm ..................................................................................................................................

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)

Schedule A

Contact Information for Notice of Collection and Use of Personal Information

 Form 33-109F4, Schedule L BEFORE amended by BC Reg 167/2010, effective July 1, 2010.

Schedule L

Civil Disclosure (Item 15)

Item 15.1

For each outstanding civil proceeding, state below (1) the dates the statement of claim and statement of defence were issued, (2) the name of the plaintiff(s) in the proceeding, (3) whether the proceeding is pending or on appeal, (4) whether the proceeding was against a firm where you are, or were, a partner, director, officer or major shareholder and whether you have been named individually in the allegations, and (5) the jurisdiction where the action is being pursued.

......................................................................................................................................................................

Item 15.2

For each civil proceeding, state below (1) the dates the statement of claim and statement of defence were issued, (2) each plaintiff in the proceeding, (3) the jurisdiction where the action was pursued, (4) whether the proceeding was about a firm where you are, or were, a partner, director, officer or major shareholder and whether you have been named individually in the allegations and (5) a summary of any disposition or any settlement over $10,000. You must disclose any actions settled without admission of liability.

......................................................................................................................................................................

 Form 33-109F4, definition of "Approved person" under "Terms" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

"Approved person" means, in respect of a member of the IIROC (Member), an individual who is a partner, director, officer, employee or agent of a Member who is approved by the IIROC or another Canadian SRO to perform any function required under any IIROC or another Canadian SRO By-law, Regulation, or Policy.

 Form 33-109F4, paragraphs "NRD format" and "Format, other than NRD format" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

NRD format

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca. You are only required to submit one form regardless of the number of registration categories you are seeking. If you have any questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser, or visit the NRD information website at www.nrd-info.ca.

Format, other than NRD format

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format.

If you need more space, use a separate sheet of paper. Clearly identify the Item and question number. Complete and sign the form, and send it to the relevant regulator(s) or, in Québec, the securities regulatory authority, SRO(s) or similar authority. The number of originally signed copies of the form you are required to submit depends on the province or territory, and on the regulator, the securities regulatory authority or SRO.

To avoid delays in processing this form, be sure to answer all of the questions that apply to you. If you have questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser, or visit the National Registration Database information website at www.nrd-info.ca.

 Form 33-109F4, Item 8, sections 1 to 3 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

1. Course or examination information and other education

Complete Schedule E to indicate each course and examination that is required for registration or approval and that you have successfully completed or have been exempted from.

[ ] Check here if you are not required under securities legislation or derivatives legislation or both, or the rules of an SRO to satisfy any course or examination requirements.

2. Student numbers

If you have a student number for a course that you successfully completed with one of the following organizations, provide it below:

CSI Global Education (formerly Canadian Securities Institute): ..........................................

IFSE Institute (formerly IFIC): ..........................................

Institute of Canadian Bankers (ICB): ..........................................

CFA Institute (formerly AIMR): ..........................................

Advocis (formerly CAIFA): ..........................................

3. Exemption refusal

Has any securities regulator, derivatives regulator or SRO refused to grant you an exemption from a course, examination or experience requirement?

Yes [ ] No [ ]

If "Yes", complete Schedule F.

 Form 33-109F4, Item 8, section 4 was added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F4, Item 9, section 4 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

4. Name of branch manager: .....................................................................................

 Form 33-109F4, Item 14 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Item 14 — Criminal disclosure

Offences you must disclose

You must disclose all criminal offences committed in any province, territory, state or country. This includes, but is not limited to, criminal offences under federal statutes such as the Criminal Code (Canada), Income Tax Act (Canada), the Competition Act (Canada), Immigration Act (Canada) and the Controlled Drugs and Substances Act (Canada) (or its predecessor, the Narcotic Control Act (Canada)). This includes pleas or findings of guilt for impaired driving, which are Criminal Code (Canada) matters. If you have been found guilty of a criminal offence, you must disclose the offence even if you have been granted an absolute or conditional discharge.

With respect to questions 14.2 and 14.4, if you or your firm has been found guilty of a criminal offence, or participated in the Alternative Measures Program within the past three years, you must disclose that offence even if an absolute or conditional discharge has been granted, or the charge has been dismissed, withdrawn or stayed. Some exceptions apply to stayed charges, and the Alternative Measures Program which are outlined below.

If you do not disclose a criminal offence under any statute other than the Young Offenders Act (Canada) or the Youth Criminal Justice Act (Canada), regulators or, in Québec, the securities regulatory authority or self regulatory organization may treat it as a non-disclosure of material information.

Offences you do not have to disclose

The appropriate response is "No" if any of the following circumstances apply.

You are not required to disclose:

• crimes for which you received an absolute or conditional discharge if the crime has been purged from the criminal records in accordance with the Criminal Records Act (Canada)

• speeding, parking violations or any offence for which a pardon has been granted under the Criminal Records Act (Canada) and the pardon has not been revoked

• stayed charges for summary conviction offences that have been stayed for six months or more

• stayed charges for indictable offences that have been stayed for a year or more, and

• offences under the Young Offenders Act (Canada) or the Youth Criminal Justice Act (Canada)

With respect to questions 14.2 and 14.4, you are not required to disclose an offence for which you or your firm was found guilty if you or the firm participated in the Alternative Measures Program more than three years ago for that offence.

1. Are there any outstanding or stayed charges against you alleging a criminal offence that was committed in any province, territory, state or country?

Yes [ ] No [ ]

If "Yes", complete Schedule K, Item 14.1.

2. Have you ever been found guilty, pleaded no contest to, or granted an absolute or conditional discharge from any criminal offence that was committed in any province, territory, state or country?

Yes [ ] No [ ]

If "Yes", complete Schedule K, Item 14.2.

3. To the best of your knowledge, are there any outstanding charges against any firm of which you were, at the time the criminal offence was alleged to have taken place in any province, territory, state or country, a partner, director, officer or major shareholder?

Yes [ ] No [ ]

If "Yes", complete Schedule K, Item 14.3.

4. To the best of your knowledge, has any firm, when you were a partner, officer, director or major shareholder, ever been found guilty, pleaded no contest to or granted an absolute or conditional discharge from a criminal offence that was committed in any province, territory, state or country?

Yes [ ] No [ ]

If "Yes", complete Schedule K, Item 14.4.

 Form 33-109F4, Schedule A, Item 1.3, Name 1 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Name: ..................................................................................................................

Provide the reasons for the use of this other name (for example, trade name or team name)?: ........................................................................................

If this other name is or was used in connection with any sponsoring firm, did the sponsoring firm approve the use of the name?

Yes [ ] No [ ]

 Form 33-109F4, Schedule C, heading "Investment Industry Regulatory Organization of Canada" was abbreviated to "IIROC" by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F4, Schedule E, BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule E

Proficiency (Item 8)

Item 8.1 — Course or examination information and other education

 Form 33-109F4, Schedule F, Item 8.3 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule F

Proficiency (Item 8.3)

Item 8.3 — Exemption refusal

Complete the following for each exemption that was refused.

1. Which securities regulator, derivatives regulator or SRO 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:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

2. Which securities regulator, derivatives regulator or SRO 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:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

3. Which securities regulator, derivatives regulator or SRO 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:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

 Form 33-109F4, Schedule F, Item 8.4 was added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F4, Schedule G, section 5 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

5. Conflicts of interest

If you have more than one employer or are engaged in business related activities, disclose any potential for confusion by clients and any potential for conflicts of interest arising from your multiple employment or business related activities or proposed business related activities. Include whether or not any of your employers or organizations where you engage in business related activities are listed on an exchange. Confirm whether the firm has procedures for minimizing potential conflicts of interest and if so, confirm that you are aware of these procedures.

If you do not perceive any conflicts of interest arising from this employment, explain why.

......................................................................................................................................................

 Form 33-109F4, Schedule O BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule O

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F4, paragraph under heading "General Instructions" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Complete and submit this form to the relevant regulator(s) or in Québec, the securities regulatory authority, or self-regulatory organization (SRO) if an individual is seeking registration in individual categories or is seeking to be reviewed as a permitted individual. You only need to complete and submit one form regardless of the number of categories you are seeking to be registered in.

 Form 33-109F4, portion under heading "Terms" and before heading "How to submit this form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

In this form, "you", "your" and "individual" mean the individual who is seeking registration or the individual who is filing this form as a permitted individual under securities legislation or derivatives legislation or both.

"Approved person" means, in respect of a member (Member) of the Investment Industry Regulatory Organization of Canada (IIROC), an individual who is a partner, director, officer, employee or agent of a Member who is approved by the IIROC or another Canadian SRO to perform any function required under any IIROC or another Canadian SRO By-law, Regulation, or Policy.

"Derivatives" means financial instruments, such as futures contracts (including exchange traded contracts), futures options and swaps whose market price, value or payment obligations are derived from, or based on, one or more underlying interests. Derivatives can be in the form of instruments, agreements or securities.

"Major shareholder" and "shareholder" mean a shareholder who, in total, directly or indirectly owns voting securities carrying 10 per cent or more of the votes carried by all outstanding voting securities.

"Sponsoring firm" means the registered firm where you will carry out your duties as a registered or permitted individual.

Several terms used in this form are defined in the securities legislation of your province or territory. Please refer to those definitions.

 Form 33-109F4, paragraph under heading "NRD format" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca. You are only required to submit one form regardless of the number of registration categories you are seeking. If you have any questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser with securities regulation experience, or visit the NRD information website at www.nrd-info.ca.

 Form 33-109F4, second and third paragraphs under heading "Format other than NRD format" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

If you need more space, use a separate sheet of paper. Clearly identify the Item and question number. Complete and sign the form, and send it to the relevant regulator(s) or, in Québec, the securities regulatory authority, SRO(s) or similar authority. The number of originally signed copies of the form you are required to submit depends on the province or territory, and on the regulator, the securities regulatory authority or SRO.

To avoid delays in processing this form, be sure to answer all of the questions that apply to you. If you have questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser with securities regulation experience, or visit the National Registration Database information website at www.nrd-info.ca.

 Form 33-109F4, Item 1, sections 2 and 3 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

2. Other personal names

Are you currently, or have you ever been, known by any names other than your full legal name above, for example, nicknames or names due to marriage?

Yes [  ] No [  ]

If "yes", complete Schedule A.

3. Use of other names

Are you currently, or have you ever used, operated under, or carried on business under any name other than the name(s) mentioned above, for example, trade names for sole proprietorships or team names?

Yes [  ] No [  ]

If "yes", complete Schedule A.

 Form 33-109F4, Item 2, section 3 was added by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F4, Item 5, section 1 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

1. Are you filing this form under the passport system / interface for registration?

Only choose "no" if:

(a) you are seeking registration only in your principal jurisdiction,

(b) you are seeking review as a permitted individual only in your principal jurisdiction

and you are not currently registered under securities legislation in any jurisdiction of Canada,

Yes [  ] No [  ]

 Form 33-109F4, Item 7, section 1, first paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

You must have one address for service in each province or territory where you are submitting this form. A residential address or a business address is acceptable. A post office box is not acceptable. Complete Schedule D for each additional address for service you are providing.

 Form 33-109F4, Item 8, section 2 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

2. Student numbers

If you have a student number for a course that you successfully completed with one of the following organizations, provide it below:

CSI Global Education (formerly Canadian Securities Institute): ..........................................

IFSE Institute (formerly IFIC): ..........................................

Institute of Canadian Bankers (ICB): ..........................................

CFA Institute (formerly AIMR): ..........................................

Advocis (formerly CAIFA): ..........................................

RESP Dealers Association of Canada: .......................................

Other: ..........................................

 Form 33-109F4, Item 8, section 4 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

4. Relevant securities industry experience

If you are an individual applying for IIROC approval, select "Not Applicable" below.

If you have not been registered in the last 36 months and you passed the required examination more than 36 months ago, do you consider that you have gained 12 months of relevant securities industry experience during the 36 month period?

Yes [  ] No [  ] N/A [  ]

If "yes", complete Schedule F.

 Form 33-109F4, Item 9 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 9 — Location of employment

1. Provide the following information for your new sponsoring firm. 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 location number: ..........................................

Unique Identification Number (optional): ..........................................

Business address: ..........................................................................................................................
(number, street, city, province, territory or state, country, postal code)

Telephone number: (.....) ............... Fax number: (.....) ...............

2. If the firm has a foreign head office, and/or you are not a resident of Canada, provide the address for the location in which you will be conducting business.

Business address: ..........................................................................................................................
(number, street, city, province, territory or state, country, postal code)

Telephone number: (.....) ............... Fax number: (.....) ...............

[The following under #3 "Type of location", #4 and #5 is for a Format other than NRD format only]

3. Type of location — for Format other than NRD format only:

[  ] Head office [  ] Branch or Business Location [  ] Sub-branch

4. Name of supervisor or branch manager: .....................................................................................

5. [  ] 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)

 Form 33-109F4, Item 10 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 10 — Current employment, other business activities, officer positions held and directorships

Complete a separate Schedule G for each of your current business and employment activities, including employment and business activities with your sponsoring firm and any employment and business activities outside your sponsoring firm. Also include all business related officer or director positions and any other equivalent positions held, whether you receive compensation or not.

 Form 33-109F4, Item 11 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 11 — Previous employment and other activities

On Schedule H, complete your employment and other activities history for the past 10 years.

 Form 33-109F4, Item 12 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 12 — Resignations and terminations

Have you ever resigned, been terminated or been dismissed for cause by an employer from a position following allegations that you:

1. Violated any statutes, regulations, rules or standards of conduct?

Yes [  ] No [  ]

If "Yes", complete Schedule I Item 12.1.

2. Failed to appropriately supervise compliance with any statutes, regulations, rules or standards of conduct?

Yes [  ] No [  ]

If "Yes", complete Schedule I Item 12.2.

3. Committed fraud or the wrongful taking of property, including theft?

Yes [  ] No [  ]

If "Yes", complete Schedule I Item 12.3.

 Form 33-109F4, Item 13 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 13 — Regulatory disclosure

1. Securities and derivatives regulation

(a) Other than a registration or permitted individual status that has been recorded under this NRD number, are you now, or have you ever been, registered or licensed with any securities regulator or derivatives regulator or both in any province, territory, state or country to trade in or advise on securities or derivatives or both?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1(a).

(b) Have you ever been refused registration or a licence to trade in or advise on securities or derivatives or both in any province, territory state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1(b).

(c) Have you ever been denied the benefit of any exemption from registration provided in any securities or derivatives or both legislation or rules in any province, territory, state or country, other than what was disclosed in Item 8(3) of this form?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1(c).

(d) Are you now, or have you ever been subject to any disciplinary proceedings or any order resulting from disciplinary proceedings under any securities legislation or derivatives legislation or both in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1(d).

2. SRO regulation

(a) Other than an approval that has been recorded under this NRD number, are you now, or have you ever been, an approved person of an SRO or similar organization in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item13.2(a).

(b) Have you ever been refused approved person status by an SRO or similar organization in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.2(b).

(c) Are you now, or have you ever been, subject to any disciplinary proceedings conducted by any SRO or similar organization in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.2(c).

3. Non-securities regulation

(a) Are you now, or have you ever 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 derivatives or both in any province, territory, state or country (e.g. insurance, real estate, accountant, lawyer, teacher)?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3(a)

(b) Have you ever been refused registration or a licence under any legislation relating to your professional activities unrelated to securities or derivatives in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3(b).

(c) Are you now, or have you ever been, a subject of any disciplinary actions conducted under any legislation relating to your professional activities unrelated to securities or derivatives in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3(c).

 Form 33-109F4, Item 14 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 14 — Criminal disclosure

Offences you must disclose

You must disclose all criminal offences committed in any province, territory, state or country. This includes, but is not limited to, criminal offences under federal statutes such as the Criminal Code (Canada), Income Tax Act (Canada), the Competition Act (Canada), Immigration and Refugee Protection Act (Canada) and the Controlled Drugs and Substances Act (Canada) (or its predecessor, the Narcotic Control Act (Canada)). This includes pleas or findings of guilt for impaired driving, which are Criminal Code (Canada) matters. If you have been found guilty of a criminal offence, you must disclose the offence even if you have been granted an absolute or conditional discharge.

With respect to questions 14.2 and 14.4, if you or your firm has been found guilty of a criminal offence, or participated in the Alternative Measures Program within the past three years, you must disclose that offence even if an absolute or conditional discharge has been granted, or the charge has been dismissed, withdrawn or stayed. Some exceptions apply to stayed charges, and the Alternative Measures Program which are outlined below.

If you do not disclose a criminal offence under any statute other than the former Young Offenders Act (Canada) or the Youth Criminal Justice Act (Canada), regulators or, in Québec, the securities regulatory authority or self regulatory organization may treat it as a non-disclosure of material information.

Offences you do not have to disclose

The appropriate response is "No" if any of the following circumstances apply.

You are not required to disclose:

• crimes for which you received an absolute or conditional discharge if the crime has been purged from the criminal records in accordance with the Criminal Records Act (Canada)

• speeding, parking violations or any offence for which a pardon has been granted under the Criminal Records Act (Canada) and the pardon has not been revoked

• stayed charges for summary conviction offences that have been stayed for six months or more

• stayed charges for indictable offences that have been stayed for a year or more, and

• offences under the former Young Offenders Act (Canada) or the Youth Criminal Justice Act (Canada)

With respect to questions 14.2 and 14.4, you are not required to disclose an offence for which you or your firm was found guilty if you or the firm participated in the Alternative Measures Program more than three years ago for that offence.

1. Are there any outstanding or stayed charges against you alleging a criminal offence that was committed in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.1.

2. Have you ever been found guilty, pleaded no contest to, or granted an absolute or conditional discharge from any criminal offence that was committed in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.2.

3. To the best of your knowledge, are there any outstanding charges against any firm of which you were, at the time the criminal offence was alleged to have taken place in any province, territory, state or country, a partner, director, officer or major shareholder?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.3.

4. To the best of your knowledge, has any firm, when you were a partner, officer, director or major shareholder, ever been found guilty, pleaded no contest to or granted an absolute or conditional discharge from a criminal offence that was committed in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.4.

 Form 33-109F4, Item 15 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 15 — Civil disclosure

1. Are there currently any outstanding civil actions alleging fraud, theft, deceit, misrepresentation or similar misconduct against you or a firm where you are or were a partner, director, officer or major shareholder in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule L, Item 15.1.

2. Have you or a firm where you are or were a partner, director, officer or major shareholder ever been a defendant or respondent in any civil proceeding in which fraud, theft, deceit, misrepresentation or similar misconduct is, or was, successfully established in a judgment in any province, territory, state or country?

Yes [  ] No [  ]

If "Yes", complete Schedule L, Item 15.2.

 Form 33-109F4, Item 16, section 2 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

2. Debt obligations

Over the past 10 years, have you failed to meet a financial obligation of $5,000 or more as it came due or, to the best of your knowledge, has any firm, while you were a partner, director, officer or major shareholder of that firm, failed to meet any financial obligation of $5,000 or more as it came due?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.2.

 Form 33-109F4, Item 20, second paragraph below heading "SROs" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

By submitting this form, you authorize the SROs to which this form is submitted to collect any information from any source whatsoever. This includes, but is not limited to, personal confidential information about you that is otherwise protected by law such as: police, credit, employment, education and proficiency course completion records, and records from other government or non-governmental regulatory authorities, securities commissions, stock exchanges or other SROs, private bodies, agencies, individuals or corporations, as may be necessary for the SROs to complete their review of your form or continued fitness for registration or approval in accordance with their rules for the duration of the period you remain so registered or approved. You further consent to and authorize the transfer of confidential information between SROs, securities commissions or stock exchanges from whom you now, or may in the future, seek registration or approval, or with which you are currently registered or approved for the purpose of determining fitness or continued fitness for registration or approval or in connection with the performance of an investigation or other exercise of regulatory authority, whether or not you are registered with or approved by them.

 Form 33-109F4, Item 20, last paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

You certify that you have discussed the questions in this form, 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 that are subject to securities rules and derivatives rules or both will be limited strictly to those permitted by the category of your registration or approval.

 Form 33-109F4, Item 21 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 21 — Warning

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

 Form 33-109F4, Item 22, section 1 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

1. Certification — NRD format

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, 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.

 Form 33-109F4, Item 22, paragraph under heading "Individual" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

By signing below, I certify to the regulator, or in Québec the securities regulatory authority, in each jurisdiction where I am filing or 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 .............................................(YYYY/MM/DD)

 Form 33-109F4, Schedule A, Item 1.2 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 1.2 — Other personal names

Name 1:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname)? .............................................

Name 2:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname)? ............................................

Name 3:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname)? ............................................

 Form 33-109F4, Schedule A, Item 1.3, under heading "Name 1:" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Name 1:

Name: ..................................................................................................................

Provide the reasons for the use of this other name (for example, trade name or team name)?: ........................................................................................

If this other name is or was used in connection with any sponsoring firm, did the sponsoring firm approve the use of the name?

Yes [  ] No [  ] N/A [  ]

 Form 33-109F4, Schedule C, under first instance of heading "Individual categories and permitted activities" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Individual categories and permitted activities

[  ] Dealing Representative

[  ] Advising Representative

[  ] Associate Advising Representative

[  ] Ultimate Designated Person

[  ] Chief Compliance Officer

[  ] Officer — Specify title:

[  ] Director

[  ] Partner

[  ] Shareholder

[  ] Branch Manager (MFDA members only)

[  ] IIROC approval only

 Form 33-109F4, Schedule C, under heading "Individual categories and permitted activities", under heading "Manitoba" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Individual categories and permitted activities

[  ] Floor Trader

[  ] Salesperson

[  ] Branch Manager

[  ] Adviser

[  ] Officer — Specify title:

[  ] Director

[  ] Partner

[  ] Futures Contracts Portfolio Manager

[  ] Associate Futures Contracts Portfolio Manager

[  ] IIROC approval only

[  ] Local

 Form 33-109F4, Schedule C, under heading "Québec", BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Québec — activities relating to derivatives

For information purposes, indicate whether you will carry on activities as a representative of:

[  ] An Investment Dealer Acting as a Derivatives Dealer

[  ] A Portfolio Manager Acting as a Derivatives Portfolio Manager

 Form 33-109F4, Schedule D, Item 7.1 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 7.1 — Address for service

You must have one address for service in each province or territory in which you are now, or are seeking to become, a registered individual or permitted 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: ............................................................................

 Form 33-109F4, Schedule E, text after the table BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

If you have listed the CFA Charter in Item 8.1, please indicate by checking the box below whether you are a current member of the CFA Institute permitted to use the CFA Charter.

Yes [  ] No [  ]

If "no", please explain why you no longer hold this designation:

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

If you have listed the CIM designation in Item 8.1, please indicate by checking the box below whether you are currently permitted to use the CIM designation.

Yes [  ] No [  ]

If "no", please explain why you no longer hold this designation:

.....................................................................................................................................................................

.....................................................................................................................................................................

 Form 33-109F4, Schedule F, Item 8.4, last paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Indicate the continuing education activities which you have participated in during the last 36 months and which are relevant to the category of registration you are applying for:

 Form 33-109F4, Schedule G, first paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Complete a separate Schedule G for each of your current business and employment activities with your sponsoring firm and with all other organizations. This includes any business related officer or director positions held, or any other equivalent positions held, whether you receive compensation or not.

 Form 33-109F4, Schedule G, paragraph under heading "3. Description of duties" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Describe all employment and business activities related to this employer. Include the nature of the business and your duties, title or relationship with the business. If you are seeking registration that requires specific experience, include details with this firm such as level of responsibility, value of accounts under direct supervision, number of years of experience, and percentage of time spent on each activity.

 Form 33-109F4, Schedule K, Items 14.2 and 14.4 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 14.2

For each finding of guilty, pleading no contest to, or granting of an absolute or conditional discharge from a criminal offence state below (1) the offence, (2) the date found guilty, and (3) the disposition (any penalty or fine and the date any fine was paid).

Item 14.4

For each finding of guilty, pleading no contest to, or granting of an absolute or conditional discharge from a criminal offence state below (1) the name of the firm, (2) the offence, (3) the date of the conviction, and (4) the disposition (any penalty or fine and the date any fine was paid).

 Form 33-109F4, Schedule M, Item 16.2 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 16.2 — Debt obligation

For each event, state below (1) the person or firm that failed to meet its financial obligation, (2) the amount that was owing at the time the person or firm failed to meet its financial obligation, (3) the person or firm 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 the regulator or, in Québec, the securities regulatory authority may request, including why obligation has not been met/satisfied.

 Form 33-109F4, Schedule N, first paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Firm name: .......................................................................................

 Form 33-109F4, Schedule N, paragraph (g) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

(g) Name of beneficial owner:

 Form 33-109F4, Schedule O BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Schedule O

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F4, Schedule C under heading "Individual categories and permitted activities" BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

Individual categories and permitted activities

[  ] Dealing Representative

[  ] Advising Representative

[  ] Associate Advising Representative

[  ] Ultimate Designated Person

[  ] Chief Compliance Officer

[  ] Permitted Individual

[  ] Officer — Specify title:

[  ] Director

[  ] Partner

[  ] Shareholder

[  ] Branch Manager (MFDA members only)

[  ] IIROC approval only

 Form 33-109F4, Schedule O table BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F4 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F4

[am. B.C. Regs. 167/2010; 121/2011, Sch. B, s. 17; 238/2014, App. C, s. 12; 209/2017, ss. 6 and 7.]

Registration of Individuals and Review
of Permitted Individuals

(section 2.2)

General instructions

Complete and submit this form to the relevant regulator(s) or, in Québec, the securities regulatory authority, or self-regulatory organization (SRO) if an individual is seeking

• registration in individual categories, or

• to be reviewed as a permitted individual.

You are only required to submit one form even if you are applying to be registered in several categories. This form is also used if you are seeking to be reviewed as a permitted individual. A post office box is not acceptable as a valid business location address.

Terms

In this form:

"Approved person" means, in respect of a member (Member) of the Investment Industry Regulatory Organization of Canada (IIROC), an individual who is a partner, director, officer, employee or agent of a Member who is approved by IIROC or another Canadian SRO to perform any function required under any IIROC or other Canadian SRO by-law, rule, or policy;

"Canadian Investment Manager designation" means the designation earned through the Canadian investment manager program prepared and administered by CSI Global Education Inc. and so named on the day this Instrument comes into force, and every program that preceded that program, or succeeded that program, that does not have a significantly reduced scope and content when compared to the scope and content of the first-mentioned program;

"CFA Charter" means the charter earned through the Chartered Financial Analyst program prepared and administered by the CFA Institute and so named on the day this Instrument comes into force, and every program that preceded that program, or succeeded that program, that does not have a significantly reduced scope and content when compared to the scope and content of the first-mentioned program;

"Derivatives" means financial instruments, such as futures contracts (including exchange traded contracts), futures options and swaps whose market price, value or payment obligations are derived from, or based on, one or more underlying interests. Derivatives can be in the form of instruments, agreements or securities;

"Major shareholder" and "shareholder" mean a shareholder who, in total, directly or indirectly owns voting securities carrying 10 per cent or more of the votes carried by all outstanding voting securities;

"Sponsoring firm" means the registered firm where you will carry out your duties as a registered or permitted individual; and

"You", "your" and "individual" mean the individual who is seeking registration or the individual who is filing this form as a permitted individual under securities legislation or derivatives legislation or both.

How to submit this form

NRD format

Submit this form at the National Registration Database (NRD) website in NRD format at www.nrd.ca. If you have any questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser with securities law experience, or visit the NRD information website at www.nrd-info.ca.

Format other than NRD format

If you are relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database, you may submit this form in a format other than NRD format.

If you need more space, use a separate sheet of paper. Clearly identify the item and question number. Complete and sign the form, and send it to the relevant regulator(s) or, in Québec, the securities regulatory authority, SRO(s) or similar authority. The number of originally signed copies of the form you are required to submit depends on the province or territory, and on the regulator, the securities regulatory authority or SRO.

To avoid delays in processing this form, be sure to answer all of the questions that apply to you. If you have questions, contact the compliance, registration or legal department of the sponsoring firm or a legal adviser with securities law experience, or visit the NRD information website at www.nrd-info.ca.

Item 1 – Name

1. Legal name

NRD number (if applicable) ............................

2. Other personal names

Are you currently, or have you ever been, known by any names other than your full legal name above, for example, nicknames or names due to marriage?

Yes [  ] No [  ]

If "Yes", complete Schedule A.

3. Use of other names

Are you currently, or have you ever used, operated under, or carried on business under any name other than the name(s) mentioned above, for example, trade names for sole proprietorships or team names?

Yes [  ] No [  ]

If "Yes", complete Schedule A.

Item 2 – Residential address

Provide all of your residential addresses, including any foreign residential addresses, for the past 10 years.

1. Current and previous residential addresses

.......................................................................................................................................................
(number, street, city, province, territory or state, country, postal code)

Telephone number ........................................

Lived at this address since (YYYY/MM) ........................................

If you have lived at this address for less than 10 years, complete Schedule B.

2. Mailing address

[  ] Check here if your mailing address is the same as your current residential address provided above. Otherwise, complete the following:

.......................................................................................................................................................
(number, street, city, province, territory or state, country, postal code)

3. Business e-mail address

.....................................................................................

Item 3 – Personal information

1. Date of birth ........................................ (YYYY/MM/DD)

2. Place of birth ......................................................... (city, province, territory or state, country)

3. Gender Female [  ] Male [  ]

4. Eye colour ....................

5. Hair colour ....................

6. Height .......... [  ] in. or .......... [  ] cm

7. Weight .......... [  ] lbs. or .......... [  ] kg

Item 4 – Citizenship

1. Citizenship information

What is your country of citizenship?

[  ] Canada

[  ] Other, specify: ..............................................

2. If you are a citizen of a country other than Canada, complete the following for that citizenship.

[  ] Check here if you do not have a valid passport. Otherwise, provide:

Passport number: ..............................................

Date of issue: .............................................. (YYYY/MM/DD)

Place of issue: .............................................. (city, province, territory or state, country)

Item 5 – Registration jurisdictions

1. Are you filing this form under the passport system / interface for registration?

Only choose "No" if:

(a) you are seeking registration only in your principal jurisdiction,

(b) you are seeking review as a permitted individual

and you are not currently registered under securities legislation in any jurisdiction of Canada.

Yes [  ] No [  ]

2. Check each jurisdiction where you are seeking registration or review as a permitted individual:

[  ] All jurisdictions

[  ] Alberta

[  ] British Columbia

[  ] Manitoba

[  ] New Brunswick

[  ] Newfoundland and Labrador

[  ] Northwest Territories

[  ] Nova Scotia

[  ] Nunavut

[  ] Ontario

[  ] Prince Edward Island

[  ] Québec

[  ] Saskatchewan

[  ] Yukon

Item 6 – Individual categories

1. On Schedule C, check each category for which you are seeking registration as an individual or review as a permitted individual. If you are seeking review as a permitted individual, check each category that describes your position with your sponsoring firm.

2. If you are seeking registration as a representative of a mutual fund dealer or of a scholarship plan dealer in Québec, are you covered by your sponsoring firm's professional liability insurance?

Yes [  ] No [  ]

If "No", state:

The name of your insurer ............................................................................................

Your policy number ..............................................

Item 7 – Address and agent for service

1. Address for service

You must have one address for service in each province or territory where you are submitting this form. A residential address or a business address is acceptable. 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, if applicable ..............................................

Business e-mail address ............................................................................................

2. Agent for service

If you have appointed an agent for service, provide the following information for the agent in each province or territory where you have an agent for service. The address of your agent for service must be the same as the address for service above. If your agent for service is not an individual, provide the name of your contact person.

Name of agent for service: ..............................................

Contact person: ..............................................
Last name, First name

Item 8 – Proficiency

1. Course, examination or designation information and other education

Complete Schedule E to indicate each course, examination and designation that is required for registration or approval and that you have successfully completed or have been exempted from.

[  ] Check here if you are not required under securities legislation or derivatives legislation or both, or the rules of an SRO to satisfy any course, examination or designation requirements.

2. Student numbers

If you have a student number for a course that you successfully completed with one of the following organizations, provide it below:

CSI Global Education: ..............................................................

IFSE Institute: ...........................................................................

Institute of Canadian Bankers (ICB): .......................................

CFA Institute: ...........................................................................

Advocis: ....................................................................................

RESP Dealers Association of Canada: ..................................................................

Other: ....................................................................................................................

3. Exemption refusal

Has any securities regulator, derivatives regulator or SRO refused to grant you an exemption from a course, examination, designation or experience requirement?

Yes [  ] No [  ]

If "Yes", complete Schedule F.

4. Relevant securities industry experience

If you are an individual applying for IIROC approval, select "N/A".

If you have not been registered in the last 36 months and you passed the required examination more than 36 months ago, do you consider that you have gained 12 months of relevant securities industry experience during the 36-month period?

Yes [  ] No [  ] N/A [  ]

If "Yes", complete Schedule F.

Item 9 – Location of employment

1. Provide the following information for your new sponsoring firm. If you will be working out of more than one business location, provide the following information for the business location out of which you will be doing most of your business. If you are only filing this form because you are a permitted individual and you are not employed by, or acting as agent for, the sponsoring firm, select "N/A".

NRD location number: ..............................................................................

Unique Identification Number (optional): ................................................

Business location address: ...........................................................................................................

(number, street, city, province, territory or state, country, postal code)

Telephone number: (.....) ...........................

Fax number: (.....) ............................

N/A [  ]

2. If the firm has a foreign head office, and/or you are not a resident of Canada, provide the address for the business location in which you will be conducting most of your business. If you are only filing this form because you are a permitted individual and you are not employed by, or acting as agent for, the sponsoring firm, select "N/A".

Business location address: ...........................................................................................................

(number, street, city, province, territory or state, country, postal code)

Telephone number: (.....) ..........................

Fax number: (.....) ............................

N/A [  ]

[The following under #3 "Type of business location", #4 and #5 is for a Format other than NRD format only]

3. Type of business location:

[  ] Head office

[  ] Branch or business location

[  ] Sub-branch (members of the Mutual Fund Dealers Association of Canada only)

4. Name of supervisor or branch manager: ......................................................................................

5. [  ] Check here if the mailing address of the business location is the same as the business location address provided above. Otherwise, complete the following:

Mailing address: ...........................................................................................................................

(number, street, city, province, territory or state, country, postal code)

Item 10 – Current employment, other business activities, officer positions held and directorships

Complete a separate Schedule G for each of your current business and employment activities, including employment and business activities with your sponsoring firm and any employment and business activities outside your sponsoring firm. Also include all officer or director positions and any other equivalent positions held, as well as positions of influence. The information must be provided

• whether or not you receive compensation for such services, and

• whether or not any such position is business related.

Item 11 – Previous employment and other activities

On Schedule H, complete your history of employment and other activities for the past 10 years.

Item 12 – Resignations and terminations

Have you ever resigned, been terminated or been dismissed for cause by an employer from a position following allegations that you:

1. Violated any statutes, regulations, rules or standards of conduct?

Yes [  ] No [  ]

If "Yes", complete Schedule I, Item 12.1.

2. Failed to appropriately supervise compliance with any statutes, regulations, rules or standards of conduct?

Yes [  ] No [  ]

If "Yes", complete Schedule I, Item 12.2.

3. Committed fraud or the wrongful taking of property, including theft?

Yes [  ] No [  ]

If "Yes", complete Schedule I, Item 12.3.

Item 13 – Regulatory disclosure

The questions below relate to any jurisdiction of Canada and any foreign jurisdiction.

1. Securities and derivatives regulation

(a) Other than a registration or permitted individual status that has been recorded under this NRD number, are you now, or have you ever been, registered or licensed with any securities regulator or derivatives regulator or both to trade in or advise on securities or derivatives or both?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1 (a).

(b) Have you ever been refused registration or a licence to trade in or advise on securities or derivatives or both?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1 (b).

(c) Have you ever been denied the benefit of any exemption from registration provided in any securities or derivatives or both legislation or rules, other than what was disclosed in Item 8.3 of this form?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1 (c).

(d) Are you now, or have you ever been subject to any disciplinary proceedings or any order resulting from disciplinary proceedings under any securities legislation or derivatives legislation or both?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.1 (d).

2. SRO regulation

(a) Other than an approval that has been recorded under this NRD number, are you now, or have you ever been, an approved person of an SRO or similar organization?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.2 (a).

(b) Have you ever been refused approved person status by an SRO or similar organization?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.2 (b).

(c) Are you now, or have you ever been, subject to any disciplinary proceedings conducted by any SRO or similar organization?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.2 (c).

3. Non-securities regulation

(a) Are you now, or have you ever 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 derivatives or both (e.g. insurance, real estate, accountant, lawyer, teacher)?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3 (a).

(b) Have you ever been refused registration or a licence under any legislation relating to your professional activities unrelated to securities or derivatives?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3 (b).

(c) Are you now, or have you ever been, a subject of any disciplinary actions conducted under any legislation relating to your professional activities unrelated to securities or derivatives?

Yes [  ] No [  ]

If "Yes", complete Schedule J, Item 13.3 (c).

Item 14 – Criminal disclosure

The questions below apply to offences committed in any jurisdiction of Canada and any foreign jurisdiction.

You must disclose all offences, including:

• a criminal offence under federal statutes such as the Criminal Code (Canada), the Income Tax Act (Canada), the Competition Act (Canada), the Immigration and Refugee Protection Act (Canada) and the Controlled Drugs and Substances Act (Canada), even if

• a record suspension has been ordered under the Criminal Records Act (Canada), or

• you have been granted an absolute or conditional discharge under the Criminal Code (Canada), and

• a criminal offence, with respect to questions 14.2 and 14.4, of which you or your firm has been found guilty or for which you or your firm have participated in the alternative measures program within the previous three years, even if a record suspension has been ordered under the Criminal Records Act (Canada).

You are not required to disclose:

• charges for summary conviction offences that have been stayed for six months or more,

• charges for indictable offences that have been stayed for a year or more,

• offences under the Youth Criminal Justice Act (Canada), and

• speeding or parking violations.

Subject to the exceptions above:

1. Are there any outstanding or stayed charges against you alleging a criminal offence that was committed?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.1.

2. Have you ever been found guilty, pleaded no contest to, or been granted an absolute or conditional discharge from any criminal offence that was committed?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.2.

3. To the best of your knowledge, are there any outstanding or stayed charges against any firm of which you were, at the time the criminal offence was alleged to have taken place, a partner, director, officer or major shareholder?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.3.

4. To the best of your knowledge, has any firm, when you were a partner, officer, director or major shareholder, ever been found guilty, pleaded no contest to or been granted an absolute or conditional discharge from a criminal offence that was committed?

Yes [  ] No [  ]

If "Yes", complete Schedule K, Item 14.4.

Item 15 – Civil disclosure

The questions below relate to any jurisdiction of Canada and any foreign jurisdiction.

1. Are there currently any outstanding civil actions alleging fraud, theft, deceit, misrepresentation or similar misconduct against you or a firm where you are or were a partner, director, officer or major shareholder?

Yes [  ] No [  ]

If "Yes", complete Schedule L, Item 15.1.

2. Have you or a firm where you are or were a partner, director, officer or major shareholder ever been a defendant or respondent in any civil proceeding in which fraud, theft, deceit, misrepresentation or similar misconduct is, or was, successfully established in a judgment?

Yes [  ] No [  ]

If "Yes", complete Schedule L, Item 15.2.

Item 16 – Financial disclosure

1. Bankruptcy

Under the laws of any applicable jurisdiction, have you or has any firm when you were a partner, director, officer or major shareholder of that firm:

(a) Had a petition in bankruptcy issued or made a voluntary assignment in bankruptcy or any similar proceeding?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.1 (a).

(b) Made a proposal under any legislation relating to bankruptcy or insolvency or any similar proceeding?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.1 (b).

(c) Been subject to proceedings under any legislation relating to the winding up or dissolution of the firm, or under the Companies' Creditors Arrangement Act (Canada)?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.1 (c).

(d) Been subject to or initiated any proceedings, arrangement or compromise with creditors? This includes having a receiver, receiver-manager, administrator or trustee appointed by or at the request of creditors, privately, through court process or by order of a regulatory authority, to hold your assets.

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.1 (d).

2. Debt obligations

Over the past 10 years, have you failed to meet a financial obligation of $10,000 or more as it came due or, to the best of your knowledge, has any firm, while you were a partner, director, officer or major shareholder of that firm, failed to meet any financial obligation of $10,000 or more as it came due?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.2.

3. Surety bond or fidelity bond

Have you ever been refused for a surety or fidelity bond?

Yes [  ] No [  ]

If "Yes", complete Schedule M, Item 16.3.

4. Garnishments, unsatisfied judgments or directions to pay

Has any federal, provincial, territorial or state authority or court ever issued any of the following against you regarding your indebtedness or, to the best of your knowledge, the indebtedness of a firm where you are or were a partner, director, officer or major shareholder:

If "Yes", complete Schedule M, Item 16.4.

Item 17 – Ownership of securities and derivatives firms

Are you now, or have you ever been, a partner or major shareholder of any firm (including your sponsoring firm) whose business is trading in or advising on securities or derivatives or both?

Yes [  ] No [  ]

If "Yes", complete Schedule N.

Item 18 – Agent for service

By submitting this form, you certify that in each jurisdiction of Canada where you have appointed an agent for service, you have completed the appointment of agent for service required in that jurisdiction.

Item 19 – Submission to jurisdiction

By submitting this form, you agree to be subject to the securities legislation or derivatives legislation or both of each jurisdiction of Canada, and to the by-laws, regulations, rules, rulings and policies (collectively referred to as "rules" in this form) of the SROs to which you have submitted this form. This includes the jurisdiction of any tribunals or any proceedings that relate to your activities as a registrant or a partner, director or officer of a registrant under that securities legislation or derivatives legislation or both or as an Approved Person under SRO rules.

Item 20 – 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 O to administer and enforce certain provisions of their securities legislation or derivatives legislation or both.

By submitting this form, the individual consents to the collection by the securities regulatory authorities 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 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 them. Securities regulatory authorities 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 authority in any jurisdiction in which the required information is submitted. See Schedule O 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.

SROs

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 rules of the SROs.

By submitting this form, you authorize the SROs to which this form is submitted to collect any information from any source whatsoever. This includes, but is not limited to, personal confidential information about you that is otherwise protected by law such as police, credit, employment, education and proficiency course completion records, and records from other government or non-governmental regulatory authorities, securities commissions, stock exchanges or other SROs, private bodies, agencies, individuals or corporations, as may be necessary for the SROs to complete their review of your form or continued fitness for registration or approval in accordance with their rules for the duration of the period you remain so registered or approved. You further consent to and authorize the transfer of confidential information between SROs, securities commissions or stock exchanges from whom you now, or may in the future, seek registration or approval, or with which you are currently registered or approved for the purpose of determining fitness or continued fitness for registration or approval or in connection with the performance of an investigation or other exercise of regulatory authority, whether or not you are registered with or approved by them.

By submitting this form, you certify that you understand the rules of the applicable SROs 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 SROs 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 SROs from whom you are seeking 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 form may be revoked, terminated or suspended at any time in accordance with the then applicable rules of the respective SROs. 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 SROs or any approved affiliated company or other affiliate of such member without obtaining the approval of or registration with the SROs, in accordance with their rules.

By submitting this form, you undertake to notify the SROs from whom you are seeking 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 form, without amendment, to other SROs in the event that at some time in the future you seek registration or approval from such other SROs.

You certify that you have discussed the questions in this form, together with this Agreement, with an Officer, Supervisor or Branch Manager of your sponsoring member firm and, to your knowledge and belief, the authorized Officer, Supervisor or Branch Manager was satisfied that you fully understood the questions and the terms of this Agreement. You further certify that your business activities that are subject to securities rules and derivatives rules or both will be limited strictly to those permitted by the category of your registration or approval.

Item 21 – 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 22 – Certification

1. Certification – NRD format

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, 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. If the business location specified in this form is a residence, I hereby give my consent for the regulator or, in Québec, the securities regulatory authority to enter that residence for the administration of securities legislation and derivatives legislation, including commodity futures legislation.

[  ] 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 and the certification above.

2. Certification – Format other than NRD format

Individual

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

• I have read this form and understand the questions,

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

• if the business location specified in this form is a residence, I hereby give my consent for the regulator or, in Québec, the securities regulatory authority to enter that residence for the administration of securities legislation and derivatives legislation, including commodity futures legislation.

Signature of individual ................................................... Date ....................................

Authorized partner or officer of the firm

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, for the individual that:

• the individual identified in this form will be engaged by the sponsoring firm as a registered individual or a permitted individual, and

• I have, or a branch manager, or supervisor, or another officer or partner has, discussed the questions set out in this form with the individual and, to the best of my knowledge, the individual fully understands the questions.

Name of firm .....................................................................................

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)

Schedule A

Names (Item 1)

Item 1.2 – Other personal names

Name 1:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname): .............................................

Name 2:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname): ............................................

Name 3:

Provide the reasons for the use of this name (for example, marriage, divorce, court order, commonly used name or nickname): ............................................

Item 1.3 – Use of other names

Name 1:

Name: ..................................................................................................................

Provide the reasons for the use of this other name (for example, trade name or team name): ........................................................................................

If this other name is or was used in connection with any sponsoring firm, did the sponsoring firm approve the use of the name?

Yes [  ] No [  ] N/A [  ]

Name 2:

Name: ..................................................................................................................

Provide the reasons for the use of this other name (for example, trade name or team name): ........................................................................................

If this other name is or was used in connection with any sponsoring firm, did the sponsoring firm approve the use of the name?

Yes [  ] No [  ] N/A [  ]

Name 3:

Name: ..................................................................................................................

Provide the reasons for the use of this other name (for example, trade name or team name): ........................................................................................

If this other name is or was used in connection with any sponsoring firm, did the sponsoring firm approve the use of the name?

Yes [  ] No [  ] N/A [  ]

Schedule B

Residential Address (Item 2)

Item 2.1 – Current and previous residential addresses

If you have lived at your current address for less than 10 years, list all previous addresses for the past 10 years.

You do not have to include a postal code or ZIP code, or a telephone number for any previous address.

Address 1:

Address 2:

Address 3:

Schedule C

Individual Categories (Item 6)

Check each category for which you are seeking registration, approval or review as a permitted individual.

Categories common to all jurisdictions under securities legislation

Firm categories [Format other than NRD format only]

[  ] Investment Dealer

[  ] Mutual Fund Dealer

[  ] Scholarship Plan Dealer

[  ] Exempt Market Dealer

[  ] Restricted Dealer

[  ] Portfolio Manager

[  ] Restricted Portfolio Manager

[  ] Investment Fund Manager

Individual categories and permitted activities

[  ] Dealing Representative

[  ] Advising Representative

[  ] Associate Advising Representative

[  ] Ultimate Designated Person

[  ] Chief Compliance Officer

[  ] Permitted Individual as described in paragraph (c) of the definition of "permitted individual" in section 1.1 of National Instrument 33-109 Registration Information

[  ] Officer – Specify title:

[  ] Director

[  ] Partner

[  ] Shareholder

[  ] Branch Manager (MFDA members only)

[  ] IIROC approval only

IIROC

Approval categories

[  ] Executive

[  ] Director (Industry)

[  ] Director (Non-Industry)

[  ] Supervisor

[  ] Investor

[  ] Registered Representative

[  ] Investment Representative

[  ] Trader

Additional approval categories

[  ] Chief Compliance Officer

[  ] Chief Financial Officer

[  ] Ultimate Designated Person

Products

[  ] Non-Trading

[  ] Securities

[  ] Options

[  ] Futures Contracts and Futures Contract Options

[  ] Mutual Funds only

Customer type

[  ] Retail

[  ] Institutional

[  ] Not Applicable

Portfolio management

[  ] Portfolio Management

Categories under local commodity futures and derivatives legislation

Ontario

Firm categories

[  ] Commodity Trading Adviser

[  ] Commodity Trading Counsel

[  ] Commodity Trading Manager

[  ] Futures Commission Merchant

Individual categories and permitted activities

[  ] Advising Representative

[  ] Salesperson

[  ] Branch Manager

[  ] Officer – Specify title:

[  ] Director

[  ] Partner

[  ] Shareholder

[  ] IIROC approval only

Manitoba

Firm categories

[  ] Dealer (Merchant)

[  ] Dealer (Futures Commission Merchant)

[  ] Dealer (Floor Broker)

[  ] Adviser

[  ] Local

Individual categories and permitted activities

[  ] Floor Broker

[  ] Salesperson

[  ] Branch Manager

[  ] Adviser

[  ] Officer – Specify title:

[  ] Director

[  ] Partner

[  ] Futures Contracts Portfolio Manager

[  ] Associate Futures Contracts Portfolio Manager

[  ] IIROC approval only

[  ] Local

Québec

Firm categories

[  ] Derivatives Dealer

[  ] Derivatives Portfolio Manager

Individual categories and permitted activities

[  ] Derivatives Dealing Representative

[  ] Derivatives Advising Representative

[  ] Derivatives Associate Advising Representative

Schedule D

Address and Agent for Service (Item 7)

Item 7.1 – Address for service

You must have one address for service in each province or territory in which you are now, or are seeking to become, a registered individual or permitted 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 (.....) ...............

Business e-mail address: ............................................................................

Item 7.2 – Agent for service

If you have appointed an agent for service, provide the following information about 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)

Item 8.1 – Course, examination or designation information and other education

If you have listed the CFA Charter in Item 8.1, please indicate by checking "Yes" below if you are a current member of the CFA Institute permitted to use this charter.

Yes [  ] No [  ]

If "No", please explain why you no longer hold this designation:

.....................................................................................................................................................................

.....................................................................................................................................................................

If you have listed the Canadian Investment Manager Designation in Item 8.1, please indicate by checking "Yes" below if you are currently permitted to use this designation.

Yes [  ] No [  ]

If "No", please explain why you no longer hold this designation:

.....................................................................................................................................................................

.....................................................................................................................................................................

Schedule F

Proficiency (Items 8.3 and 8.4)

Item 8.3 – Exemption refusal

Complete the following for each exemption that was refused.

1. Which securities regulator, derivatives regulator or SRO refused to grant the exemption?

......................................................................................................................................................

State the name of the course, examination, designation or experience requirement:

......................................................................................................................................................

State the reason given for not being granted the exemption:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

2. Which securities regulator, derivatives regulator or SRO refused to grant the exemption?

......................................................................................................................................................

State the name of the course, examination, designation or experience requirement:

......................................................................................................................................................

State the reason given for not being granted the exemption:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

3. Which securities regulator, derivatives regulator or SRO refused to grant the exemption?

......................................................................................................................................................

State the name of the course, examination, designation or experience requirement:

......................................................................................................................................................

State the reason given for not being granted the exemption:

......................................................................................................................................................

Date exemption refused: .................................................................. (YYYY/MM/DD)

Item 8.4 – Relevant securities industry experience

Describe your responsibilities in areas relating to the category you are applying for, including the title(s) you have held, as well as the start and end dates:

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

What is the percentage of your time devoted to these activities?

..........%

Indicate the continuing education activities in which you have participated during the last 36 months and that are relevant to the category of registration you are applying for:

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

.....................................................................................................................................................................

Schedule G

Current Employment, Other Business Activities,
Officer Positions Held and Directorships (Item 10)

Complete a separate Schedule G for each of your current business and employment activities, including employment and business activities with your sponsoring firm and any employment and business activities outside your sponsoring firm. Also include all officer or director positions and any other equivalent positions held, as well as positions of influence. The information must be provided

• whether or not you receive compensation for such services, and

• whether or not any such position is business related.

1. Start date ................................................................. (YYYY/MM/DD)

2. Firm information

[  ] Check here if this activity is employment with your sponsoring firm.

If the activity is with your sponsoring firm, you are not required to indicate the firm name and address information below:

Name of business or employer: .................................................................................................

Address for service: ....................................................................................................................
(number, street, city, province, territory or state, postal code)

Name and title of your immediate supervisor: ..........................................................................

3. Description of duties

Describe all employment and business activities related to this employer. Include the nature of the business and your duties, title or relationship with the business. If you are seeking registration that requires specific experience, include details such as level of responsibility, value of accounts under direct supervision, number of years of experience, and percentage of time spent on each activity.

......................................................................................................................................................

4. Number of work hours per week

How many hours per week do you devote to this business or employment? ......................

If this activity is employment with your sponsoring firm and you work less than 30 hours per week, explain why.

......................................................................................................................................................

5. Conflicts of interest

If you have more than one employer or are engaged in business related activities:

A. Disclose any potential for confusion by clients and any potential for conflicts of interest arising from your multiple employment or business related activities or proposed business related activities.

...........................................................................................................................

...........................................................................................................................

B. Indicate whether or not any of your employers or organizations where you engage in business related activities are listed on an exchange.

...........................................................................................................................

...........................................................................................................................

C. Confirm whether the firm has procedures for minimizing potential conflicts of interest and if so, confirm that you are aware of these procedures.

...........................................................................................................................

...........................................................................................................................

D. State the name of the person at your sponsoring firm who has reviewed and approved your multiple employment or business related activities or proposed business related activities.

...........................................................................................................................

E. If you do not perceive any conflicts of interest arising from this employment, explain why.

...........................................................................................................................

Schedule H

Previous Employment and Other Activities (Item 11)

Provide the following information for each of your employment and other activities in the past 10 years. Account for all of your time, including full-time and part-time employment, self-employment or military service. Include your status for each, such as unemployed, full-time student, or other similar statuses. Do not include short-term employment of four months or less while a student, unless it was in the securities, derivatives or financial industry.

In addition to the information required in the paragraph above, if you were employed or had business activities in the securities or derivatives industry or both during and before the 10-year period, disclose all your securities and derivatives or both employment or business activities (both before and during the 10-year period).

[  ] Unemployed

[  ] Full-time student

[  ] Employed or self-employed

Complete the following only if you are, or were, employed or self-employed during this period.

Name of business or employer:

......................................................................................................................................................................

Address of business or employer:

.......................................................................................................................................................................
(number, street, city, province, territory or state, country)

Name and title of immediate supervisor, if applicable:

......................................................................................................................................................................

Describe the firm's business, your position, duties and your relationship to the firm. If you are seeking registration in a category of registration that requires specific experience, include details of that experience. Examples include level of responsibility, value of accounts under direct supervision, number of years of that experience and research experience, and percentage of time spent on each activity.

Reason why you left the firm:

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

Schedule I

Resignations and Terminations (Item 12)

Item 12.1

For each allegation of violation of any statutes, regulations, rules or internal/external standards of conduct, state below (1) the name of the firm from which you resigned, were terminated or dismissed for cause, (2) whether you resigned, were terminated or dismissed for cause, (3) the date you resigned, were terminated or dismissed for cause, and (4) the circumstances relating to your resignation, termination or dismissal for cause.

......................................................................................................................................................................

Item 12.2

For each allegation of failure to supervise compliance with any statutes, regulations, rules or standards of conduct, state below (1) the name of the firm from which you resigned, were terminated or dismissed for cause, (2) whether you resigned, were terminated or dismissed for cause, (3) the date you resigned, were terminated or dismissed for cause, and (4) the circumstances relating to your resignation, termination or dismissal for cause.

......................................................................................................................................................................

Item 12.3

For each allegation of fraud or the wrongful taking of property, including theft, state below (1) the name of the firm from which you resigned, were terminated or dismissed for cause, (2) whether you resigned, were terminated or dismissed for cause, (3) the date you resigned, were terminated or dismissed for cause, and (4) the circumstances relating to your resignation, termination or dismissal for cause.

......................................................................................................................................................................

Schedule J

Regulatory Disclosure (Item 13)

Item 13.1 – Securities and derivatives regulation

(a) For each registration or licence, state below (1) the name of the firm, (2) the securities or derivatives regulator with which you are, or were, registered or licensed, (3) the type or category of registration or licence, and (4) the period that you held the registration or licence.

.....................................................................................................................................................

(b) For each registration or licence refused, state below (1) the name of the firm, (2) the securities or derivatives regulator 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.

.....................................................................................................................................................

(c) For each exemption from registration denied or licence refused, other than what was disclosed in Item 8.3 of this form, state below (1) the party that was refused the exemption from registration or licence, (2) the securities or derivatives regulator that refused the exemption from registration or licence, (3) the type or category or registration or licence refused, (4) the date of the refusal, and (5) the reasons for the refusal.

.....................................................................................................................................................

(d) For each order or disciplinary proceeding, state below (1) the name of the firm, (2) the securities or derivatives regulator that issued the order or is conducting or conducted 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), (6) whether you are or were a partner, director, officer or major shareholder of the firm and named individually in the order or disciplinary proceeding, and (7) any other relevant details.

.....................................................................................................................................................

Item 13.2 – SRO regulation

(a) For each approval, state below (1) the name of the firm, (2) the SRO with which you are or were an approved person, (3) the categories of approval, and (4) the period that you held the approval.

.....................................................................................................................................................

(b) For each approval refused, state below (1) the name of the firm, (2) the SRO that refused the approval, (3) the category of approval refused, (4) the date of the refusal, and (5) the reasons for the refusal.

.....................................................................................................................................................

(c) For each order or disciplinary proceeding, state below (1) the name of the firm, (2) the SRO 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), (6) whether you are or were a partner, director, officer or major shareholder of the firm and named individually in the order or disciplinary proceeding, and (7) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

.....................................................................................................................................................

Item 13.3 – Non-securities regulation

(a) For each registration or licence, state below (1) the party who is, or was, registered or licensed (if insurance licensed, also indicate the name of the insurance agency), (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 period that the party held the registration or licence.

.....................................................................................................................................................

(b) For each registration or licence refused, state below (1) the party that was refused registration or licensing (if insurance licensed, also indicate the name of the insurance agency), (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 (if insurance licensed, indicate the name of the insurance agency), (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), (6) whether you are or were a partner, director, officer or major shareholder of the firm and named individually in the order or disciplinary proceeding and (7) any other information that you think is relevant or that the regulatory authority may request.

.....................................................................................................................................................

Schedule K

Criminal Disclosure (Item 14)

Item 14.1

For each charge, state below (1) the type of charge, (2) the date of the charge, (3) any trial or appeal dates, and (4) the court location.

......................................................................................................................................................................

Item 14.2

For each finding of guilty, pleading no contest to, or granting of an absolute or conditional discharge from a criminal offence, state below (1) the offence, (2) the date found guilty, and (3) the disposition (any penalty or fine and the date any fine was paid).

......................................................................................................................................................................

Item 14.3

For each charge, state below (1) the name of the firm, (2) the type of charge, (3) the date of the charge, (4) any trial or appeal dates, and (5) the court location.

......................................................................................................................................................................

Item 14.4

For each finding of guilty, pleading no contest to, or granting of an absolute or conditional discharge from a criminal offence, state below (1) the name of the firm, (2) the offence, (3) the date of the conviction, and (4) the disposition (any penalty or fine and the date any fine was paid).

......................................................................................................................................................................

Schedule L

Civil Disclosure (Item 15)

Item 15.1

For each outstanding civil proceeding, state below (1) the dates the notice of civil claim and response to civil claim were filed, (2) the name of the plaintiff(s) in the proceeding, (3) whether the proceeding is pending or on appeal, (4) whether the proceeding was against a firm where you are, or were, a partner, director, officer or major shareholder and whether you have been named individually in the allegations, and (5) the jurisdiction where the action is being pursued.

......................................................................................................................................................................

Item 15.2

For each civil proceeding, state below (1) the dates the notice of civil claim and response to civil claim were filed, (2) each plaintiff in the proceeding, (3) the jurisdiction where the action was pursued, (4) whether the proceeding was about a firm where you are, or were, a partner, director, officer or major shareholder and whether you have been named individually in the allegations and (5) a summary of any disposition or any settlement over $10,000. You must disclose any actions settled without admission of liability.

......................................................................................................................................................................

Schedule M

Financial Disclosure (Item 16)

Item 16.1 – Bankruptcy

(a) For each event, state below (1) the date of the petition or voluntary assignment, (2) the person or firm about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, (7) date of discharge or release, if applicable, and (8) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

.....................................................................................................................................................

(b) For each event, state below (1) the date of the proposal, (2) the person or firm about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

.....................................................................................................................................................

(c) For each event, state below (1) the date of the proceeding, (2) the person or firm about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

.....................................................................................................................................................

(d) For each proceeding, arrangement or compromise with creditors, state below (1) the date of proceeding, (2) the person or firm about whom this disclosure is being made, (3) any amounts currently owing, (4) the creditors, (5) the status of the matter, (6) a summary of any disposition or settlement, and (7) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

.....................................................................................................................................................

Item 16.2 – Debt obligation

For each event, state below (1) the person or firm that failed to meet its financial obligation, (2) the amount that was owing at the time the person or firm failed to meet its financial obligation, (3) the person or firm 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 the regulator or, in Québec, the securities regulatory authority may request, including why the obligation has not been met/satisfied.

......................................................................................................................................................................

Item 16.3 – Surety bond or fidelity bond

For each bond refused, state 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.

......................................................................................................................................................................

Item 16.4 – Garnishments, unsatisfied judgments or directions to pay

For each garnishment, unsatisfied judgment or direction to pay regarding your indebtedness, indicate below (1) the amount that was owing at the time the garnishment, judgment or direction to pay was rendered, (2) the person or firm 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) the percentage of earnings to be garnished or the amount to be paid, (5) any amounts currently owing, and (6) any other information that you think is relevant or that the regulator or, in Québec, the securities regulatory authority may request.

......................................................................................................................................................................

Schedule N

Ownership of Securities and Derivatives Firms (Item 17)

Name of firm (whose business is trading in or advising on securities or derivatives, or both):

........................................................................................................................................

What is your relationship to the firm? Partner [  ] Major shareholder [  ]

Provide the following information:

(a) State the number, value, class and percentage of securities, or the amount of partnership interest you own or propose to acquire when you are registered or approved as a result of the review of this form. If acquiring shares when you are so approved or registered, state the source (for example, treasury shares, or if upon transfer, state name of transferor).

.....................................................................................................................................................

(b) State the market value (approximate, if necessary) of any 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:

.....................................................................................................................................................

(c) If another person or firm has provided you with funds to invest in the firm, provide the name of the person or firm and state the relationship between you and that person or firm:

.....................................................................................................................................................

(d) Are the funds to be invested (or proposed to be invested) guaranteed directly or indirectly by any person or firm?

Yes [  ] No [  ]

If "Yes", provide the name of the person or firm and state the relationship between you and that person or firm:

.....................................................................................................................................................

(e) Have you directly or indirectly given up any rights relating to these securities or this partnership interest, or do you, when you are registered or approved as a result of the review of this form, intend to give up any of these rights (including by hypothecation, pledging or depositing as collateral the securities or partnership interest with any firm or person)?

Yes [  ] No [  ]

If "Yes", provide the name of the person or firm, state the relationship between you and that person or firm and describe the rights that have been or will be given up: ...............................................................................................

(f) Is a person other than you the beneficial owner of the shares, bonds, debentures, partnership units or notes held by you?

Yes [  ] No [  ]

If "Yes", complete (g), (h) and (i).

(g) Name of beneficial owner:

(h) Residential address:

......................................................................................................................................................
(number, street, city, province, territory or state, country, postal code)

(i) Occupation:

.....................................................................................................................................................

Schedule O

Contact Information for Notice of Collection and Use of Personal Information

 Form 33-109F5, under "How to submit this form", the following information was added below paragraph (b) by BC Reg 121/2011, effective July 11, 2011.

Name of firm ................................................................................................................................................

Registration categories .................................................................................................................................

NRD number (firm) ...............................................

 Form 33-109F5, Item 1, line starting with "If submitting changes to Form 33-109F6" was added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F5, Item 5, section 2, "Name of firm" below the bullets was deleted by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F5, Schedule A BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F5, paragraph under heading "General instructions" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

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:

1. Form 33-109F6, except for the changes set out in section 3.1 of National Instrument 33-109, or

2. Form 33-109F4.

 Form 33-109F5, paragraph under heading "How to submit this form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

How to submit this form

To report changes to information in a Form 33-109F4, 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 33-109F6, or

(b) Form 33-109F4, if the individual is relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database.

 Form 33-109F5, Item 3, second paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

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

 Form 33-109F5, Item 4, BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Item 4 — Warning

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

 Form 33-109F5, Item 5, first sentence of paragraph 3 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

3. 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 NI 31-102 when making changes to Form 33-109F4

 Form 33-109F5, Schedule A BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F5, Schedule A table BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F5 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F5

[am. B.C. Regs. 121/2011, Sch. B, s. 18; 238/2014, App. C, s. 13; 209/2017, s. 8.]

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 33-109F6, except for the changes set out in section 3.1 of National Instrument 33-109, or

• Form 33-109F4.

How to submit this form

To report changes to information in a Form 33-109F4, 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 33-109F6, or

(b) Form 33-109F4, if the individual is relying on the temporary hardship exemption in section 5.1 of National Instrument 31-102 National Registration Database.

Name of firm ................................................................................................................................................

Registration categories .................................................................................................................................

NRD number (firm) ...............................................

Item 1 – Type of form

Check the form that is being updated:

[  ] Form 33-109F6

If submitting changes to Form 33-109F6, please attach a blackline of the amended sections of the form,

[  ] Form 33-109F4 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 them. 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 33-109F4

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.

2. Use the following certification when submitting this form in a format other than NRD format when making changes to Form 33-109F6

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)

3. 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 NI 31-102 National Registration Database when making changes to Form 33-109F4

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

 Form 33-109F6, section 5.13 BEFORE re-enacted by BC Reg 382/2010, effective January 1, 2011.

5.13 Audited financial statements

Attach audited financial statements prepared within the last 90 days.

If the firm is a start-up company, you can attach an audited opening balance sheet instead.

 Form 33-109F6, section 1.4 (a) and 1.5 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

1.4 In what category and jurisdiction is the firm seeking registration? Check all that apply.

(a) Categories under securities legislation

1.5 Exemptions

Is the firm applying for any exemptions under securities or derivatives legislation?

Yes [ ] No [ ]

If yes, provide the following information for each exemption:

 Form 33-109F6, under Definitions heading, definitions of "Foreign jurisdiction", "Jurisdiction or jurisdiction of Canada" and "NI 52-107" were added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F6, under Definitions heading, definition of "NI 31-103" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

NI 31-103 — National Instrument 31-103 Registration Requirements and Exemptions.

 Form 33-109F6, under "Contents of the form" heading, list item 2 of required supporting documents BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

2 Business plan, policies and procedures manual, and client agreements (British Columbia, Alberta and Manitoba only) (question 3.3)

 Form 33-109F6, one instruction paragraph under "How to complete and submit the form" heading BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

You must include all supporting documents and fees with your submission. We may ask you to provide other information and documents to help determine whether the firm is suitable for registration.

 Form 33-109F6, under "How to complete and submit the form" heading the following instruction paragraph was added by BC Reg 121/2011, effective July 11, 2011.

In most of this form, answers are required to questions which apply only to Canadian provinces and territories; you will find that the questions are referenced to "jurisdictions" or "jurisdiction of Canada". These refer to all provinces and territories of Canada. However, the questions in Part 4 – Registration History and Part 7 – Regulatory Action are to be answered in respect of any jurisdiction in the world.

 Form 33-109F6, section 1.3 BEFORE amended and footnote was added by BC Reg 121/2011, effective July 11, 2011.

1.3 Why are you submitting this form?

 Form 33-109F6, section 2.2 (b) BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(b) If a firm is not registered in a jurisdiction of Canada or has not completed its first financial year since being registered, indicate the jurisdiction of Canada in which the firm expects most of its clients to be resident at the end of its current financial year. In all other circumstances, indicate the jurisdiction of Canada in which most of the firm's clients were resident at the end of its most recently completed financial year.

 Form 33-109F6, sections 2.5 and 2.6 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Contact names

2.5 Ultimate designated person

2.6 Chief compliance officer

[ ] Same as ultimate designated person

 Form 33-109F6, section 3.3 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

3.3 Business documents

Does the firm have the following documents to support its business activities?

If no, explain why the firm does not have the document:

If the regulator in British Columbia, Alberta or Manitoba is the principal regulator of the firm seeking registration, attach the firm's business plan, policies and procedures manual and client agreements, including any investment policy statements and investment management agreements.

 Form 33-109F6, Part 4, note just below the title BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

The questions in Part 4 apply to any jurisdiction in the world.

 Form 33-109F6, section 4.5 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

4.5 Refusal of registration, licensing or membership

Has the firm, or any predecessors or specified affiliates of the firm ever been refused registration, licensing or membership with a financial services regulator, securities or derivatives exchange, SRO or similar organization?

Yes [ ] No [ ]

If yes, provide the following information for each refusal:

 Form 33-109F6, section 5.1 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

5.1 Calculation of excess working capital

Attach the firm's calculation of excess working capital. Firms that are members of an SRO must use the capital calculation form required by their SRO. Firms that are not members of an SRO must use Form 31-103F1 Calculation of Excess Working Capital. See Schedule C.

 Form 33-109F6, sections 5.4 to 5.6 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

5.4 Jurisdictions covered

Where does the firm have bonding or insurance coverage?

AB [ ]

BC [ ]

MB [ ]

NB [ ]

NL [ ]

NT [ ]

NS [ ]

NU [ ]

ON [ ]

PE [ ]

QC [ ]

SK [ ]

YT [ ]

If the firm's bonding or insurance does not cover all jurisdictions of Canada where it is seeking registration, explain why.

5.5 Bonding or insurance details

If the firm's insurance or proposed insurance is not in the form of a financial institution bond, explain how it provides equivalent coverage to the bond.

5.6 Professional liability insurance (Québec only)

If the firm is seeking registration in Québec as a mutual fund dealer or a scholarship plan dealer, provide the following information about the firm's professional liability insurance:

 Form 33-109F6, section 5.13 BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

5.13 Audited financial statements

Attach audited financial statements prepared within the last 90 days.

If the firm is a start-up company, you can attach an audited opening statement of financial position instead.

 Form 33-109F6, a new sentence was added just after Part 6 title "Client Relationships" by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F6, sections 6.1, sentence just below "Client assets" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Does the firm hold or have access to client assets?

 Form 33-109F6, Part 7, sentence just below title BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

The questions in Part 7 apply to any jurisdiction in the world.

 Form 33-109F6, Section 7.1, sentence just below "Settlement agreements" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Has the firm, or any predecessors or specified affiliates of the firm ever entered into a settlement agreement with any financial services regulator, securities or derivatives exchange, SRO or similar organization?

 Form 33-109F6, Part 8, sentence just below title BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Has the firm, or any predecessors or specified affiliates of the firm ever been convicted of any criminal or quasi-criminal offence?

 Form 33-109F6, Section 8.1, sentence just below "Criminal convictions" BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Has the firm, or any predecessors or specified affiliates of the firm ever been convicted of any criminal or quasi-criminal offence?

 Form 33-109F6, Schedule A BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F6, Schedule B, section 4, "Phone number of the Agent for Service:" was added by BC Reg 121/2011, effective July 11, 2011.

 Form 33-109F6, Schedule B, section 7, BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

(a) a new Submission to Jurisdiction and Appointment of Agent for Service in this form no later than the 7th day after the date this Submission to Jurisdiction and Appointment of Agent for Service is terminated; and

(b) an amended Submission to Jurisdiction and Appointment of Agent for Service no later than the 7th day after any change in the name or above address of the Agent for Service.

 Form 33-109F6, Schedule C BEFORE amended by BC Reg 121/2011, effective July 11, 2011.

Schedule C

Form 31-103F1 Calculation of Excess Working Capital

.........................................................................

Firm Name

Capital Calculation

(as at.....................................................with comparative figures as at...................................................)

Notes:

This form must be prepared on an unconsolidated basis.

Line 8. Minimum Capital — The amount on this line must be not less than (a) $25,000 for an adviser, (b) $50,000 for a dealer, and (c) $100,000 for an investment fund manager.

Line 9. Market Risk — The amount on this line must be calculated according to the instructions set out in Schedule 1 to this Form.

Line 11. Guarantees — If the registered firm is guaranteeing the liability of another party, the total amount of the guarantee must be included in the capital calculation. If the amount of a guarantee is included in the firm's balance sheet as a current liability and is reflected in line 4, do not include the amount of the guarantee on line 11.

Line 12. Unresolved differences — Any unresolved differences that could result in a loss from either firm or client assets must be included in the capital calculation.

The examples below are intended to provide guidance as to how to calculate unresolved differences:

(i) If there is an unresolved difference relating to client securities, the amount to be reported on Line 12 will be equal to the market value of the client securities that are short, plus the applicable margin rate for those securities.

(ii) If there is an unresolved difference relating to the registrant's investments, the amount to be reported on Line 12 will be equal to the market value of the investments (securities) that are short.

(iii) If there is an unresolved difference relating to cash, the amount to be reported on Line 12 will be equal to the amount of the shortfall in cash.

Management Certification

Schedule 1 of Form 31-103F1 Calculation of Excess Working Capital

(calculating line 9 [market risk])

For each security whose value is included in line 1, Current Assets, multiply the market value of the security by the margin rate for that security set out below. Add up the resulting amounts for all of the securities you hold. The total is the "market risk" to be entered on line 9.

(a) Bonds, Debentures, Treasury Bills and Notes

(i) Bonds, debentures, treasury bills and other securities of or guaranteed by the Government of Canada, of the United Kingdom, of the United States of America and of any other national foreign government (provided such foreign government securities are currently rated Aaa or AAA by Moody's Investors Service, Inc. or Standard & Poor's Corporation, respectively), maturing (or called for redemption):

(ii) Bonds, debentures, treasury bills and other securities of or guaranteed by any province of Canada and obligations of the International Bank for Reconstruction and Development, maturing (or called for redemption):

(iii) Bonds, debentures or notes (not in default) of or guaranteed by any municipal corporation in Canada or the United Kingdom maturing:

(iv) Other non-commercial bonds and debentures, (not in default):

10% of market value

(v) Commercial and corporate bonds, debentures and notes (not in default) and non-negotiable and non-transferable trust company and mortgage loan company obligations registered in the registered firm's name maturing:

(b) Bank Paper

Deposit certificates, promissory notes or debentures issued by a Canadian chartered bank (and of Canadian chartered bank acceptances) maturing:

(c) Acceptable foreign bank paper

Deposit certificates, promissory notes or debentures issued by a foreign bank, readily negotiable and transferable and maturing:

"Acceptable Foreign Bank Paper" consists of deposit certificates or promissory notes issued by a bank other than a Canadian chartered bank with a net worth (i.e., capital plus reserves) of not less than $200,000,000.

(d) Mutual Funds

Where securities of mutual funds qualified by prospectus for sale in any province of Canada, the margin required is:

(i) 5% of the market value of the fund, where the fund is a money market mutual fund as defined in National Instrument 81-102; or

(ii) the margin rate determined on the same basis as for listed stocks multiplied by the market value of the fund.

(e) Stocks

(i) On securities (other than bonds and debentures) including rights and warrants listed on any exchange in Canada or the United States:

Long Positions — Margin Required

Securities selling at $2.00 or more — 50% of market value

Securities selling at $1.75 to $1.99 — 60% of market value

Securities selling at $1.50 to $1.74 — 80% of market value

Securities selling under $1.50 — 100% of market value

Short Positions — Credit Required

Securities selling at $2.00 or more — 150% of market value

Securities selling at $1.50 to $1.99 - $3.00 per share

Securities selling at $0.25 to $1.49 — 200% of market value

Securities selling at less than $0.25 — market value plus $0.25 per shares

(ii) For positions in securities (other than bonds and debentures but including warrants and rights), 50% of the market value if the security is a constituent security on a major broadly-based index of one of the following exchanges:

(a) American Stock Exchange

(b) Australian Stock Exchange Limited

(c) Bolsa de Valores de Sao Paulo

(d) Borsa Italiana

(e) Boston Stock Exchange

(f) Chicago Board of Options Exchange

(g) Chicago Board of Trade

(h) Chicago Mercantile Exchange

(i) Chicago Stock Exchange

(j) Euronext Amsterdam

(k) Euronext Brussels

(l) Euronext Paris S.A.

(m) Frankfurt Stock Exchange

(n) London International Financial Futures and Options Exchange

(o) London Stock Exchange

(p) Montreal Exchange

(q) New York Mercantile Exchange

(r) New York Stock Exchange

(s) New Zealand Exchange Limited

(t) Pacific Exchange

(u) Swiss Exchange

(v) The Stock Exchange of Hong Kong Limited

(w) Tokyo Stock Exchange

(x) Toronto Stock Exchange

(y) TSX Venture Exchange

(f) For all other securities — 100% of market value.

 Form 33-109F6, Schedule C (part) BEFORE amended by BC Reg 179/2013, effective May 31, 2013.

(a) Bonds, Debentures, Treasury Bills and Notes

(i) Bonds, debentures, treasury bills and other securities of or guaranteed by the Government of Canada, of the United Kingdom, of the United States of America and of any other national foreign government (provided such foreign government securities are currently rated Aaa or AAA by Moody's Investors Service, Inc. or Standard & Poor's Corporation, respectively), maturing (or called for redemption):

 Form 33-109F6, Schedule C, paragraph (d) (i) of Schedule 1 of Form 31-103F1 BEFORE amended by BC Reg 176/2014, effective September 22, 2014.

(i) 5% of the net asset value per security as determined in accordance with National Instrument 81-106 Investment Fund Continuous Disclosure, where the fund is a money market mutual fund as defined in National Instrument 81-102 Mutual Funds; or

 Form 33-109F6, section 1.3, third entry BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F6, Schedule A BEFORE amended by BC Reg 238/2014, effective January 11,2015.

Schedule A

Contact Information for
Notice of Collection and Use of Personal Information

 Form 33-109F6, Schedule B, Sections 7 and 8 and under heading "Acceptance" BEFORE amended by BC Reg 238/2014, effective January 11,2015.

7. Until six years after the Firm ceases to be registered, the Firm must file

(a) a new Submission to Jurisdiction and Appointment of Agent for Service in this form no later than the 10th day after the date this Submission to Jurisdiction and Appointment of Agent for Service is terminated; and

(b) an amended Submission to Jurisdiction and Appointment of Agent for Service no later than the 10th day after any change in the name or above address of the Agent for Service.

8. This Submission to Jurisdiction and Appointment of Agent for Service is governed by and construed in accordance with the laws of the local jurisdiction.

Dated: ..................................................................

..............................................................................
(Signature of the Firm or authorized signatory)

.............................................................................
(Name and Title of authorized signatory)

Acceptance

The undersigned accepts the appointment as Agent for Service of (Insert name of the Firm) under the terms and conditions of the foregoing Submission to Jurisdiction and Appointment of Agent for Service.

 Form 33-109F6, first sentence under heading "Definitions" was added by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F6, entry for "Principal Regulator" under heading "Definitions" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Principal Regulator — see NI 33-109.

 Form 33-109F6, entry "1." under heading "Contents of this form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

1. Schedule B — Submission to Jurisdiction and Appointment of Agent for Service for each jurisdiction where the firm is seeking registration (question 2.4)

 Form 33-109F6, entry "2." under heading "Contents of this form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

2. Business plan, policies and procedures manual, and client agreements (British Columbia, Alberta, Manitoba and New Brunswick only) (question 3.3)

 Form 33-109F6, second to last paragraph under heading "How to complete and submit the form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

In most of this form, answers are required to questions which apply only to Canadian provinces and territories; you will find that the questions are referenced to "jurisdictions" or "jurisdiction of Canada". These refer to all provinces and territories of Canada. However, the questions in Part 4 – Registration History and Part 7 – Regulatory Action are to be answered in respect of any jurisdiction in the world.

 Form 33-109F6, last paragraph under heading "How to complete and submit the form" BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

It is an offence under securities legislation or derivatives legislation to give false or misleading information on this form.

 Form 33-109F6, section 2.2 (a) and (b) BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F6, section 2.5 and 2.6 BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F6, section 3.3, last paragraph BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

If the regulator in British Columbia, Alberta, Manitoba or New Brunswick is the principal regulator of the firm seeking registration, attach the firm's business plan, policies and procedures manual and client agreements, including any investment policy statements and investment management agreements.

 Form 33-109F6, section 5.6, guidance note was added by BC Reg 238/2014, effective January 11, 2015.

 Form 33-109F6, Part 9, first paragraph BEFORE amended by BC Reg 238/2014, effective January 11,2015.

It is an offence under securities legislation or derivatives legislation to give false or misleading information on this form.

 Form 33-109F6, Schedule C BEFORE amended by BC Reg 238/2014, effective January 11, 2015.

Schedule C

Form 31-103F1 Calculation of Excess Working Capital

.........................................................................

Firm Name

Capital Calculation

(as at.....................................................with comparative figures as at...................................................)

Notes:

This form must be prepared using the accounting principles that you use to prepare your financial statements in accordance with National Instrument 52-107 Acceptable Accounting Principles and Auditing Standards. Section 12.1 of Companion Policy 31-103CP Registration Requirements, Exemptions and Ongoing Registrant Obligations provides further guidance in respect of these accounting principles.

Line 5. Related-party debt — Refer to the CICA Handbook for the definition of "related party" for publicly accountable enterprises.

Line 8. Minimum Capital — The amount on this line must be not less than (a) $25,000 for an adviser and (b) $50,000 for a dealer. For an investment fund manager, the amount must be not less than $100,000 unless subsection 12.1 (4) applies.

Line 9. Market Risk — The amount on this line must be calculated according to the instructions set out in Schedule 1 to this Form.

Line 11. Guarantees — If the registered firm is guaranteeing the liability of another party, the total amount of the guarantee must be included in the capital calculation. If the amount of a guarantee is included in the firm's statement of financial position as a current liability and is reflected in line 4, do not include the amount of the guarantee on line 11.

Line 12. Unresolved differences — Any unresolved differences that could result in a loss from either firm or client assets must be included in the capital calculation. The examples below provide guidance as to how to calculate unresolved differences:

(i) If there is an unresolved difference relating to client securities, the amount to be reported on Line 12 will be equal to the fair value of the client securities that are short, plus the applicable margin rate for those securities.

(ii) If there is an unresolved difference relating to the registrant's investments, the amount to be reported on Line 12 will be equal to the fair value of the investments (securities) that are short.

(iii) If there is an unresolved difference relating to cash, the amount to be reported on Line 12 will be equal to the amount of the shortfall in cash.

Please refer to section 12.1 of Companion Policy 31-103CP Registration Requirements, Exemptions and Ongoing Registrant Obligations for further guidance on how to prepare and file this form.

Management Certification

Schedule 1 of Form 31-103F1 Calculation of Excess Working Capital

(calculating line 9 [market risk])

For purposes of completing this form:

(1) "Fair value" means the value of a security determined in accordance with Canadian GAAP applicable to publicly accountable enterprises.

(2) For each security whose value is included in line 1, Current Assets, multiply the fair value of the security by the margin rate for that security set out below. Add up the resulting amounts for all of the securities you hold. The total is the "market risk" to be entered on line 9.

(a) Bonds, Debentures, Treasury Bills and Notes

(i) Bonds, debentures, treasury bills and other securities of or guaranteed by the Government of Canada, of the United Kingdom, of the United States of America and of any other national foreign government (provided such foreign government securities are currently rated Aaa or AAA by Moody's Canada Inc. or its DRO affiliate or Standard & Poor's Rating Services (Canada) or its DRO affiliate, respectively), maturing (or called for redemption):

(ii) Bonds, debentures, treasury bills and other securities of or guaranteed by any province of Canada and obligations of the International Bank for Reconstruction and Development, maturing (or called for redemption):

(iii) Bonds, debentures or notes (not in default) of or guaranteed by any municipal corporation in Canada or the United Kingdom maturing:

(iv) Other non-commercial bonds and debentures, (not in default): 10% of fair value

(v) Commercial and corporate bonds, debentures and notes (not in default) and non-negotiable and non-transferable trust company and mortgage loan company obligations registered in the registered firm's name maturing:

(b) Bank Paper

Deposit certificates, promissory notes or debentures issued by a Canadian chartered bank (and of Canadian chartered bank acceptances) maturing:

(c) Acceptable foreign bank paper

Deposit certificates, promissory notes or debentures issued by a foreign bank, readily negotiable and transferable and maturing:

"Acceptable Foreign Bank Paper" consists of deposit certificates or promissory notes issued by a bank other than a Canadian chartered bank with a net worth (i.e., capital plus reserves) of not less than $200,000,000.

(d) Mutual Funds

Securities of mutual funds qualified by prospectus for sale in any jurisdiction of Canada:

(i) 5% of the net asset value per security as determined in accordance with National Instrument 81-106 Investment Fund Continuous Disclosure, where the fund is a money market mutual fund as defined in National Instrument 81-102 Investment Funds; or

(ii) the margin rate determined on the same basis as for listed stocks multiplied by the net asset value per security of the fund as determined in accordance with National Instrument 81-106 Investment Fund Continuous Disclosure.

(e) Stocks

In this paragraph, "securities" includes rights and warrants and does not include bonds and debentures.

(i) On securities including investment fund securities, rights and warrants, listed on any exchange in Canada or the United States of America:

Long Positions — Margin Required

Securities selling at $2.00 or more — 50% of fair value

Securities selling at $1.75 to $1.99 — 60% of fair value

Securities selling at $1.50 to $1.74 — 80% of fair value

Securities selling under $1.50 — 100% of fair value

Short Positions — Credit Required

Securities selling at $2.00 or more — 150% of fair value

Securities selling at $1.50 to $1.99 - $3.00 per share

Securities selling at $0.25 to $1.49 — 200% of fair value

Securities selling at less than $0.25 — fair value plus $0.25 per share

(ii) For positions in securities that are constituent securities on a major broadly-based index of one of the following exchanges, 50% of the fair value:

(a) Australian Stock Exchange Limited

(b) Bolsa de Madrid

(c) Borsa Italiana

(d) Copenhagen Stock Exchange

(e) Euronext Amsterdam

(f) Euronext Brussels

(g) Euronext Paris S.A.

(h) Frankfurt Stock Exchange

(i) London Stock Exchange

(j) New Zealand Exchange Limited

(k) Stockholm Stock Exchange

(l) Swiss Exchange

(m) The Stock Exchange of Hong Kong Limited

(n) Tokyo Stock Exchange

(f) Mortgages

(i) For a firm registered in any jurisdiction of Canada except Ontario:

(a) Insured mortgages (not in default): 6% of fair value

(b) Mortgages which are not insured (not in default): 12% of fair value of the loan or the rates set by Canadian financial institutions or Schedule III banks, whichever is greater.

(ii) For a firm registered in Ontario:

(a) Mortgages insured under the National Housing Act (Canada) (not in default): 6% of fair value

(b) Conventional first mortgages (not in default): 12% of fair value of the loan or the rates set by Canadian financial institutions or Schedule III banks, whichever is greater.

(g) For all other securities — 100% of fair value.

 Form 33-109F6, section 4.2 BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F6, Schedule A table BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F6, Schedule C, table, line 10 under "Component" BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F6, Schedule C, in Schedule 1, subparagraph (a) (i) (part) BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

 Form 33-109F6, Schedule C, in Schedule 1, paragraph (d) BEFORE amended by BC Reg 209/2017, effective December 4, 2017.

(d) Mutual Funds

 Form 33-109F6, Schedule C, paragraph (a) (i) of Schedule 1 of Form 31-103F1 BEFORE amended by BC Reg 111/2018, effective June 12, 2018.

 Form 33-109F6 BEFORE amended by BC Reg 126/2022, effective June 6, 2022.

Form 33-109F6

[am. B.C. Regs. 382/2010, s. (c); 121/2011, Sch. B, s. 19; 179/2013, s. (b); 176/2014, Sch. F, s. 1 (d); 238/2014, App. C, s. 14; 209/2017, ss. 9 to 11; 111/2018, Sch. B, s. 2.]

Firm Registration