FORM 33-109F3
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 it. Securities regulatory authorities or SROs may contact government and private bodies or
agencies, individuals, corporations and other organizations for information about the individual.
If you have any questions about the collection and use of this information, contact the securities regulatory authorities or
applicable SRO in any jurisdiction in which the required information is submitted. See Schedule A for details. In Québec, you
can also contact the Commission d’accès à l’information at 1-888-528-7741 or visit its website at www.cai.gouv.qc.ca.
Item 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
Alberta
Alberta Securities Commission
Suite 600, 250–5th St. SW
Calgary, AB T2P 0R4
Attention: Information Officer
Telephone: (403) 297-6454
British Columbia
British Columbia Securities Commission
P.O. Box 10142, Pacific Centre
701 West Georgia Street
Vancouver, BC V7Y 1L2
Attention: Freedom of Information Officer
Telephone: (604) 899-6500 or (800) 373-6393 (in Canada)
Manitoba
The Manitoba Securities Commission
500 - 400 St. Mary Avenue
Winnipeg, MB R3C 4K5
Attention: Director of Registrations
Telephone: (204) 945-2548
Fax: (204) 945-0330
New Brunswick
Financial and Consumer Services Commission of New
Brunswick / Commission des services financiers et des
services aux consommateurs du Nouveau-Brunswick
Suite 300, 85 Charlotte Street
Saint John, NB E2L 2J2
Attention: Director of Securities
Telephone: (506) 658-3060
Newfoundland and Labrador
Superintendent of Securities, Service NL
Government of Newfoundland and Labrador
P.O. Box 8700
2nd Floor, West Block
Confederation Building
St. John's, NL A1B 4J6
Attention: Manager of Registrations
Telephone: (709) 729-5661
Nova Scotia
Nova Scotia Securities Commission
Suite 400, 5251 Duke Street
Halifax, NS B3J 1P3
Attention: Deputy Director, Capital Markets
Telephone: (902) 424-7768
Northwest Territories
Government of the Northwest Territories
Department of Justice
1
st
Floor Stuart M. Hodgson Building
5009 – 49
th
Street
Yellowknife, NWT X1A 2L9
Attention: Deputy Superintendent of Securities
Telephone: (867) 920-8984
Nunavut
Government of Nunavut
Department of Justice
P.O. Box 1000 Station 570
Iqaluit, NU X0A 0H0
Attention: Deputy Registrar of Securities
Telephone: (867) 975-6590
Ontario
Ontario Securities Commission
22
nd
Floor
20 Queen Street West
Toronto, ON M5H 3S8
Attention: Compliance and Registrant Regulation
Telephone: (416) 593-8314
e-mail: registration@osc.gov.on.ca
Prince Edward Island
Securities Office
Department of Community Affairs and Attorney General
P.O. Box 2000
Charlottetown, PE C1A 7N8
Attention: Deputy Registrar of Securities
Telephone: (902) 368-6288
Québec
Autorité des marchés financiers
800, square Victoria, 22e étage
C.P. 246, tour de la Bourse
Montréal (Québec) H4Z 1G3
Attention: Responsable de l’accès à l’information
Telephone: (514) 395-0337 or (877) 525-0337
Saskatchewan
Financial and Consumer Affairs Authority of Saskatchewan
Suite 601, 1919 Saskatchewan Drive
Regina, SK S4P 4H2
Attention: Deputy Director, Capital Markets
Telephone: (306) 787-5871
Yukon
Government of Yukon
Superintendent of Securities
Department of Community Services
P.O. Box 2703 C-6
Whitehorse, YT Y1A 2C6
Attention: Superintendent of Securities
Telephone: (867) 667-5314
Self-regulatory organization
Investment Industry Regulatory Organization of Canada
121 King Street West, Suite 2000
Toronto, Ontario M5H 3T9
Attention: Privacy Officer
Telephone: (416) 364-6133
E-mail: PrivacyOfficer@iiroc.ca
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.