FORM 93-101F1
SUBMISSION TO JURISDICTION AND APPOINTMENT OF AGENT FOR SERVICE OF PROCESS

(Sections 39 [foreign derivatives dealer] and 46 [foreign derivatives adviser])

 

 

1.         Name of person or company (“Foreign Firm”):

 

2.          If the Foreign Firm was previously assigned an NRD number as a registered firm or an unregistered

exempt international firm, provide the NRD number of the firm.

 

3.          Jurisdiction of incorporation of the Foreign Firm:

 

4.         Head office address of the Foreign Firm:

 

5.         The name, email address, phone number and fax number of the Foreign Firm’s chief compliance officer, or equivalent.

 

Name:

 

Email address:

 

Phone:

 

Fax:

 

6.         Section of National Instrument 93-101 Derivatives: Business Conduct the Foreign Firm is relying on:

 

 Section 39 [foreign derivatives dealer]

 

 Section 46 [foreign derivatives adviser]

 

 Other [specify] [e.g exemptive relief decision – please explain]

 

7.         Name of agent for service of process (the "Agent for Service"):

 

8.         Address for service of process on the Agent for Service:

 

9.         The Foreign Firm designates and appoints the Agent for Service at the address stated above as its agent upon whom may be served a notice, pleading, subpoena, summons or other process in any action, investigation or administrative, criminal, quasi-criminal or other proceeding (a "Proceeding") arising out of or relating to or concerning the Foreign Firm's activities in the local jurisdiction and irrevocably waives any right to raise as a defence in any such Proceeding any alleged lack of jurisdiction to bring such Proceeding.

 

10.        The Foreign Firm irrevocably and unconditionally submits to the non-exclusive jurisdiction of the judicial, quasi-judicial and administrative tribunals of the local jurisdiction in any Proceeding arising out of or related to or concerning the Foreign Firm's activities in the local jurisdiction.

 

11.        Until 7 years after the Foreign Firm ceases to rely on section 39 [foreign derivatives dealer] or section 46 [foreign derivatives adviser], the Foreign Firm must submit to the securities regulatory authority

 

a.          a new Submission to Jurisdiction and Appointment of Agent for Service in this form no later than the 30th day before the date this Submission to Jurisdiction and Appointment of Agent for Service is terminated;

 

b.          an amended Submission to Jurisdiction and Appointment of Agent for Service no later than the 30th day before any change in the name or above address of the Agent for Service; and

 

c.          a notice detailing a change to any information submitted in this form, other than the name or above address of the Agent for Service, no later than the 20^th day after the change.

 

12.        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 Foreign Firm or authorized signatory)
(Name of signatory)
(Title of signatory)

Acceptance

The undersigned accepts the appointment as Agent for Service of ______________________________ [Insert name of Foreign Firm] under the terms and conditions of the foregoing Submission to Jurisdiction and Appointment of Agent for Service.

Dated:
(Signature of the Agent for Service or authorized signatory)
(Name of signatory)
(Title of signatory)